What is Disinhibited Social Engagement Disorder?

Disinhibited social engagement disorder, like its cousin reactive attachment disorder, is a trauma disorder of infancy or early childhood. Both disorders are caused by severe neglect resulting in unmet physical and emotional needs. As a result of such extreme neglect, the infant does not form an attachment to a caregiving adult. Without this necessary bond, the child doesn’t develop a sense of security, safety, and trust that paves the way for healthy adjustment and social relationships, and either reactive attachment disorder or disinhibited social engagement disorder can follow (Reactive Attachment Disorder (RAD) Symptoms).

Both trauma disorders are rare. Less than 10 percent of infants who experience grave neglect develop reactive attachment disorder, a condition that causes withdrawal, avoidance, and an inability to seek or accept comfort. In disinhibited social engagement disorder, experienced by less than 20 percent of dangerously neglected infants, children seek affection and attachment wherever they can and from whomever they can.

Disinhibited Social Engagement Disorder in the DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) from the American Psychiatric Association (2013) provides the official criteria necessary for an infant or young child to receive a diagnosis of disinhibited social engagement disorder. The primary criterion for disinhibited social engagement disorder is that the child purposely and indiscriminately approaches and interacts with unfamiliar adults. Further, the young child shows

• No hesitation in approaching and interacting with strangers
• Inappropriately familiar verbal or physical behavior with strangers
• No type of checking back with the caregiver after wandering off
• Willingness to go off with anyone who approaches

According to the DSM-5, this trauma disorder can only be diagnosed between the developmental ages of nine months and two years. If disinhibited social engagement disorder hasn’t manifested by age two, it is highly unlikely that it will develop. That said, the effects of non-attachment are stable over time and affect children of all ages.

Disinhibited Social Engagement Disorder in Specific Age Groups

No matter the age of the child disinhibited social engagement disorder involves a complete lack of hesitation in approaching, engaging with, and/or going off with adults whether known or unknown. Other behaviors are added as children develop.

• Toddlers don’t check back with the caregiver as is typical in this stage of development
• Preschoolers begin to display blatant attention-seeking behavior and intrusiveness
• Elementary-aged children violate boundaries and act in overly familiar ways
• In teens, inappropriate and indiscriminate behaviors often lead to conflicts and superficial relationships

Behaviors Associated with Disinhibited Social Engagement Disorder

The child with disinhibited social engagement disorder seeks attachment and bonding from anyone, anywhere, at any time. The behaviors that result from this are outside of socially accepted norms and ironically end up driving others farther away rather than fostering bonding and attachment.

• Exaggerating needs, sometimes dramatically
• Dependence
• Neediness
• Being overly clingy/affectionate
• Developmentally inappropriate childishness/immaturity
• Becoming easily upset with disruptions in routine
• Showing distress for no apparent reason
• Intense, frequent romantic crushes
• Sexual promiscuity
• Watchful, anxious demeanor
• Impatience
• Lying
• Manipulation
• Quickness to anger
• Aggression
• Difficulty making friends

This behavior can be quite challenging to deal with. It can mimic such other disorders such as oppositional-defiant disorder or conduct disorder. Disinhibited social engagement disorder, though, is unique in that severe neglect and lack of attachment must be present before the age of two.

It can be helpful to remember that the behavior, while maladaptive, has a purpose: to draw people close in order to feel the safety, security, trust, and affection that comes with attachment. Treating disinhibited social engagement disorder is possible. As in treating reactive attachment disorder, establishing a safe, nurturing, secure environment that fosters trust can gradually and drastically reduce the effects of disinhibited social engagement disorder.

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