Disinhibited Social Engagement Disorder (DSED): Symptoms And Treatment Options
Disinhibited social engagement disorder (DSED) is a relatively rare behavioral disorder that affects children, though it may also impact an individual in the future as an adolescent or adult if left untreated. One of the primary signs of DSED is a child fearlessly approaching, interacting, and being overly familiar with strangers in a way that’s culturally and developmentally unusual. Read on to find out more about this disorder, including treatment options.
Signs of disinhibited social engagement disorder
Disinhibited social engagement disorder is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a trauma- and stressor-related disorder. In earlier editions of the DSM, it was listed as a subtype of reactive attachment disorder, but it’s since been classified separately. While both disorders may be connected to neglect or abuse in early childhood, reactive attachment disorder symptoms can vary significantly from DSED symptoms.
Regarding risk factors, DSED may be more likely for those who experienced neglect by a primary caregiver or inconsistent care from them in the first one or two years of a child's life. Not all children who experience social neglect or lack a secure attachment develop DSED, but the risk for it is much higher among them than among the general population. Other risk factors, as well as genetic and neurological elements, may also play a role.
Symptoms of disinhibited social engagement disorder tend to develop around the age of nine months. Instead, they will readily go to them on their own and may even leave with unfamiliar adults without hesitation.
According to an article in the Journal of Abnormal Child Psychology, key signs of DSED include:
- Wandering away from a caregiver
- A willingness to leave with a stranger
- Not looking back to check with their caregiver before leaving with a stranger
- Not displaying hesitance or shyness when meeting a new adult
- A disregard for social boundaries or overly familiar physical behaviors or, such as hugging with unfamiliar adults
How DSED is diagnosed
A proper diagnosis is important for the prognosis of this disorder, as the study from the Journal of Abnormal Child Psychology cited above suggests that untreated DSED can lead to “reduced competence” in early adolescence. Another study in the Scientific World Journal found a relationship between untreated DSED and borderline or emerging personality disorder. Untreated DSED is also likely to lead to the individual having difficulty forming stable relationships and attachments as an adult.
For a diagnosis of DSED to be considered as a result of the presence of the signs listed above, a child must be at least nine months of age and typically must have experienced a neglectful care environment. Examples include frequent changes in living situations because of foster care, care institutions with inadequate resources, or parent(s) or guardian(s) who did not meet their basic emotional support needs or provide proper stimulation and affection. If a neglectful environment has not been present, their behaviors may simply be the product of an especially outgoing or extroverted personality, or signs of another mental health condition such as attention-deficit hyperactivity disorder (ADHD).
DSED may go undiagnosed because the primary caregivers who are providing inadequate attention don’t notice the signs of disinhibited social engagement behavior. It can also happen if foster care situations are changed too frequently for caregivers to realize that there are behavioral problems. Note that only a qualified healthcare provider can make a clinical diagnosis of a condition like DSED, so seeking the proper evaluation and support is typically recommended if your child is displaying symptoms.
Treatment for disinhibited social engagement disorder
Treatment for DSED usually involves two parts. The first is improving the child’s emotional environment, if that hasn’t been done already by the time symptoms have been observed. If the same caregiver(s) who caused or contributed to the neglect is still the child’s primary caregiver(s), parenting classes may help them recognize and change the environment they have created for their child. Regardless of other treatment methods that may be employed, the child is likely to show little to no progress unless they are provided with an emotionally safe environment to grow in.
If the child is moved to a foster environment with more attentive caregivers, a treatment known as filial therapy may help them heal their childhood trauma and properly bond to their new guardians. This type of treatment has been shown to reduce DSED symptoms in many children as a result of “rebuilding, regenerating, and enhancing the relationship between foster children and foster parents”.
Finally, play therapy is a type of treatment that’s often used to help treat DSED once the child is in a safe, stable home environment. It offers the child an outlet for constructively expressing their emotions and experiences. During this type of therapy, they can decide the outcome of an exercise or game, providing them with a sense of power and control that can aid in self-healing and emotional development. Although more research is needed into this modality, one review of the literature notes that “available evidence supports the use of play therapy as a valid approach to treating children” and that it “represents a vibrant and viable resource [...] to reduce suffering in the child population”. Play therapy is not appropriate in all cases, however, so it’s usually best to have your child evaluated by a professional to learn about treatment options.
Coping when your child receives a DSED diagnosis
Seeking out the professional opinion of a child psychologist is recommended if you believe your child is exhibiting symptoms of DSED. If they are then diagnosed with this disorder, it can be difficult for you, as their caregiver, to cope. While they undergo treatment under the guidance of their psychologist, you as their original or new caregiver may benefit from receiving professional support as well. Meeting with a therapist can provide you with a safe, nonjudgmental space where you can process your emotions, and your provider may also be able to help you learn how to support your child during this time.
Research suggests that in-person and online therapy can offer similar benefits in many cases, which means an individual can typically choose the format that feels best for them. If you have a busy schedule or are having trouble locating a provider in your area, online therapy may represent a helpful alternative. With a virtual therapy platform like BetterHelp, you can fill out a simple questionnaire about your needs and preferences and get matched with a licensed therapist accordingly. You can then meet with them via phone, video call, and/or in-app messaging to address the challenges you may be facing in relation to parenting.
Takeaway
What happens to disinhibited social engagement disorder over time?
According to studies in American psychiatric publishing journals, disinhibited social engagement disorder (DSED), attachment disorders, and socially disinhibited behavior develop due to psychosocial deprivation, which may be due to abuse, neglect, or maltreatment from caregivers in a child’s life. The study found that symptoms of DSED commonly decrease over time, especially when children are removed from the situation causing the condition. This condition often disappears in children around middle childhood or adolescence, starting at 12.
Children and adolescents experiencing attachment disorders may benefit from meeting with a professional for child or adolescent psychiatry services. Adolescent psychiatry focuses on unique mental illnesses and how they present in children aged ten to 18. When meeting with an adolescent psychiatry provider, discuss any prior diagnoses your child has received, including attachment disorders. Although attachment disorders aren’t often treated with medication, adolescent psychiatry can also offer a referral to a therapist.
What are some interesting facts about disinhibited social engagement disorder?
Children with disinhibited social engagement disorder may respond this way due to an insecure attachment style, which often forms in early childhood. In addition, disinhibited social engagement disorder is one of the only early childhood disorders that may go away in childhood. This condition is most common in school-aged foster children and children with other attachment disorders. It can be crucial for a foster parent to have knowledge of child development, attachment disorders, and adolescent psychiatry when looking at why this disorder forms.
How can you prevent disinhibited social engagement disorder?
Preventing socially disinhibited behavior can be an effort for all family members. Whether these behaviors occur in early childhood, middle childhood, or adolescence, the entire family can work together to create a healthy environment for the child experiencing signs of attachment disorders. If you are a foster parent of school-aged foster children, you may start by enrolling in a trauma-informed foster care class. You can also learn about child development and the impacts of institutional care by meeting with a child development specialist like a therapist or social worker. These providers often work with children in institutional care and can explore child and adolescent psychiatry and therapy options with you.
If your child shows signs of attachment disorders, consider enrolling them in individual and family therapy for attachment disorders. The entire family can attend sessions and learn healthier coping strategies together. Maladaptive child behavior is often treatable and doesn’t necessarily indicate attachment disorders in early childhood or the need for adolescent psychiatry. If your child is a teen or in middle school, consider enrolling them in adolescent psychiatry for further support.
How do I parent my child with DSED?
Parenting a child with socially disinhibited behavior can be challenging, regardless of the child’s age. It may be beneficial to consider early childhood or adolescent mental health care and adolescent psychiatry for your child. A mental health professional can guide you through working with attachment disorders, supporting school-aged foster children (if applicable), and involving the entire family in supporting your child. The therapist can teach your child how to avoid indiscriminate behavior caused by attachment disorders and appropriately connect with others in early childhood or adolescence. Adolescents can work with an adolescent psychiatry provider for guidance and potential medication while undergoing therapy.
Can you have both reactive attachment disorder and disinhibited social engagement disorder?
Only children and teens can be diagnosed with attachment disorders like reactive attachment disorder (RAD) and DSED. These attachment disorders occur in early childhood and are opposite of each other in symptoms, so they do not occur together. RAD involves avoidant symptoms and difficulty connecting with other children. DSED is the opposite, involving reactivity, anxiety, and dependent behaviors. Both conditions are common in school-aged foster children and children with traumatic pasts. In some cases, these attachment disorders may persist into adolescence. In these cases, adolescent psychiatry may be a beneficial treatment strategy.
Is disinhibition helpful or harmful to online interactions?
Social disinhibition online is dangerous regardless of a child’s age or whether they have one of the two attachment disorders outlined in the DSM-5 by the American Psychiatric Association. Children should be monitored on the internet in early childhood and adolescence to ensure they are not conversing with adults or interacting with unhealthy websites.
The entire family can look after children online by ensuring child-safe defenses on the family computer and offering timed social media or internet usage that a parent monitors. Attachment disorders like DSED could cause children to interact with adults online, which could endanger them.
Children in institutional care may be more likely to run away from home, talk to unsafe adults, or get into dangerous situations. If you are a foster parent supporting children in institutional care, reaching out to the child’s support team can be crucial if risky behaviors occur. You can also consider adolescent psychiatry and therapy for long-term guidance. Institutional care is often traumatic for children, which may lead to them continuing to partake in a traumatic lifestyle after being removed from a traumatic household.
How does disinhibition relate to personality disorders?
Disinhibited social engagement disorder is one of two attachment disorders that form in early childhood. Attachment disorders are childhood conditions, regardless of a child’s age. Adults cannot continue to be diagnosed with DSED or RAD if diagnosed with these attachment disorders in early childhood. Instead, they may start to showcase symptoms of a different mental illness, such as a personality disorder.
Personality disorders form from similar causes to attachment disorders, such as trauma and abuse. Early childhood attachment disorders often have similar symptoms to adult personality disorders, as well. People with RAD may have signs of antisocial personality disorder or avoidant personality disorder as adults. People with DSED may be at risk of borderline personality disorder (BPD), histrionic personality disorder (HPD), or narcissistic personality disorder (NPD) as adults.
High-quality foster care, not being put in institutional care, not being neglected or abused, and having a social support system can help children avoid the possibility of developing a personality disorder later in life. Some children with early childhood attachment disorders, regardless of the child’s age, may fully recover with mental health support, adolescent psychiatry, and continued social systems into adulthood.
What is a kind of online disinhibition effect where a person self-reveal more in social media rather than in real life?
Benign online disinhibition is a term for when people do not restrain themselves online. For example, someone may reveal intimate details about their life on a website, putting details out that could give someone else enough details to emotionally or physically harm them. It can be crucial to practice internet safety when using social media.
Some people may decide to blur their children's faces in photos of their early childhood, as new AI technologies can replicate any face and be used for criminal activity. Other people may avoid mentioning challenges their children are experiencing, such as early childhood attachment disorders or a life transition.
It can also be crucial for parents to avoid allowing their young children to post sensitive information or photos online. Although giving adolescents boundaries online and with their devices can be beneficial to an extent, young children and at-risk teens can be monitored to ensure they aren’t revealing information that could put them or someone else in danger. Teach your children internet safety and how to spot predatory or grooming behavior from adults.
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