Difference Between RAD & NPD

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All children who have parents who are neglectful, abusive, intrusive, and unstable are likely to develop serious problems as adults. The most common problems involve issues with intimacy, relationships, trust, and self-esteem.

What is Reactive Attachment Disorder (RAD)?

Reactive Attachment Disorder is diagnosed in children, not adults. Children given this diagnosis may exhibit either inhibited attachment behavior or display inappropriate and indiscriminate attachment behaviors.

RAD is believed to result from severe neglect, abuse, and lack of appropriate attunement by the child’s caregivers. It can also be caused by subjecting the child to multiple disruptions and changes in caregivers, such as children who are in foster care and repeatedly get uprooted and sent to different homes.

In the beginning they may form strong attachments to their caregivers, but after repeated separations and disruptions, they may stop forming secure attachments because attachment only leads to pain.

In adulthood, these children are at greater risk for developing depression, behavioral problems, difficulty forming relationships, aggressive and disruptive behaviors, and low self-esteem. People with RAD are also at risk for developing a personality disorder in adulthood, but in my experience it is unlikely to be NPD.

The basic treatment for children with RAD ideally involves working with the primary caregiver to teach the person better parenting skills and to provide some form of psychotherapy for the child. There are no drugs that cure RAD.

If the child is being physically or sexually abused, he or she may need to be removed from the home. Ideally the child would be placed with a caregiver who could be consistent, loving, have appropriate boundaries, show a great deal of real interest in the child’s thoughts, feelings, and interests, while modeling appropriate attachment behaviors.

What is Narcissistic Personality Disorder (NPD)?

This is a personality disorder. Although it starts in childhood like RAD, it is not diagnosed in children. Children and teens may exhibit narcissistic traits, but most grow out of it as they mature. Therefore, NPD is only diagnosed in adults.

NPD can be viewed as an adaptation by a particular child to a home situation where attention and approval were contingent on achievement, love was unstable and conditional, and at least one of the parents had some form of NPD. People can develop NPD without being subjected to the conditions that create RAD in children. You can become a Narcissist without severe abuse or neglect.

Narcissistic Personality Disorder is characterized by:

• A lack of whole object relations and a lack of object constancy.
• A lack of emotional empathy for other people.
• Extreme reliance on other people for continual validation of their worth.
• Unstable self-esteem.
• Perfectionism.
• Competitiveness.
• Hierarchical thinking.
• A reliance on achievement as a substitute for love.
• A diminished capacity for intimacy.
• The drive for status.
• A preoccupation with status.
• A vulnerability to feelings of shame about the self.
• The devaluation of other people.
• Indiscriminate idealization of those people who they see as higher in status, coupled with contempt or indifference to those people they see as lower in status.
• Impulsive rage over trivial matters that most people would overlook or react to more mildly.
• The need to shift blame for their bad behavior to other people.
• Difficulty accepting that other people can have valid opinions that are different from their own.
• Projecting their person flaws onto other people.

Do children with RAD develop NPD?

I am not an expert in RAD. I actually had to look up what these initials meant. However, I have many people in my practice who experienced RAD as children. They grew up to develop Schizoid Personality Disorder, not Narcissistic Personality Disorder.

What is Schizoid Personality Disorder (SPD)?

Schizoid Personality, like NPD, is diagnosed in adults, not children. People with SPD lack basic trust in other people because their early caregivers were abusive and neglectful. They never learned to negotiate differences of opinion because their opinions did not matter.

Most of my Schizoid clients decided by age 7 that they could not count on adults to care for them, protect them, show real interest in them, or even treat them as real human beings with any rights. They reacted to this situation by becoming fiercely independent and self-sufficient and finding ways to control how emotionally and physical close they are to other people. Some turn to animals for affection instead of people.

Here are some common characteristics of people with SPD:

• They have a fragile sense of self with weak boundaries.
• They may dissociate from their emotions, their bodies, and even their sense of self when they are stressed. This started in early childhood as a reaction to abuse.
• They tend to treat their bodies with the same indifference that their caregivers treated them.
• Like children with RAD, they may either avoid intimate relationships or become inappropriately intimate too soon with the wrong people.
• They use distancing as a defense.
• They often report feeling like robots or aliens, not real people.
• They lack whole object relations and object constancy.
• They prefer other people to be predictable.
• They suffer from existential dread. Life can seem pointless and something to be endured.
• They also suffer from what the theorist Ralph Klein calls the “Schizoid Dilemma”: If they become emotionally close with someone, this feels threatening to their autonomy. If they distance themselves and do not have enough human contact, they may become so disconnected that have trouble reconnecting.
• They are more likely to live alone by choice than most other people.

Punchline: It is really quite easy to differentiate between RAD and NPD. They have very little in common. However, in my experience, the conditions associated with RAD often lead to the development of Schizoid Personality Disorder in adulthood.

-Elinor Greenberg,PhD Psychology