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Disinhibited Social Engagement Disorder

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

According to DSM-5, symptoms of DSED 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 of DSED may continue into the teenage years, but the condition is not known to last into adulthood.

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Causes

Unfavorable early caregiving environments can lead to an attachment disorder. Babies between the ages of six months and two 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, 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.

Treatment

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 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.)
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.
Last updated: 04/02/2019