Disinhibited social engagement disorder

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Disinhibited Social Engagement Disorder (DSED) or Disinhibited Attachment Disorder of Childhood is an attachment disorder that consists of "a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults." and which "...significantly impairs young children’s abilities to relate interpersonally to adults and peers."[1] For example, sitting on the lap of a stranger or peer, or leaving with a stranger. DSED is exclusively a childhood disorder and is not diagnosed before the age of nine months or after the age of five. Infants and very young children are at risk if they receive inconsistent or insufficient care from a primary caregiver.


Disinhibited Social Engagement Disorder (DSM-5 313.89 (F94.2)) is the 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) name formerly listed as a subtype of reactive attachment disorder (RAD) called disinhibited attachment disorder (DAD). The corresponding disorder in ICD-10 is Disinhibited Attachment Disorder of Childhood.

The American Psychiatric Association considers "...disinhibited social engagement disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even secure attachments. The two disorders differ in other important ways, including correlates, course, and response to intervention, and for these reasons are considered separate disorders."[2]

Risk factors[edit]

DSED is a result of inconsistent or absent connection to a primary caregiver in the first years of life. Children who are institutionalized may receive inconsistent care, isolation during hospitalization, and parental problems such as mental health problems which interfere with attachment such as depression or a personality disorder, absence, poverty, teen parenting, or substance abuse. DSED "...may have a biological cause in some cases (e.g., Williams syndrome)."


The most obvious symptom is "...the absence of normal fear or discretion when approaching strangers. The child is unusually comfortable talking to, touching, and leaving a location with an adult stranger."[1] DSED has some similar symptoms of Attention Deficit Hyperactivity Disorder (ADHD).


"Here are the criteria for Disinhibited Social Engagement Disorder in the DSM-5:

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

  1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
  2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
  3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
  4. Willingness to go off with an unfamiliar adult with little or no hesitation.

B. The behaviors in Criterion A are not limited to impulsivity (as in Attention-Deficit/Hyperactivity Disorder) but include socially disinhibited behavior.

C. The child has exhibited a pattern of extremes of insufficient care as evidenced by at least one of the following:

Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults. Repeated changes of primary caregivers that limit ability to form stable attachments (e.g., frequent changes in foster care). Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios). D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

E. The child has a developmental age of at least nine months."[3]

The ICD-10 definition is: "A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, e.g. diffuse, nonselectively focused attachment behaviour, attention-seeking and indiscriminately friendly behaviour, poorly modulated peer interactions; depending on circumstances there may also be associated emotional or behavioural disturbance."[4]

Social concerns[edit]

Little is known about adolescents or adults with DSED, but it is believed that symptoms lessen with development.


Two effective treatment approaches are play therapy and expressive therapy help form attachment through multi-sensory means and some therapy can be non-verbal.[citation needed]