Unraveling Disinhibited Social Engagement Disorder (DSED) : A Guide to Causes, Symptoms, and Treatment

Disinhibited social engagement disorder (DSED) is a behavioral disorder where the affected children do not form healthy and strong connections with their parents or caregivers. This is a condition that occurs majorly in young children. Read below to know more about the condition.

Disinhibited social engagement disorder is an attachment disorder that makes it difficult for children to form an emotional bond with others, especially with their parents and caregivers. However, children with DSED can easily talk with strangers and show excessive friendliness toward them.

In general, children are cautious with adults they do not know. However, those who have disinhibited social engagement disorder are not afraid of strangers.⁽¹⁾ Rather, they become more comfortable with strangers or unfamiliar people and become excessively friendly with them.

Disinhibited social engagement disorder is common in children who have experienced abuse, trauma, neglect, or abandonment during their early childhood. This condition is more common among children who have been placed in foster care or have been removed from their homes.⁽²⁾ Studies suggest that about 20% of children in high-risk populations develop the condition.⁽¹⁾

Children with DSED require proper treatment and care. If left untreated, they can develop other mental disorders at later stages in their lives.

Disinhibited social engagement disorder (DSED) is a common condition, generally diagnosed in children below 18 years and those who have experienced severe trauma, abuse, or neglect in their early childhood.

There are two types of disinhibited social engagement disorder (DSED). They are:

This type of disinhibited social engagement disorder is characterized by a lack of social inhibition and an extreme willingness to talk to strangers. However, children with this type of disinhibited social engagement disorder may also show little hesitation or fear while approaching strangers.

This type of DSED is characterized by an excessive eagerness to have social contact with unfamiliar adults. Children with this type of disinhibited social engagement disorder might appear overly fawning, clingy, or desperate for attention, and also exhibit affection for strangers. 

Common symptoms of disinhibited social engagement disorder include excessive familiarity toward strangers, lack of social boundaries, not being willing to be with parents or caregivers, and willingness to mingle with unfamiliar adults with little or no hesitation.⁽³⁾

Some characteristics that children with this disorder might display are mentioned below.

Most children look for their parents or primary caregivers too often, especially when they need comfort. However, children with disinhibited social engagement disorder would reach out to strangers for emotional support or comfort. They might even sit on a stranger’s lap and talk with excessive friendliness.

For example, if a child falls somewhere outside, they would naturally seek comfort from their primary caregiver. However, children with DSED will run to any random passerby and tell that they are hurt. This specific action can be confusing for caregivers and any parent or adult involved might find it extremely difficult to understand why their child is interacting with strangers without any hesitation.

One more characteristic of children with disinhibited social engagement disorder is that they crave kindness from others. They cannot specifically identify a familiar or safe person and thus show affection toward anyone who pays them attention, even if they are unsafe and unfamiliar adults. Children with this disorder seek physical affection quite indiscriminately.⁽⁴⁾

Most children are cautious about strangers and can make correct judgments about whether the unfamiliar person looks kind or mean. Research has shown that children make initial assessments about any person’s trustworthiness based on that individual’s appearance.⁽⁵⁾

However, kids with disinhibited social engagement disorder, have difficulties with facial recognition, and this could contribute to their willingness to talk or mingle with people they do not even know. Research using brain imaging has discovered that children with DSED cannot discriminate between a person who looks safe and kind and someone who looks unsafe and mean.⁽⁶⁾

Disinhibited social engagement disorder (DSED) behaviors in children can change and evolve as they get older.⁽⁷⁾ Let us learn about disinhibited social engagement disorder behaviors by age.

Toddlers with disinhibited social engagement disorder begin showing a lack of fear toward strangers or persons they do not know. They often become so close to them that they start holding their hands or sit on their laps and talk for hours.

Children during their preschool years who suffer from disinhibited social engagement disorder often begin exhibiting attention-seeking behavior, such as making loud noises in the parks to get the attention of unfamiliar adults.

School-age or middle-childhood children with DSED often show verbal and physical overfamiliarity and might easily get manipulated in a social situation. Sometimes, they might even become so familiar with someone they might have met for the first time that they get ready to go to their house.

Teens or adolescents with disinhibited social engagement disorder usually have problems with their parents, teachers, peers, and coaches or instructors. They tend to develop superficial relationships with outsiders, struggle with conflict with dear ones, and continue to demonstrate indiscriminate behavior toward adults.⁽⁷⁾

Research in this area is limigted. However, certain studies have shown that children with disinhibited social engagement disorder might experience more cognitive impairment in their young adulthood, and also exhibit more emotional symptoms.⁽⁸⁾

Neglect, ignorance, and abuse during infancy can cause disinhibited social engagement disorder. Neglect during infancy often interferes with attachment and bonding. It impairs a child’s ability to develop trustworthy relationships with parents or caregivers and usually persists into their adult life.

Infants or babies learn to trust their caregivers when these people respond to their needs. For instance, a baby who is properly and timely fed, who is taken care of attentively, and responded well learn that they can count on their parents or caregivers anytime they are in need.

However, children who are neglected, say for instance a crying infant when left ignored, may not bond with their parents or caregivers. They start believing that people around them are unreliable. Such children will often experience disinhibited social engagement disorder.

Children with disinhited social engagement disorder should get consistent support, care, and appropriate treatment at the right time. Children with DSED who move from one foster home to another or one who is not taken care of by their primary caregiver are not likely to improve.

With consistent care, treatment can begin for such children with disinhibited social engagement disorder. Profession treatment for any type of attachment disorder consists of therapy with both the affected children and their caregivers, and the treatment plans are usually individualized to meet the children’s unique requirements and based on their symptoms.

Some steps that can be beneficial for coping with disinhibited social engagement disorder include:

Provide Stability and Care: A child who has been diagnosed with disinhibited social engagement disorder (DSED) should be offered reliable, stable, and consistent care and love.

Develop Routines: Foster consistency by having your daily household routines. Helping your kids know what to expect and then consistently sticking to it helps develop a sense of trust in you as their primary caregiver.

Set Rules and Expectations: Apart from having your expectations for them to manage their behavior, you should also let them know what they can expect from you. You should mention your rules and consequences with a greater sense of consistency.

Disinhibited social engagement disorder is a serious behavioral disorder that needs to be treated and children who are being affected with this condition should be given proper care and attention. Apart from special care, they should get appropriate medical attention. If you are concerned that a child in your care might have this type of attachment disorder, talk to your pediatrician or reach out for help from a mental health professional.

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