What Is Anaclitic Depression?

Anaclitic depression was a pediatric diagnosis in the 1940s given to hospitalized or institutionalized infants who were wasting away and failing to thrive. Anaclitic means "leaning upon"; the diagnosis was given to children with no one to lean on for consistent, nurturing care.

History

• The term "anaclitic depression" was coined by Hungarian psychiatrist René Spitz in 1946 while researching orphaned children and referred to infants who became depressed after separation from their mothers for at least three months during their second six months of life. Infants who were reunited with their mothers within six months suffered no lasting effects; however, infants who remained separated and who had no maternal substitute became withdrawn and suffered from sleeplessness, weight loss, agitation, a lack of physical and psychological development, and, in some cases, physical rigidity or even death.

Current Terminology

• The current medically recognized term for anaclitic depression, as stated by the Diagnostic and Statistic Manual of Mental Disorders (DSM) IV, is inhibited reactive attachment disorder (RAD).

Causes

• Children who develop inhibited reactive attachment disorder are almost always persistently abused, neglected or moved from one caregiver to another during the first year of life, and the needs of nurturing, caring, comfort and security were unmet. When the basic physical and emotional needs of infants are not met, differential attachment patterns may develop, creating a sense of detachment, distrust, hopelessness or apathy in the growing child.

Signs and Symptoms

• Infants with inhibited reactive attachment disorder may be withdrawn from everybody around them. They may not smile, reach out when picked up or interact with others. They may be lethargic and show no interest in eating or drinking. They may have no interest in playing with toys and may exhibit self-soothing behaviors such as rocking.

  Toddlers and older children may avoid comforting gestures, withdraw from others or act aggressively toward peers. They may refuse to ask for help when needed and may watch people closely, but refrain from interacting.

Treatment

• The goal of treatment for inhibited reactive attachment disorder is for the child to develop a healthy dependency on his or her caregivers. According to the Mayo Clinic, treatment may consist of psychological counseling, family therapy and parenting classes. Play therapy is often beneficial to children suffering from RAD, as it gives them a safe and fun outlet while still providing interaction with others.

  There are no medications that specifically treat RAD; however, medications may be prescribed for issues such as hyperactivity, explosive anger and anxiety. Other medical treatments may focus on developmental, speech and nutritional therapies, as the mistreated children often have delays and difficulties in these areas.

Prognosis

• Most children with RAD, when placed in an environment with an emotionally available and nurturing caregiver do well. However, some continue to suffer with attachment and anxiety issues. In many cases, the length and severity of the abuse or neglect determines the response to treatment.