Disinhibited Social Engagement Disorder (DSED): Symptoms And Treatment Options

Medically reviewed by Laura Angers Maddox, NCC, LPC
Updated May 3, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

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. 

Is your child constantly going up to strangers?

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.

Most babies and very young children do not readily go to strangers and are usually shy when meeting new adults. If a child interacts with strangers abnormally or inappropriately, that may indicate they are developing DSED. This is because in many cases, children with DSED, do not have any inhibitions when it comes to interacting with those they don’t know.

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.

Is your child constantly going up to strangers?

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.


If you suspect your child may be exhibiting signs of disinhibited social engagement disorder (DSED), it’s typically best to seek the support of a qualified healthcare provider who specializes in treating children. If you’re having trouble coping with their diagnosis or otherwise managing the challenges of parenting, you might consider seeking in-person or online therapy for yourself as well.
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