What does disinhibited social engagement disorder look like?

Teaching kids to form positive and secure relationships is a critical part of parenting. Unfortunately, many children who grow up in institutionalized care or have frequent disruptions in who their primary caretaker is experience disrupted attachment with their caregivers. For some, these experiences can lead to attachment disorders.

Disinhibited social engagement disorder — or DSED — is one such attachment disorder that can arise when a child doesn’t have a stable or healthy adult caregiver. Attachment disorders are relatively rare in the general population, but they’re much more common in children in foster care and other institutionalized settings.

If a child you love has disinhibited social engagement disorder, there’s hope. Most children can learn to heal and manage these symptoms — especially if they’re placed in a stable family environment. Getting treatment for the affected child and their caregivers is key to healing from past neglect and helping the child form healthy relationships moving forward.

Signs of disinhibited social engagement disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), there are specific features that characterize disinhibited social engagement disorder in children.

Symptoms include:

• Being less shy or cautious when approaching and interacting with unfamiliar adults: This means that the child doesn’t show any distinction between adults who are close to them and adults who are complete strangers. For example, if a child without DSED meets a stranger in a park, they may ignore the adult or even feel afraid of them. But a child with disinhibited social engagement disorder might immediately warm up to the adult, even when it’s inappropriate.
• Overly familiar verbal or physical behavior: The child may show signs of physical or verbal affection that are inappropriate for their age or for the relationship they have with the adult. For example, a teenager with disinhibited social engagement disorder might tell their new teacher about their past sexual abuse on the first day of meeting them. Or a 10-year-old child may continuously wish to hold hands with or sit on the lap of an adult who they hardly know.
• Less frequent or no longer looking back at their caregiver after wandering away: One sign of a secure attachment is that the child is able to venture away from the primary caregiver and explore alone. However, in cases of secure attachment, the child will occasionally look back to their caregiver for signs of safety and connection. Children with disinhibited social engagement disorder may simply go off to explore their surroundings and meet new people without ever checking back with their caregiver.
• Willingness to go off with an unfamiliar adult with little to no hesitation: While children with secure attachments to their caregivers may be wary or even suspicious of strangers, children with disinhibited social engagement disorder are too willing to trust any adult who they come across. They may have no inhibition when it comes to trusting and going off with adults, even when they’re complete strangers. This puts these children particularly at risk.

For a child to be diagnosed with disinhibited social engagement disorder, they must also have experienced significant neglect or abandonment during their childhood. For example, they may have had to switch homes or caregivers multiple times or have been severely neglected.

Disinhibited social engagement disorder vs. reactive attachment disorder

Disinhibited social engagement disorder is one of two attachment disorders. The other is reactive attachment disorder (RAD).

Although disinhibited social engagement disorder and reactive attachment disorder both signify problems with attachment, they tend to display themselves in almost opposite ways.

Children with DSED are too undiscerning when it comes to adults they trust. It may appear almost as if they don’t know how to recognize “red flags.” They become attached to adults even if they’re strangers because they may be desperate for a safe connection. They venture away from their caregivers easily and don’t appear to miss them when they’re gone.

On the other hand, children with reactive attachment disorder may see red flags even when there aren’t any. They tend to be more inhibited and withdrawn and may have a very hard time trusting adults — even those who are safe. While children with DSED tend to form superficial attachments with any adult without discrimination, children with reactive attachment disorder have a very difficult time forming attachments with anybody.

What causes disinhibited social engagement disorder?

Unlike most other mental health conditions, attachment disorders like disinhibited social engagement disorder and reactive attachment disorder have one clear cause: the absence of a stable caregiver during childhood. Specifically, this condition is linked to children who’ve grown up in institutionalized care, like group homes or foster care. It can also happen when the child faces neglect, abandonment, or abuse.

Some specific risk factors include:

• Growing up in foster care or institutionalized settings
• Experiencing parental substance use disorders
• Having caregivers with untreated mental health conditions
• Enduring early childhood neglect or abuse
• Frequent changes in caregivers or homes
• Experiencing the traumatic loss of a parent

As a parent, this can be hard to read or think about. But it isn’t about pointing fingers and placing blame for the cause of disinhibited social engagement disorder. It’s simply about understanding the various factors and events that may have led to it.

What happens to DSED over time?

The symptoms of DSED often decrease and stabilize over time if the child is removed from institutionalized care and placed with a stable family. Children who have the best outcomes with DSED are placed in a stable family environment before they’re two years old.

However, these symptoms don’t always go away completely. Research shows that, for around 15% of children, symptoms of DSED can continue on into adolescence and even adulthood. Children who continue to go from home to home over many years are more likely to live with symptoms of DSED long term.

In adolescence, continuing DSED symptoms can show up as difficulties with impulse control, inappropriate social and sexual behaviors, and challenges in forming friendships with both peers and adults. This can get in the way of teens’ relationships and social functioning. Some teens with DSED are also more likely to have mental health challenges like depression and struggle academically.

Even if the overt symptoms of DSED go away before adolescence, the early experiences of neglect and deprivation can have lasting impacts on the child’s life well into adulthood. For example, they may continue to struggle with risk-taking behaviors and emotional dysregulation.

Guidance for parenting a child with DSED

There are many factors for why parents may not be able to give their children the care and attention they need. For example, they may have substance use disorder or mental health conditions, or experienced a traumatic loss that led to abandonment trauma for the child. Perhaps your child experienced an illness that led them to grow up in a medical institution. Or maybe you adopted a child after they experienced neglect.

It’s understandable to feel remorse or sadness about your child’s attachment traumas and how you and other caregivers may or may not have contributed to them. But the fact that you’re reading this article, hoping to learn more about disinhibited social engagement disorder and how to help your child, demonstrates the love you have for your child and your dedication to parenting.

Regardless of the exact causes, it’s never too late to provide love and care to a child who’s been neglected.

Keep these tips in mind:

• Learn more about DSED. Educate yourself to better understand what your child is going through.
• Start going to therapy. Individual therapy can help you process your feelings about the situation — including remorse — and equip you with tools to support your child.
• Get your child into therapy. Therapy designed to support children with attachment disorders can help them learn healthier ways to connect and build trust.
• Go to family therapy or parent training. Programs like parent-child interaction therapy (PCIT) or filial therapy can strengthen your bond and help you learn techniques to support secure attachment.
• Practice strong attachment-building skills. Spend quality time together, be consistent in your caregiving, and show empathy to help your child feel safe and connected. Practice the skills you learn in family therapy.
• Play with your child. Playtime is a way to build trust and foster a stronger attachment.
• Show empathy and reflection. Validate your child’s feelings and reflect on their experiences to help them process their emotions and build resilience.

How is disinhibited social engagement disorder treated?

Since disinhibited social engagement disorder usually affects younger children, it’s important to find a treatment plan that takes this into consideration. Psychotherapy is the most recommended treatment for children with DSED.

Some specific therapy methods that may be used with the child include:

• Play therapy
• Art and expressive therapy
• Trauma-focused cognitive behavioral therapy (TF-CBT)

In most cases, it’s important for the caregiver — including foster parents — to be involved in the child’s treatment. Treatment methods such as parent-child interaction training (PCIT) and filial therapy can teach the parent how to interact with and play with their child in a way that builds a more secure attachment pattern. Family therapy can also help heal attachment disruptions that may have come from events that happened earlier in the child’s life.

Find care with Rula

Parenting a child with DSED or another mental health condition can be challenging. But with the right support, you can help your child thrive. 

At Rula, we strive to make it as easy as possible for parents and caregivers to find the right therapist for the child they love. In just a few minutes, we’ll connect you with a child or family therapist who takes your insurance, and you and your child could have your first session as soon as tomorrow.

Find support with Rula