Disinhibited Social Engagement Disorder

Disinhibited Social Engagement Disorder - What is it

Most children are at least somewhat cautious with adults they don’t know. However, children can sometimes act overly familiar and over-friendly around people they don’t know, even completely lacking any wariness around strangers. This could be the result of a unique attachment disorder called disinhibited social engagement disorder (DSED). Kids with DSED aren’t afraid of strangers and are often so comfortable around them that an outside viewer might assume they are family. Because of this, DSED can make children particularly vulnerable to abuse or kidnapping.

Though it was previously thought that DSED vanished as a person ages, we now know that it could cause problems well into adulthood. Much about how DSED affects adults remains unknown. Some of the symptoms are similar to those in children, but there may also be new issues.

In this article, we’ll look at DSED, as well as its symptoms and causes, how it progresses as a person ages, and what treatment options are available.

An Overview of Disinhibited Social Engagement Disorder

Clinically, DSED is classified as an attachment disorder. There is still no professional consensus for the specific definition for the term “attachment disorder,” but most agree that it describes a range of disorders impacting mood, behavior, and social relationships, leading to socially inappropriate behavior for the child’s age. These disorders originate from unhealthy caregiving situations early in a person’s life.

One such condition is reactive attachment disorder, which manifests in two forms. The first—the inhibited subtype—involves a persistent failure to properly initiate or respond to social interactions. The second is the opposite, which means a persistent and inappropriate initiation or response to social interactions. This second type is now known as DSED and has its own diagnostic criteria, separate from reactive attachment disorder. Some groups even refer to DSED as a “detachment” disorder, rather than attachment.

A person with DSED does not have the same verbal and physical boundaries that most people have.

Due to a lack of inhibition and wariness around strangers, DSED can lead to situations where a child may willingly leave with a stranger, hug or kiss them, or tell the stranger inappropriate information. Typically, DSED symptoms are stronger in younger children and slowly diminish with age. However, many experts believe that early DSED could impact a person’s social and cognitive functioning later in life, even if the symptoms seem to vanish. In some cases, the same symptoms in childhood continue to be present. In others, the adult may have entirely new problems, though they still typically involve difficulties with social engagement.

Symptoms and Diagnostic Criteria

Symptoms of DSED usually first occur in young children under age five and may develop even in infancy. Usually, these symptoms involve some level of overfamiliarity around strangers and an unusual distance from parents or caregivers. Examples of this include wandering away from caregivers, showing no anxiety about being distant from their caregiver, and lacking any signs of fear, inhibition, or restraint around strangers.

Both children and adults with DSED may perform attention-seeking behaviors, along with impulsive behavior, high levels of hyperactivity, and decreased motor skills. In many cases, older people with this disorder will be very sociable, showing an extreme readiness to interact with strangers.

The DSM-5 gives five criteria that a person must meet before qualifying for an official DSED diagnosis:

  • A pattern of behavior involving the child actively approaching and interacting with unfamiliar adults, and exhibiting at least two of the following:
    • Lack of inhibition in approaching adult strangers
    • Overly familiar verbal or physical behavior that is not age-appropriate and culturally accepted
    • Reduced or completely absent checking in with adult caregivers
    • Willingness to follow an unfamiliar adult with little to no hesitation

The behaviors from the first criteria do not belong to impulsivity, such as those stemming from attention-deficit/hyperactivity disorder, but are socially disinhibited behavior.

The child has shown signs of insufficient care, such as:

  • Social neglect or lack of basic emotional needs, resulting in a need for comfort, stimulation, and affection from an adult
  • Repeated changes of caregivers, leading to an inability to form stable attachments
  • Having lived in unusual settings that make it difficult to form stable attachments to adults, such as a facility with a high child-to-caregiver ratio
  • The lack of care is likely responsible for the disinhibited behavior
  • The child is at least nine months old

Because the concept of DSED in adults is relatively new, there are no official diagnostic criteria for the disorder in older people. Some professionals will delve into a person’s childhood and diagnose them based on their previous symptoms.

Causes and Risk Factors

Even with modern research improving and revealing more info about DSED, there is still a lot we don’t know about the condition. One example of this is that the specific cause of the condition remains unknown. However, researchers have been able to identify numerous risk factors that appear to impact the chance of someone developing DSED.

Most prominently, having an unfavorable caregiving environment is one of the biggest predictors of a child having DSED. The vast majority of cases first occur between the ages of six months and two years, especially if the individual has spent time in the foster system or has experienced trauma or emotional neglect. Current estimates are that nearly a quarter of children raised in high-risk environments like foster or institutional care develop DSED.

It is unknown if an adult can develop DSED without having it as a child, though most experts believe it is unlikely.

Impact on Social Functioning

The specific actions and behaviors that DSED influences vary from person to person, though there are some broad categories that each one falls into.

No Preference for Caregivers

A child without DSED or a similar condition will typically seek contact with their main caregivers, especially when they need comfort. When a young kid scrapes their knee, they will likely run to the nearest caregiver for care and attention. This is not usually the case in children with DSED.

Should someone with DSED scrape their knee, they might choose a random stranger for support. Rather than run to their caregiver, they could run over and sit on the lap of a strange sitting nearby.

Adults with DSED may distance themselves from their parents or the people who raised them. They may also find comfort in strangers who exhibit caregiving behaviors.

Struggling to Tell Who Is Trustworthy

The average child usually struggles to identify predators. After all, they don’t have the experience or knowledge to do so. However, they will still exhibit a certain level of wariness around most strangers and use what clues they can spot to determine how trustworthy the stranger is.

A child with DSED usually does not have this same wariness. In fact, there’s some evidence that children with DSED struggle with facial recognition, which could impact the typical way they would identify trustworthiness. Using brain scans, researchers found that those with DSED literally could not tell the difference between someone who looks mean and someone who looks nice.

This may continue well into adulthood, leading to the individual being vulnerable to scams or abuse.

Wanting Kindness

People need kindness. Children, especially, need kindness. In a healthy household with active and present caregivers, children receive plenty of love and compassion. Children with DSED do not usually come from such a household, however, so they instead seek kindness from any adult they can—even unknown or unsafe strangers. This can include striking up extremely personal conversations or even physical acts of affection like hugging or kissing.

As adults, this may manifest in an extreme trust of people that they do not know well. This can come with a lack of inhibition, leading to an increase of sexual activity and similar behaviors.

The Unknown

Researchers also suggest that we don’t understand the full impact of DSED on social functioning, especially as the individual ages. Experts used to believe that the condition essentially resolved itself with time, but the newer consensus is that symptoms take on a different form. Adults with DSED may be resistant to affection or struggle to show affection themselves. Maintaining relationships in general may be a struggle. There could also be a range of cognitive problems, as well as difficulties with self-esteem, trust, and impulsivity.

How Doctors Diagnose DSED

With the recognition of DSED as a unique condition, separate from reactive affective disorder, the DSM-5 laid out clear diagnostic requirements for the disorder. To tell if a child meets those requirements, a professional will attempt to ask questions about the child’s home environment and their relationship with their caregivers. They may also look for signs of physical abuse, malnourishment, or other forms of trauma that could increase the risk of DSED.

Depending on the age of the child, there will likely also be observational periods during which the expert will see how the patient interacts with unfamiliar adults.

Treatment Approaches

It’s critical for children with DSED to have constant and unconditional care from stable caregivers. Should the child continue to bounce from foster home to foster home or from facility to facility, they are unlikely to improve. Once the child has access to consistent care, an experienced counselor can begin the process of improving the bond between the child and caregiver.

Treatments need to be personalized, targeting the specific sources of abuse and building on the person’s unique needs for attention and care.

There is no set treatment path for adults with DSED. Throughout the treatment process, a mental health professional may use a variety of techniques to improve their patient’s condition. Social skills training can help someone with DSED to learn social boundaries and improve their ability to interact with others. Talk therapies can help with any of the mental symptoms that may develop, including anxiety or low self-esteem.

Support Services and Resources

Managing any type of persistent childhood condition is difficult, especially if it continues to affect you as an adult. However, it doesn’t need to be something you do alone. Finding a local mental health professional you trust is a big step toward improving DSED symptoms.

You may also find aid in support groups with people experiencing the same thing. You can find these groups through a therapist or similar professional. Alternatively, you may find online communities through social media and sites like Reddit that fulfill a similar purpose.

Final Words

DSED is a unique condition that causes children to be overly familiar with strangers and distant from their caregivers. In adults, it can cause a range of symptoms, many of which are still a mystery. With treatment and consistent care, it is possible to manage this condition and improve its symptoms.

If you believe you were a child with DSED who now has issues as an adult, various interventions may help, from talk therapies to social skills training. For more information about these options, reach out to us anytime.