What Is Disinhibited Social Engagement Disorder (DSED)?

Table of ContentsView AllTable of ContentsSymptomsCharacteristicsBehaviorsDiagnosisComparisonCausesPrevalenceRisksTreatmentHow to Help

Table of ContentsView All

View All

Table of Contents

Symptoms

Characteristics

Behaviors

Diagnosis

Comparison

Causes

Prevalence

Risks

Treatment

How to Help

Close

Most children are naturally cautious with adults they don’t know. For the most part, a fear of unfamiliar people is healthy and helpful. However, children with disinhibited social engagement disorder do not have this fear.

Kids who have DSED aren’tafraid of strangers.In fact, they are so comfortable around unfamiliar people that they wouldn’t think twice about climbing into a stranger’s car or accepting an invitation to a stranger’s home. This uninhibited friendliness can become a serious safety problem if the disorder is left untreated.

Symptoms of Disinhibited Social Engagement Disorder

Common symptoms of disinhibited social engagement disorder include:

Characteristics of Disinhibited Social Engagement Disorder

Children with DSED may display certain characteristics. Here are three to consider.

No Preference for Caregivers

Most children seek contact with their primary caregivers, especially when they are in need of comfort. For example, a child who falls off a swing and skins their knee will likely look for the parent or caregiver who brought them to the playground to soothe them and tend to the wound.

The child’s uninhibited behavior can be confusing and unnerving for caregivers. Any adults involved may find it difficult to understand why a child interacts with unfamiliar adults without a moment’s hesitation.

Difficulty Knowing Who Is Trustworthy

Young children aren’t good at identifying predators, but most are cautious about people they don’t know. Most kids are able to make judgments about whether a stranger looks kind or mean based on an individual’s face. Research has found that children make initial assessments about an individual’s trustworthiness based on that person’s appearance.

For a child with disinhibited social engagement, difficulties withfacial recognitionmay contribute to their willingness to talk to and engage with strangers. Research using brain imaging has shown that children with the disorder cannot discriminate between a person who looks kind and safe and someone who looks mean and untrustworthy.

Craving Kindness

Kids with disinhibited social engagement disorder crave kindness from others. Since they can’t specifically identify a safe person, they may show affection toward anyone who gives them attention—including someone who is unsafe.

It’s not unusual for a child with the disorder to hug a stranger in the grocery store or strike up a highly personal conversation with an unfamiliar adult at the playground. They may even sit down with another family at the park as if they had been invited to the picnic.

A child with disinhibited social engagement disorder indiscriminately seeksphysical affection.For example, they may sit on a stranger’s lap in a waiting room.

Disinhibited social engagement disorder behaviors can change and evolve as a child gets older.

Toddlers

Toddlers with the disorder often begin showing a lack of fear toward unfamiliar adults, such as holding hands with a stranger or sitting on the lap of a person they have only just met.

Preschoolers

During the preschool years, children with DSED will also begin exhibitingattention-seeking behavior, such as making loud noises on the playground to get unfamiliar adults to look at them.

School-Age Children

By middle childhood, children often show verbal and physical overfamiliarity and inauthentic expression of emotions. A preteen may laugh when others laugh or appear sad to manipulate a social situation (rather than out of genuine emotion).

Among peers, they may be overly familiar if not forward. For example, they might say, “I want to go to your house,” when meeting a new classmate for the first time.

Teens

Adolescents with disinhibited social engagement disorder are likely to have problems with peers, parents, teachers, and coaches. They tend to develop superficial relationships with others,struggle with conflict, and continue to demonstrate indiscriminate behavior toward adults.

Adults

While research in this area is limited, some studies have found that children with DSED may experience more cognitive impairment in young adulthood, along with more emotional symptoms.

Diagnosis of Disinhibited Social Engagement Disorder

Disinhibited social engagement disorder was originally considered to be a subtype of another attachment disorder calledreactive attachment disorder. However, in the fifth edition of theDiagnostic and Statistical Manual(DSM-5), disinhibited social engagement disorder was categorized as a separate diagnosis.

To meet the diagnostic criteria for disinhibited social engagement disorder, a child must exhibit a pattern of behavior that involves approaching and interacting with unfamiliar adults as well as at least two of the following behaviors:

If a child exhibits the behavior for more than 12 months, the disorder is considered persistent. The disorder is described as severe when a child exhibits all of the symptoms at relatively high levels.

Disinhibited Social Engagement Disorder vs. Other Disorders

Disinhibited social engagement disorder is similar to reactive attachment disorder (RAD) and attention-deficit hyperactivity disorder (ADHD). Here’s how they compare.

DSED vs. RAD

In RAD, children have difficulty forming emotional attachments with their parents or caregivers. They often struggle to show affection, have problems controlling their emotions, and fear interacting with others.

Kids with DSED, on the other hand, are overly affectionate toward others. While they are outgoing and friendly, they struggle to form meaningful connections with other people.

DSED vs. ADHD

A child only meets the criteria for disinhibited social engagement disorder if their behaviors do not stem fromimpulse controlproblems, which are common in other disorders.

Disinhibited social engagement disorder stems from neglect and therefore may co-occur with other related conditions, such as cognitive and language delays or malnutrition.

Causes of Disinhibited Social Engagement Disorder

Neglect during infancy interferes with bonding and attachment. This impairs a child’s ability to develop trusting relationships with caregivers and often persists into adult life.

While the consequences can be severe, it’s important to know that not all neglected children develop disinhibited social engagement disorder. In fact, many children will grow up to have healthy relationships with no lasting attachment issues.

A Concern for Foster and Adoptive Parents

However, disinhibited social engagement disorder may not become apparent until long after the neglect issues have been resolved. Foster parents, grandparents, and other caregivers who are raising children who experienced neglect as infants should know that children may still be at risk for developing attachment issues even if they are no longer being neglected.

Prevalence of Disinhibited Social Engagement Disorder

How common is DSED? Disinhibited social engagement disorder is thought to be fairly rare. Children who have been raised in institutions (such as orphanages) and those who have had multiplefoster care placementsare at the highest risk for developing the condition.

Many children with a history of abuse or neglect do not develop attachment disorders, but studies suggest that around 20% of children in high-risk populations develop disinhibited social engagement disorder.

Risks of Disinhibited Social Engagement Disorder

It’s important for kids to have a healthy fear of strangers and potentially harmful people. Raising a child with disinhibited social engagement disorder can be quite confusing and terrifying for caregivers.

A four-year-old with the disorder might wander off with a stranger at the mall or a nine-year-old might enter a neighbor’s home without thinking twice about the safety or potential consequences of these actions.

Caregivers raising a child with disinhibited social engagement disorder must keep constant watch to ensure the child doesn’t enter a harmful situation. They may need to frequently intervene to prevent the child from interacting with strangers.

Children with attachment disorders struggle to develop healthy relationships with teachers, coaches, daycare providers, and peers.Their behavior can be alarming enough to the people around them, such as a classmate’s family, that it precludes social activities (particularly when people are not familiar with the disorder).

Press Play for Advice On Dealing With Caregiver StressThis episode ofThe Verywell Mind Podcast, featuring actor Nathan Kress, shares how to handle the stress that can arise after you’ve taken on a caregiver role. Click below to listen now.

Press Play for Advice On Dealing With Caregiver Stress

This episode ofThe Verywell Mind Podcast, featuring actor Nathan Kress, shares how to handle the stress that can arise after you’ve taken on a caregiver role. Click below to listen now.

Treatment for Disinhibited Social Engagement Disorder

It’s important for children with attachment disorders to receive consistent care from stable caregivers. A child who continues to move from foster home to foster home or one who continues to be institutionalized is not likely to improve.

Once consistent care has been established, treatment can begin to help strengthen the bond between a child who has experienced neglect and a primary caregiver.

Attachment disorders don’t tend to get better on their own. Professional treatment typically consists of therapy with both the child and caregivers, with treatment plans individualized to meet a child’s unique needs and symptoms.

If you are concerned that a child in your care may have an attachment disorder, talk to your pediatrician. They can refer your child to a mental health professional for a comprehensive assessment.

Coping With Disinhibited Social Engagement Disorder

There are steps that parents and caregivers can take to help children with DSED form bonds and manage their behaviors.

A Word From Verywell

If a child exhibits symptoms of disinhibited social engagement disorder, caregivers need to seek advice and treatment from a professional. Offering consistent care can help, but specific interventions are needed to address the attachment issues and behavioral problems that interfere with a child’s ability to form relationships.

14 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012American Psychiatric Association.Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Association.Harris PL, Corriveau KH.Young children’s selective trust in informants.Philos Trans R Soc Lond B Biol Sci. 2011;366(1567):1179–1187. doi:10.1098/rstb.2010.0321Miellet S, Caldara R, Gillberg C, Raju M, Minnis H.Disinhibited reactive attachment disorder symptoms impair social judgements from faces.Psychiatry Res.2014;215(3):747-52. doi:10.1016/j.psychres.2014.01.004Kennedy M, Kreppner J, Knights N, et al.Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: Examination of its clinical status and functional impact.Br J Psychiatry. 2017;211(5):289-295. doi:10.1192/bjp.bp.117.200618Guyon-Harris KL, Humphreys KL, Fox NA, Nelson CA, Zeanah CH.Course of disinhibited social engagement disorder from early childhood to early adolescence.J Am Acad Child Adolesc Psychiatry.2018;57(5):329-335.e2. doi:10.1016/j.jaac.2018.02.009Guyon-Harris KL, Humphreys KL, Miron D, et al.Disinhibited social engagement disorder in early childhood predicts reduced competence in early adolescence.J Abnorm Child Psychol.2019;47(10):1735-1745. doi:10.1007/s10802-019-00547-0Sonuga-Barke E, Kennedy M, Kumsta R, et al.Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study.The Lancet. 2017;389(10078):15-21. doi:10.1016/S0140-6736(17)30045-4Lehmann S, Breivik K, Heiervang ER, Havik T, Havik OE.Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children–a confirmatory approach to dimensional measures.J Abnorm Child Psychol. 2016;44(3):445–457. doi:10.1007/s10802-015-0045-4Zeanah CH, Gleason MM.Annual research review: Attachment disorders in early childhood–clinical presentation, causes, correlates, and treatment.J Child Psychol Psychiatry. 2015;56(3):207-222. doi:10.1111/jcpp.12347von Klitzing K, Döhnert M, Kroll M, Grube M.Mental disorders in early childhood.Dtsch Arztebl Int. 2015;112(21-22):375–386. doi:10.3238/arztebl.2015.0375Scheper FY, Groot CRM, de Vries ALC, Doreleijers TAH, Jansen LMC, Schuengel C.Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.J Child Psychol Psychiatry.2019;60(5):555-565. doi:10.1111/jcpp.12994Zeanah CH, Chesher T, Boris NW.Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder.J Am Acad Child Adolesc Psychiatry.2016;55(11):990-1003. doi:10.1016/j.jaac.2016.08.004American Academy of Child and Adolescent Psychiatry.Facts for Families: Attachment Disorders.Additional ReadingGoldstein S, DeVries M, eds.Handbook of DSM-5 Disorders in Children and Adolescents. Springer.

14 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012American Psychiatric Association.Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Association.Harris PL, Corriveau KH.Young children’s selective trust in informants.Philos Trans R Soc Lond B Biol Sci. 2011;366(1567):1179–1187. doi:10.1098/rstb.2010.0321Miellet S, Caldara R, Gillberg C, Raju M, Minnis H.Disinhibited reactive attachment disorder symptoms impair social judgements from faces.Psychiatry Res.2014;215(3):747-52. doi:10.1016/j.psychres.2014.01.004Kennedy M, Kreppner J, Knights N, et al.Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: Examination of its clinical status and functional impact.Br J Psychiatry. 2017;211(5):289-295. doi:10.1192/bjp.bp.117.200618Guyon-Harris KL, Humphreys KL, Fox NA, Nelson CA, Zeanah CH.Course of disinhibited social engagement disorder from early childhood to early adolescence.J Am Acad Child Adolesc Psychiatry.2018;57(5):329-335.e2. doi:10.1016/j.jaac.2018.02.009Guyon-Harris KL, Humphreys KL, Miron D, et al.Disinhibited social engagement disorder in early childhood predicts reduced competence in early adolescence.J Abnorm Child Psychol.2019;47(10):1735-1745. doi:10.1007/s10802-019-00547-0Sonuga-Barke E, Kennedy M, Kumsta R, et al.Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study.The Lancet. 2017;389(10078):15-21. doi:10.1016/S0140-6736(17)30045-4Lehmann S, Breivik K, Heiervang ER, Havik T, Havik OE.Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children–a confirmatory approach to dimensional measures.J Abnorm Child Psychol. 2016;44(3):445–457. doi:10.1007/s10802-015-0045-4Zeanah CH, Gleason MM.Annual research review: Attachment disorders in early childhood–clinical presentation, causes, correlates, and treatment.J Child Psychol Psychiatry. 2015;56(3):207-222. doi:10.1111/jcpp.12347von Klitzing K, Döhnert M, Kroll M, Grube M.Mental disorders in early childhood.Dtsch Arztebl Int. 2015;112(21-22):375–386. doi:10.3238/arztebl.2015.0375Scheper FY, Groot CRM, de Vries ALC, Doreleijers TAH, Jansen LMC, Schuengel C.Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.J Child Psychol Psychiatry.2019;60(5):555-565. doi:10.1111/jcpp.12994Zeanah CH, Chesher T, Boris NW.Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder.J Am Acad Child Adolesc Psychiatry.2016;55(11):990-1003. doi:10.1016/j.jaac.2016.08.004American Academy of Child and Adolescent Psychiatry.Facts for Families: Attachment Disorders.Additional ReadingGoldstein S, DeVries M, eds.Handbook of DSM-5 Disorders in Children and Adolescents. Springer.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012American Psychiatric Association.Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Association.Harris PL, Corriveau KH.Young children’s selective trust in informants.Philos Trans R Soc Lond B Biol Sci. 2011;366(1567):1179–1187. doi:10.1098/rstb.2010.0321Miellet S, Caldara R, Gillberg C, Raju M, Minnis H.Disinhibited reactive attachment disorder symptoms impair social judgements from faces.Psychiatry Res.2014;215(3):747-52. doi:10.1016/j.psychres.2014.01.004Kennedy M, Kreppner J, Knights N, et al.Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: Examination of its clinical status and functional impact.Br J Psychiatry. 2017;211(5):289-295. doi:10.1192/bjp.bp.117.200618Guyon-Harris KL, Humphreys KL, Fox NA, Nelson CA, Zeanah CH.Course of disinhibited social engagement disorder from early childhood to early adolescence.J Am Acad Child Adolesc Psychiatry.2018;57(5):329-335.e2. doi:10.1016/j.jaac.2018.02.009Guyon-Harris KL, Humphreys KL, Miron D, et al.Disinhibited social engagement disorder in early childhood predicts reduced competence in early adolescence.J Abnorm Child Psychol.2019;47(10):1735-1745. doi:10.1007/s10802-019-00547-0Sonuga-Barke E, Kennedy M, Kumsta R, et al.Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study.The Lancet. 2017;389(10078):15-21. doi:10.1016/S0140-6736(17)30045-4Lehmann S, Breivik K, Heiervang ER, Havik T, Havik OE.Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children–a confirmatory approach to dimensional measures.J Abnorm Child Psychol. 2016;44(3):445–457. doi:10.1007/s10802-015-0045-4Zeanah CH, Gleason MM.Annual research review: Attachment disorders in early childhood–clinical presentation, causes, correlates, and treatment.J Child Psychol Psychiatry. 2015;56(3):207-222. doi:10.1111/jcpp.12347von Klitzing K, Döhnert M, Kroll M, Grube M.Mental disorders in early childhood.Dtsch Arztebl Int. 2015;112(21-22):375–386. doi:10.3238/arztebl.2015.0375Scheper FY, Groot CRM, de Vries ALC, Doreleijers TAH, Jansen LMC, Schuengel C.Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.J Child Psychol Psychiatry.2019;60(5):555-565. doi:10.1111/jcpp.12994Zeanah CH, Chesher T, Boris NW.Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder.J Am Acad Child Adolesc Psychiatry.2016;55(11):990-1003. doi:10.1016/j.jaac.2016.08.004American Academy of Child and Adolescent Psychiatry.Facts for Families: Attachment Disorders.

Gleason MM, Fox NA, Drury S, et al.Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types.J Am Acad Child Adolesc Psychiatry. 2011;50(3):216-231.e3. doi:10.1016/j.jaac.2010.12.012

American Psychiatric Association.Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Association.

Harris PL, Corriveau KH.Young children’s selective trust in informants.Philos Trans R Soc Lond B Biol Sci. 2011;366(1567):1179–1187. doi:10.1098/rstb.2010.0321

Miellet S, Caldara R, Gillberg C, Raju M, Minnis H.Disinhibited reactive attachment disorder symptoms impair social judgements from faces.Psychiatry Res.2014;215(3):747-52. doi:10.1016/j.psychres.2014.01.004

Kennedy M, Kreppner J, Knights N, et al.Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: Examination of its clinical status and functional impact.Br J Psychiatry. 2017;211(5):289-295. doi:10.1192/bjp.bp.117.200618

Guyon-Harris KL, Humphreys KL, Fox NA, Nelson CA, Zeanah CH.Course of disinhibited social engagement disorder from early childhood to early adolescence.J Am Acad Child Adolesc Psychiatry.2018;57(5):329-335.e2. doi:10.1016/j.jaac.2018.02.009

Guyon-Harris KL, Humphreys KL, Miron D, et al.Disinhibited social engagement disorder in early childhood predicts reduced competence in early adolescence.J Abnorm Child Psychol.2019;47(10):1735-1745. doi:10.1007/s10802-019-00547-0

Sonuga-Barke E, Kennedy M, Kumsta R, et al.Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study.The Lancet. 2017;389(10078):15-21. doi:10.1016/S0140-6736(17)30045-4

Lehmann S, Breivik K, Heiervang ER, Havik T, Havik OE.Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children–a confirmatory approach to dimensional measures.J Abnorm Child Psychol. 2016;44(3):445–457. doi:10.1007/s10802-015-0045-4

Zeanah CH, Gleason MM.Annual research review: Attachment disorders in early childhood–clinical presentation, causes, correlates, and treatment.J Child Psychol Psychiatry. 2015;56(3):207-222. doi:10.1111/jcpp.12347

von Klitzing K, Döhnert M, Kroll M, Grube M.Mental disorders in early childhood.Dtsch Arztebl Int. 2015;112(21-22):375–386. doi:10.3238/arztebl.2015.0375

Scheper FY, Groot CRM, de Vries ALC, Doreleijers TAH, Jansen LMC, Schuengel C.Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.J Child Psychol Psychiatry.2019;60(5):555-565. doi:10.1111/jcpp.12994

Zeanah CH, Chesher T, Boris NW.Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder.J Am Acad Child Adolesc Psychiatry.2016;55(11):990-1003. doi:10.1016/j.jaac.2016.08.004

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

Goldstein S, DeVries M, eds.Handbook of DSM-5 Disorders in Children and Adolescents. Springer.

Meet Our Review Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?HelpfulReport an ErrorOtherSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?HelpfulReport an ErrorOtherSubmit

What is your feedback?