Charles H. Zeanah - Professional - Practice Parameters For Attachment Disorders

Practice Parameters For Attachment Disorders

In a series of papers from 1996 onwards, Zeanah and N. Boris, building on the earlier work of A.F. Lieberman, proposed new practice parameters for the categorization of attachment disorders, currently categorized as reactive attachment disorder and disinhibited attachment disorder in DSM-IV-TR, the revised fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10). The first new category is disorder of attachment, in which a young child has no preferred adult caregiver, parallel to RAD in its inhibited and disinhibited forms, as defined in DSM and ICD. The second is secure base distortion, where the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety while gradually exploring the environment. The third is disrupted attachment. Disrupted attachment is not covered under ICD-10 and DSM criteria, and results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. This form of categorization may demonstrate more clinical accuracy overall than the current DSM and ICD classifications, but further research is required.

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