Disinhibited Social Engagement Disorder (DSED) is a childhood attachment disorders which may develop as a result of lack of affection from parents and nutrition in the children for any particular reason.

As a result of which, your child is not closely attached to you and feels more comfortable around the strangers as they feel with their main caregivers. Disinhibited Attachment Disorder is the other name for DSED.

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Children naturally have a fear of meeting strange people for the first time. Most of them are a bit conscious with the people of bigger age than them whom they don’t know. Kids who suffer from DSED are not afraid of strangers.

These children are so comfortable around unfamiliar people that you can judge if they are strangers to each other or not. They would not think twice if invited to a stranger’s home for the first time. This can become a serious safety issue if not treated on time.

Preference For Strangers Over Legal Guardians

Normally, children try to make a connection and seek comfort from their legal guardians. When a normal child falls in the playing ground and scratches his knee he will definitely look for his parents to help him with his injury.

social engagement disorder

But if a child is suffering from DSED may go to a completely unknown for their emotional help. He is likely to share his injury with a random person who is passing by and may ask for assistance or he may sit by the stranger’s side and cry for help.

Symptoms Of Disinhibited Engagement Disorder

Initially, disinhibited social engagement disorder was considered a subdivision of reactive attachment disorder. But later on, the Diagnostic and Statistical Manual confirmed it as a completely different diagnosis.

To meet the criteria for DSED, a child must have a pattern behavior that includes interacting and approaching with strangers or adults along with the two of the following:

  • Reduced or lack of introversion in interacting and approaching with strangers.
  • Overly familiar physical behavior or verbal interaction that is not continuous with culturally authorized social boundaries.
  • Reduced or lack of checking back with a caregiver after going away.
  • Willingness to go off with an adult stranger without any hesitation.
  • Social neglect including the persistent lack of having primary emotional needs for affection, comfort, and stimulation met by caregiving adults.

If a child shows this behavior for more than 1 year, then this disorder is said to be persistent. It may also be said as extreme when a child exhibits the symptoms at comparatively high levels.

Disinhibited Attachment Disorder

As Disinhibited Social Engagement Disorder roots from the neglection of the caregivers, it may occur along with other disorders such as malnutrition or cognitive and speech delays. According to DSM-5, DSED symptoms include:

  • Lack of fear and shyness while meeting strangers for the first time.
  • Over-friendly behavior or extremely talkative to strangers.
  • Cuddling or hugging the unknown adults.
  • Lack of hesitation around unknown people.
  • Not taking permission from parents while approaching strangers.

These symptoms may continue into the teenage years, but may not last into adulthood.

Differentiating Who Is Trustworthy

Obviously, children can’t really identify predators around them. But, most children definitely remain hesitated around people they haven’t seen before or are completely unknown to them.

Researches have shown that most kids make basic assessments about the individual’s trust level based on their physical appearance. They are capable of making initial judgments about the nature of the person based on their facial expressions.

dsed syndrome

Brain imaging studies have shown that children with DSED cannot differentiate between people who look safe and kind from those who look mean and untrustworthy. They think that strangers are closer to them than their legal guardians.

Crave Kindness From Anyone

Kids who have this disorder usually crave kindness from strangers or other people than their own relatives or parents. Since they cannot clearly identify who is safe and who is not, they may show attraction toward any person who gives them attention.

dsed syndrome

They may look for physical attraction from strangers too. A child who is suffering from disinhibited social engagement disorder will definitely hug a random person passing by in the store or may sit on their lap for no reason.

Causes Of DSED

Critical parenting environments can lead to this type of attachment disorder. Kids of age 6 months to 2 years who have been abandoned or sent to the orphanage or face continuous change in the environment or suffered trauma tend to have a higher risk of developing DSED.

Most studies on DSED have been done with foster children, not all children who have been adopted or fostered develop attachment disorders. The friendliness exhibited by children suffering from DSED is now thought to be independent of children’s attachment.

It is not caused if they were placed in the kindergarten and a child didn’t develop because of her mother placed her in the crib while she was crying. It only develops DSED when a child has suffered serious rejection as an infant.

disinhibited behavior

Infants tend to trust their parents as they respond to their needs. A baby who is crying gets fed believes that she can count on their mother. That is how babies develop trust and habits of being loved when a crying baby is being cuddled by their father.

When kids are rejected or given less attention, then they may not get attached to their parents or guardians. A crying baby is being ignored tends to believe that no one is there for her. So this child is likely to develop the risk of attachment disorder. Due to less attention, many children grew up with emotional neglect.

But that’s not in every case. Some children may not develop this disorder and may go on healthy relations without getting emotionally abused and suffering from attachment issues. Not all neglected kids suffer from DSED.

Adoptive Parents And Foster Parents Should Be On The Lookout

Disinhibited social engagement disorder starts from being neglected in the initial months of a child’s life. There is no proof that neglect after the age of 2 years also contributes to the disorder or not.

dsed disorder

So foster parents, adoptive parents, grandparents or guardians who raise children months or years after birth can easily identify the symptoms. As the child is no longer neglected not always means that he not at the risk.

Changes In Disinhibited Social Engagement Disorder

Toddlers usually start getting friendly with every other person they meet for the first time. They get attracted by the strangers, they may hold hands with them, sit on their lap, kiss the person they just have met.

During the early years in the school, children suffering from DSED continue to be extremely comfortable with unknown people as they gain attention seeking behavior. So these children may shout at public areas just to get looks at him from strangers.

disinhibited behavior

In middle childhood, children may show physical and verbal familiarity as well as inauthentic expression of emotions. So a 9-year-old child laughs when others laugh or she may appear sad to manipulate the situation.

Adults with disinhibited social engagement disorder usually have problems with their friends. They develop superficial relations with others and they often struggle with conflict. They continue this behavior toward adults.

How Common Is Disinhibited Social Engagement Disorder?

Disinhibited social engagement disorder is extremely rare. Children who have been raised in some critical situations like in an orphanage, or have been in multiple foster cares are at the higher risk of developing this disorder.

dsed behavior

Studies have proved that around 20% of the children in high-risk populations develop DSED. Many children who are being abused or neglected in their past may develop any kind of attachment disorder.

Treatment For DSED

It is vital for children attachment disorders to get consistent care from stable guardians or parents. A child who moves from foster home to adoptive home or who remains disturbed is not likely to improve anyway.

Attachment disorders do not get better by themselves. So it is quite important to get treatment from the professionals. Treatment consists of therapy that will include both the parents or caretaker and the child.

If you notice any child under your care who is having attachment disorders, then talk to your child’s physician. Your child may be referred to as the mental health professional for a comprehensive assessment.

social engagement disorder

Psychotherapeutic treatment for DSED involves the family especially parents and children. In evaluating the circumstances of the family and the child, a treatment plan is developed. It may include expressive therapies like a play or art therapy, whatever is comfortable for the child.

The main objective of this treatment is to help the family to understand the child’s diagnosis and strengthen the bond between the child and his family, to advance the child’s social and emotional development. Many times people having such past never forget their past and stuck in painful experiences.

Risks And Consequences

It is really important for children to have a healthy fear of strangers and potentially harmful people. So raising a child with disinhibited social engagement disorder can be quite confusing and terrifying for caregivers.

disinhibited behavior

A 4-year old may go off with an unknown person in the grocery store or a 9-year old may enter the neighbor’s house without even thinking about the safety issues. Parents who are raising a child with DSED must keep a child from interacting with strangers.

Children with this type of disorder struggle to develop healthy relationships with their teachers, friends, kindergarten providers, coaches, and other people. Their behavior is extremely alarming to their families or other parents who have no idea about it.

Now, there is little research on the long-term effects of DSED. It is not yet clear how it might affect an individual who is an adult.

Parents should visit PCIT International which stands Parent-Child Interaction Therapy as they promote healthy family functioning. You can also visit CEBC for parent-child interaction therapy.

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