Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder is one of two childhood attachment disorders that may develop when a child lacks appropriate nurturing and affection from parents for any number of reasons. As a result of these unfulfilled needs, the child is not closely bonded to parents and is as comfortable with strangers as they are with their primary caregivers. Disinhibited social engagement disorder, DSED, is also known as disinhibited attachment disorder.
According to the DSM-5, symptoms of disinhibited social engagement disorder in children may include:
- No fear of adult strangers; no shyness when meeting new people for the first time
- Behavior that is overly friendly or talkative to strangers
- Hugging or cuddling of unknown adults
- No hesitation around strangers, even when departing with an unfamiliar person
- Does not look to parents or primary caregivers for permission to approach strangers
- Symptoms may continue into the teenage years, but the condition is not known to last into adulthood
Is disinhibited social engagement disorder similar to reactive attachment disorder?
There are some similarities, but reactive attachment disorder is a condition of emotional dysfunction in which a baby or child has difficulty forming a bond with parents or caregivers due to early neglect or mistreatment. The child with reactive attachment is not necessarily friendly with strangers.
Is disinhibited social engagement disorder similar to attention deficit disorder?
Children with disinhibited social engagement disorder may appear impulsive, such as climbing onto the lap of a stranger, they are not impulsive and hyperactive like children with attention deficit disorder.
Unfavorable early caregiving environments can lead to an attachment disorder. Babies between the ages of 6 months and 2 years are at more risk of developing DSED if they have been institutionalized (abandoned or left in orphanages after the loss of birth parents), spent time in changing or inconsistent family environments (such as in foster care), or suffered trauma or even severe ongoing emotional and social neglect. Although most studies of disinhibited social engagement have been done with post-institutionalized and foster children, not all children who have been adopted or fostered develop attachment disorders. The indiscriminate friendliness exhibited by these children is thought to be independent of the child’s attachment, or lack of attachment, to primary caregivers such as adoptive or foster parents.
How common is disinhibited social engagement disorder?
Nearly a quarter of children in high-risk environments, such as foster or institutional care, develop disinhibited social engagement disorder.
Is disinhibited social engagement disorder the same as Williams syndrome?
No. Williams syndrome is a genetic disorder, whereby about 20 genes are missing from the 25,000 that make a human being. The genes are missing from either parent, egg or sperm. Williams can include problems such as developmental delays or even medical difficulties like cardiovascular disease. However, like disinhibited social engagement disorder, people with Williams are highly social and friendly.
Psychotherapeutic treatment for disinhibited social engagement disorder includes the child and the family or primary caregivers. Upon an evaluation of the child and family circumstances, an individual treatment plan is developed. Treatment may include expressive therapies such as play therapy or art therapy, in an environment that is comfortable for the child. The goal of treatment is to help the family understand the child’s diagnosis and strengthen the bond between the child and the primary caregivers, in the hope of advancing the child’s social and emotional development.
Importantly, some researchers now question whether DSED should, in fact, be considered an attachment disorder or an entirely separate type of disorder with a non-attachment basis. Future studies will help determine if this is the case and if treatment protocols should be adjusted.
How can caregivers help a child with disinhibited social engagement disorder?
These children need stable and consistent care. Children who bounce between multiple foster homes will suffer and not improve. The bond between the child and the caregiver must be strong and dependable. Plus, healthy relationships with teachers and peers also help.