Disinhibited Social Engagement Disorder

Is your child overly friendly with strangers? Do they often wander off on their own? They could have a condition called disinhibited social engagement disorder (DSED).

Disinhibited social engagement disorder (DSED) is a childhood attachment disorder where a child is overly friendly and comfortable with strangers. Young children are usually wary of strangers and find comfort from their parents or caregivers. However, children with DSED are not afraid of strangers and may seek support from unfamiliar people.

This condition may cause distress to parents or caregivers, and it can pose a risk to the child who may venture away from caregivers or willingly go off with unfamiliar people. How common is DSED, and what can be done if a child is showing signs of this disorder?

What Is Disinhibited Social Engagement Disorder?

It is common to see young children attached to parents or primary caregivers, often clinging to them for protection from the unknown. This type of protective social behavior is healthy and considered a developmental milestone for children between the ages of 6 to 12 months. This protective social behavior is lacking in children with DSED.

DSED can be defined as a pattern of behavior where a child shows little to no hesitation approaching unfamiliar adults and displaying verbal or physical behavior that is overly familiar. The child will leave the side of their caregiver without concern about checking back in and will show a willingness to go places on their own with unfamiliar adults.

This abnormal social behavior can be attributed to neglect and inadequate caregiving in the early years of life. DSED is seen most often among children with limited opportunities for secure attachment, such as those living in institutions, orphanages, foster care and other settings where social neglect is high.

Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder

Reactive attachment disorder (RAD) and DSED are both childhood attachment disorders that stem from inadequate caregiving environments. Children with RAD internalize the effects of this inadequate environment, while children with DSED externalize them.

Those with DSED can be attached to a caregiver and at the same time be just as friendly or seek the same degree of comfort from an unknown individual. RAD differs from DSED because the affected child does not show signs of attachment to anyone, including the primary caregiver. They may not seek comfort when distressed, nor respond to comfort given to them.

While DSED may persist even with adequate caregiving, RAD tends to resolve nearly completely with access to adequate care and an attachment figure.

Symptoms of Disinhibited Social Engagement Disorder

Some children may be friendly by nature and more predisposed to interactions with strangers. However, children with DSED are friendly to the extent that unfamiliar adults often see their actions as odd or intrusive.

Some common symptoms of DSED include:

• Little to no hesitation approaching unfamiliar adults
• Little to no hesitation leaving with unfamiliar adults
• Little to no concern for the whereabouts of a primary caregiver, even in unfamiliar settings
• Physical behavior that is overly friendly such as hugging or cuddling with an unknown person

Causes of DSED

DSED is a childhood disorder that can form early in infancy or later in childhood. The causes of DSEM stem from an inadequate care environment that includes neglect, frequent changes in caregivers, or stressors or trauma in early life. One study noted that mental disorders present in biological mothers and substance use were associated with DSED in children.

At least one-fifth of all post-institutionalized (children in orphanages) children will go on to develop DSED, even after adoption into a secure environment. Studies on DSED confirm that this disorder is seen more often in institutionalized and ill-treated children.

Risks of Disinhibited Social Engagement Disorder

One of the major risks associated with this disorder is the willingness to trust unfamiliar adults. While most children can determine rather quickly if a person is trustworthy, one study noted that children with DSED have difficulty consistently identifying the trustworthiness of unfamiliar faces. This can pose a direct risk to the physical and mental well-being of a child and increase the risk of kidnapping or the possibility of the child wandering off with an unknown adult. DSED can also pose a threat to the establishment of healthy relationships with caregivers and peers.

Diagnosing DSED

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has specific criteria for the diagnosis of DSED. These criteria involve a specific pattern of behavior with unfamiliar adults, including a lack of inhibition in approaching, interacting with and displaying or receiving affection from strangers and lowered awareness of caregiver whereabouts. To receive a DSED diagnosis, a child must also have experienced an extreme pattern of insufficient care related to social deprivation, lack of emotional needs being met, frequent or repeated changes in caregivers and placement in institutions where the opportunity for attachment is low.

Statistics on Disinhibited Social Engagement Disorder

Statistics on DSED help to show the link between inadequate caregiving environments and the development of DSED:

• 22% of maltreated foster children have DSED
• 20% of post-institutionalized children have DSED
• 1.4% prevalence of attachment disorders are seen in deprived school-age children
• 49% of children adopted out-of-home between ages 6–11 are classified with DSED

DSED and Co-Occurring Disorders

DSED takes root in a child’s formative years and can develop and persist into adolescence. The problem of inadequate caregiving that causes DSED to develop can also give rise to cognitive delays in children. One study showed that toddlers who showed signs of DSED were more behaviorally aggressive and hyperactive when they entered kindergarten. Another reported that children with signs of DSED had an increase in the use of mental health services and special education, and showed higher rates of psychopathology.

In older children, DSED can be associated with inattention and overactivity. While children with attention-deficit hyperactivity disorder and children with DSED may share some symptoms, the two are distinctive clinical disorders.

Disinhibited Social Engagement Disorder Treatment

The treatment of DSED is based on establishing a stable caregiver and home environment. If a child continues to reside in an institution or is moved frequently from one foster home to the next, DSED will continue to persist.

A child with signs of DSED can form an attachment to a stable caregiver, but their symptoms may persist even with a stable environment. For this reason, caregivers are encouraged to seek treatment for their child that introduces strategies, approaches and interventions to address problematic behaviors early on.

If you or someone you know is struggling with substance use and finds providing stable care for their child difficult, reach out to The Recovery Village today. You can speak with one of our representatives about a treatment plan to get you on the road to recovery. Take the first step to a better future now.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Karen Vieira, PhD

Dr. Karen Vieira has a PhD in Biomedical Sciences from the University of Florida College of Medicine Department of Biochemistry and Molecular Biology. Read more