Institutional Care and Attachment Disorders: The Impact of Institutionalization and How to Heal
You may have welcomed a child or teen into your family who might have lived through more than most adults. For instance, they may have spent time in an orphanage, bounced between foster homes, or lived in institutional care where no one really knew them. Now, they’re safe, but they might still be struggling to trust and connect.
If this sounds familiar, know that you’re not alone – and neither is your child. Many teens with attachment disorders are still in the process of healing from the mental health effects of institutionalization. While professional support is always recommended, understanding how institutional care and attachment disorders are connected is a great first step toward helping your teen. This page can help by covering:
- Attachment in institutional care settings
- How care settings affect mental and emotional health
- Therapy and support for teens with attachment disorders
- Practical steps for parents supporting their child
- The long-term healing process
- Finding professional help and support
Understanding Attachment in Institutional Care Settings
What Is Attachment?
Attachment is the emotional bond that forms between an infant and their caregiver. It is typically created in the first few years of someone’s life, and provides a template for their emotional development, relationships with others, and general beliefs about the world.1
When a child receives consistent, reliable care and support from their caregivers – mentally, emotionally, and physically – they can form a secure attachment. This is the “healthiest” type of attachment, and provides a good foundation for personal and social development.
However, when early relationships with primary attachment figures don’t provide the support and care that is so vitally needed, or if it isn’t consistently given, insecure attachment patterns can form. Insecure attachment can negatively affect a person’s development, self-beliefs, and views of the world around them. Plus, if reparative experiences aren’t encountered, these patterns and challenges can continue throughout adolescence and into adulthood.
Attachment Patterns in Orphanages and Institutions
In settings such as orphanages or institutional care, children may be more likely to develop insecure attachments. This is because, although the environments they live in may be adequate (providing food, shelter, and medical care), the nature of these homes means there will be inconsistency in caregiving.
In care homes, many people are typically involved in providing children with care due to staff shifts and rotations. Therefore, opportunities to create secure emotional connections between infants and caregivers can be limited. This isn’t an indication that staff aren’t doing their best to provide the children with the care they need. It’s just that, unfortunately, the nature of institutions means that the attention and time that staff can provide solely to one child is often divided. This can result in the infant lacking the emotional support they need.
According to research, by a child’s third birthday in an institution, they may have had more than 50 different caregivers.2 This can naturally cause difficulties in establishing a stable relationship with each one, showing the almost inevitable link between institutional or orphanage care and insecure attachment.
In fact, studies also show that between 50% and 80% of infants brought up in residential group care have insecure-disorganized patterns of attachment.3-5 Often, with disorganized attachment come trust issues, emotional dysregulation, fear of abandonment, and identity challenges.6
Complex Trauma and Institutional Care
Complex trauma refers to the emotional and psychological wounds that arise from prolonged and repeated exposure to traumatic events. For instance, long-term abuse, neglect, or inconsistent caregiving can rupture the emotional bonds a child forms with their caregiver, resulting in complex trauma. In a care setting, the difficulties forming bonds with caregivers can result in inconsistent caregiving, potentially leading to complex trauma from institutional care.
Understanding the reasons behind trauma isn’t about placing blame on anyone. Often, care staff are doing the best they can with the resources they’re allocated. Instead, it’s about making sense of the way your teen behaves and reacts in certain situations. As a result, you can then start to offer them support from a place of understanding and compassion.
How Institutionalization Affects Mental and Emotional Health
Emotional and Behavioral Challenges in Teens
Institutionalization has a significant impact on emotional and mental development. For instance, statistics show that children raised in orphanages tend to have lower IQs and experience more difficulties with their behavior, attention, sleep, and academic work than children who were not raised in institutional care. They may also have more insecure attachments, which could lead to issues managing their emotions and reactions (known as “emotional dysregulation”).7,8
Teens with disorganized attachment, in particular, may have low self-esteem and self-worth, and could be at a higher risk of developing issues such as anxiety and depression.9,10 They may find it hard to trust others, become aggressive, or act impulsively, which can cause conflicts with family, friends, peers, and teachers.11,12
Social and Developmental Issues in Adolescents
Teens with insecure attachment styles generally hold the view that others cannot be trusted or relied upon, and that the world isn’t a safe place for them. This can affect relationships they have with others, causing them to either withdraw from people to protect themselves, “cling” to others for fear of abandonment, or a combination of both.
Institutionalized children at an early age can often be friendly and affectionate toward all people without any fear, even strangers.2 This type of indiscriminate friendliness may actually be a sign of an attachment disorder: disinhibited social engagement disorder (DSED). DSED can arise from abuse and neglect – as well as time spent in multiple institutional care or foster care placements.13 It can show up as a lack of social boundaries and being overly friendly with others.14
Another attachment disorder that can develop from placements in foster homes or orphanages is reactive attachment disorder (RAD).15 RAD manifests in almost the opposite behavioral symptoms to those seen in DSED. Children with RAD have learned not to seek out comfort from others and find it very difficult to connect with people. Instead, they may withdraw as a protective mechanism.
As can be seen, institutional care can negatively impact a teen in all areas of their life. But take heart in knowing that many of these issues stem from attachment problems, which can be treated very effectively – with time, support, and patience. Next, we will explore the available therapy for teens from institutional settings with insecure attachment.
Therapy for Adopted Teens With Attachment Issues
Some of the available therapeutic approaches include:16
Eye Movement Desensitization Reprocessing Therapy (EMDR): A trauma-focused treatment that helps people process trauma by guiding eye movements without the teen having to talk extensively about past hurt.- Dialectical behavior therapy (DBT): This therapy is designed to help teens manage their intense emotions and develop skills for building healthier relationships.
- Cognitive behavioral therapy (CBT): A structured therapy that focuses on understanding and challenging patterns in unhelpful thoughts, feelings, and behaviors to move toward healthier patterns.
- Attachment-based family therapy (ABFT): An evidence-based, structured type of family counseling, grounded in attachment theory. Sessions include attachment-based interventions for foster youth and their family to rebuild trust and connection, improve communication, and create a sense of safety.
- Dyadic developmental psychotherapy (DDP): This is a family-based approach that enables children and their caregivers to build secure and trusting relationships, foster emotional regulation, and heal from trauma.
- Creative arts therapies: Therapies involving art, music, or creativity can help children find ways of dealing with feelings such as loss, frustration, and trauma. Sometimes people don’t have the right words to express themselves, especially in the case of insecure attachment, and this is where creativity can come into play.
Practical Ways to Support Your Teenager
It can be heartbreaking to watch your child struggle with trauma and emotional problems. You may be wondering what the best way for you to support them through their attachment recovery after foster care trauma is. We provide some suggestions below that may guide you in supporting your teen’s healing journey.
Build Trust and Safety at Home
Insecure attachment and complex trauma can have their roots in early experiences of feeling unsafe. Therefore, making home a safe place for a teen is vital for instilling a sense of security. Safety can come from minimizing stress at home, but also from being a safe presence. Aim to be an adult that your teen can trust. Be open with them, listen to them without judgment, and follow through on any promises you make. Healthy boundaries are also key.
Support Therapy
Encourage your teen to attend therapy to help them heal. If they go to individual therapy, you can offer to take them or pick them up and be emotionally available to talk with them about anything that comes up. But remember: What’s said in the therapy room is private and confidential. Your teen may not wish to discuss the contents of their session with you. Instead, they may want to leave everything in the therapy room and carry on with life as normal.
If you and your teen attend family therapy, be open, honest, and fully engaged with the process, even if it feels uncomfortable or challenging at times. The work you are doing is important for your teen’s recovery, and by taking part, you are showing your full support for them.
Implement Routines
One thing that may have been lacking in early childhood for teens from institutional care is consistency. Creating routines can help your teen to feel safe – they can provide predictability and reliability. Therefore, having routines and clear boundaries can bring a sense of stability into their life in a very impactful way.
Learn About Institutional Care and Attachment
Learning about the effect of institutional care, such as by reading this article, can go a long way in helping you understand your child’s behaviors and reactions. With understanding comes compassion. Encourage your teen to be open with you, and model this behavior to them, too. Listen without judgment to how they feel, what they think, and validate their feelings. With knowledge and understanding comes the ability to support your teen through their recovery.
Seek Professional Support
Sometimes, family support alone isn’t enough to heal the wounds caused by being raised in the care system. You may want to research therapy options, such as the ones mentioned earlier, for example, or even residential programs for post-institutionalized teens. These programs can provide a safe, structured, and supportive space for teens to recover and heal from the attachment trauma they have experienced.
Helping Youth Heal From Institutional Neglect: Long-Term Recovery
Recovery from institutional attachment wounds isn’t a quick process, but it is possible. With time, patience, consistency, understanding, and professional support, your teen can recover and learn how to regulate their emotions, form healthy relationships, and feel safe in the world. Adoption and attachment disorder treatment can help this process, along with the support you provide at home.
Among all of this, remember that you matter, too. Supporting a child with attachment trauma takes time and effort, so ensure that you are looking after your own needs and self-care alongside helping your teen. You can’t fill from an empty jug.
Mission Prep: Professional Support for Healing From the Effects of Institutional Care and Attachment
Attachment disorders can have an all-encompassing effect on a child or teenager’s life. Plus, without effective treatment, these effects can worsen and persist into adulthood. While healing from the effects of institutional care takes effort, with support, it is entirely achievable.
With compassionate, trauma-informed treatment, teens can learn how to trust, connect, and thrive in the world. Whether your teen struggles with attachment issues, emotional dysregulation, or the trauma of early neglect, you don’t have to face this journey alone.
At Mission Prep, we offer a range of evidence-based therapies in both outpatient and residential settings, tailored to the unique needs of your teen. To learn more, please call us or contact us through our secure online form. We are here to support you and help your teen heal.
References
- McGarvie, S., PhD. (2025, March 27). Attachment Theory, Bowlby’s Stages & Attachment Styles. PositivePsychology.com. https://positivepsychology.com/attachment-theory/
- Bakermans‐Kranenburg, M. J., Steele, H., Zeanah, C. H., Muhamedrahimov, R. J., Vorria, P., Dobrova‐Krol, N. A., Steele, M., Van IJzendoorn, M. H., Juffer, F., & Gunnar, M. R. (2011). Attachment and emotional development in institutional care: characteristics and catch up. Monographs of the Society for Research in Child Development, 76(4), 62–91. https://doi.org/10.1111/j.1540-5834.2011.00628.x
- Vorria P, Rutter M, Pickles A, Wolkind S, Hobsbaum A. A comparative study of Greek children in long-term residential group care and in two-parent families: I. Social, emotional, and behavioural differences. Journal of Child Psycholgy and Psychiatry. 1998 Feb;39(2):225-36. PMID: 9669235. https://pubmed.ncbi.nlm.nih.gov/9669235/
- St. Petersburg-USA Orphanage Research Team (2008). The effects of early social-emotional and relationship experience on the development of young orphanage children. Monographs of the Society for Research in Child Development, 73(3), vii–295. https://doi.org/10.1111/j.1540-5834.2008.00483.x
- Lionetti, F., Pastore, M., & Barone, L. (2015). Attachment in institutionalized children: A review and meta-analysis. Child Abuse & Neglect, 42, 135–145. https://doi.org/10.1016/j.chiabu.2015.02.013
- Moore, M. (2023, August 21). Understanding disorganized attachment. Psych Central. https://psychcentral.com/health/disorganized-attachment
- Maclean, K. (2003). The impact of institutionalization on child development. Development and Psychopathology, 15(4), 853–884. https://doi.org/10.1017/s0954579403000415
- Figueiredo, S., & Silvestre, P. (2025). Where do our children go? Understanding the impact of institutionalization on emotion regulation, attention, and sleep. Children, 12(4), 448. https://doi.org/10.3390/children12040448
- Doyle, C., & Cicchetti, D. (2017). From the cradle to the grave: The effect of adverse caregiving environments on attachment and relationships throughout the lifespan. Clinical Psychology Science and Practice, 24(2), 203–217. https://doi.org/10.1111/cpsp.12192
- Hornor, G. (2019). Attachment disorders. Journal of Pediatric Health Care, 33(5), 612–622. https://doi.org/10.1016/j.pedhc.2019.04.017
- Morin, A. (2023, May 3). Signs and causes of attachment issues. Verywell Mind. https://www.verywellmind.com/what-is-an-attachment-disorder-4580038
- Guyon-Harris, K. L., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018). Signs of attachment disorders and social functioning among early adolescents with a history of institutional care. Child Abuse & Neglect, 88, 96–106. https://doi.org/10.1016/j.chiabu.2018.11.005
- Morrin, A. (2025, May 19). Disinhibited Social Engagement Disorder: What every parent needs to know. Verywell Mind. https://www.verywellmind.com/what-is-disinhibited-social-engagement-disorder-4138254
- American Academy of Child & Adolescent Psychiatry (AACAP). (2017). Attachment disorders. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Attachment-Disorders-085.aspx
- Attachment and Trauma Network, ATN. (2023, October 13). Reactive Attachment Disorder (RAD). https://www.attachmenttraumanetwork.org/reactive-attachment-disorder-rad/
- First4Adoption. (2024, December 11). Adoption support services & therapies. https://www.first4adoption.org.uk/adoption-support/adoption-support-services/#elementor-action%3Aaction%3Doff_canvas%3Aopen%26settings%3DeyJpZCI6IjkwMzJhM2IiLCJkaXNwbGF5TW9kZSI6Im9wZW4ifQ%3D%3D
