Disinhibited Social Engagement Disorder

Definition

Disinhibited social engagement disorder (DSED) 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. DSED is also known as disinhibited attachment disorder.

Symptoms

Children with DSED are not afraid of adult strangers and not shy of meeting new people for the first time. Instead, they are overly friendly, very talkative to strangers and may even begin hugging or cuddling unknown adults. The child will show no fear when a stranger talks to them or touches them. A child with DSED may not hesitate to take off with an unfamiliar person and will not look to parents or primary caregivers for permission to approach strangers. Symptoms of DSED may continue into the teenage years, but the condition is not known to last into adulthood.

Causes

Unfavorable early caregiving environments can lead to an attachment disorder. Babies between the ages of six months and 2 years who have been institutionalized (for instance, abandoned or left in orphanages after loss of birthparents), spent time in changing or inconsistent family environments (such as in foster care), or suffered trauma or severe and ongoing emotional and social neglect, are at risk of developing DSED. Although most studies of DSED 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 children with DSED is now thought to be independent of the child’s attachment, or lack of attachment, to primary caregivers such as adoptive or foster parents.

Treatments

Psychotherapeutic treatment for DSED 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, to advance the child’s social and emotional development. It is important to note that some researchers now question whether DSED should, in fact, be considered an attachment disorder or an entirely separate type of disorder with a similar non-attachment basis. Future studies will help determine if this is the case and if treatment protocols should be adjusted.

References

Zeanah CH, Smyke AT. Rutter’s Child and Adolescent Psychiatry, Sixth Ed. Chapter 58: Disorders of attachment and social engagement related to deprivation. Edited by Anita Thapar et al. (2015; John Wiley & Sons, Ltd.)  

Zeanah CH, Gleason MM. Annual Research Review: Attachment disorders in early childhood—clinical presentation, causes, correlate and treatment. J Child Psychol Psychiatry. March 2015;56(3):207-222. 

Lawler JM, Koss KJ, Doyle CM, Gunnar MR. The course of early disinhibited social engagement among post-institutionalized adopted children. J Child Psychol psychiatry. Oct 2016;57(10):1126-1134. First published online 27 July 2016. 

Facts for Families: Attachment Disorders. American Academy of Child and Adolescent Psychiatry 

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

Lyons-Ruth K, Zeanah CH, Gleason MM. Commentary: Should we move away from an attachment framework for understanding disinhibited social engagement disorder (DSED)? A commentary on Zeanah, Gleason (2015). March 2015;56(3):223-227.

Last reviewed 06/08/2017