What is Disinhibited Social Engagement Disorder?

The main characteristic of Disinhibited Social Engagement Disorder is defined in the DSM-V (also known as DSM-5) as “a pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults.”

The child’s pattern of behaviour includes what is seen as culturally inappropriate and overly familiar behaviour that is either verbal or physical with complete strangers. The behaviour breaks out of the normal constraints of ordinary social customs and boundaries of the culture. These children show the willingness to venture away into unfamiliar settings without checking back on the primary caregiver and can even go off with a stranger with minimal or no hesitation.

Causes
Disinhibited social engagement disorder is a trauma & stressor-related disorder that most commonly develops in a child who has been severely neglected during the first two years of life. It is more prevalent in children whose infancy has been spent in an institution. The inconsistency in their care doesn’t allow them to develop healthy attachments or bonds.

The DSM-V explains that a diagnostic requirement of Disinhibited social engagement disorder is a background of severe neglect. Due to the fact that infants are unable to form selective attachments no diagnosis is available for children younger than nine months of age. Due to neglect in infancy the patients may present other symptoms not directly related to Disinhibited social engagement disorder. Not all children raised in institutions will develop the disorder or other attachment disorders.

Children who are non-institutionalised who experience parental adjustment problems during infancy can also develop Disinhibited social engagement disorder.

Other parental factors that can cause Disinhibited social engagement disorder in a child
• teen parenting
• depression
• a personality disorder in the parent
• substance abuse
• poverty
• other mental health issues that will fail the parent to form a bond with the child.

Social Situations
The DSM-5 states that “Disinhibited social engagement disorder significantly impairs young children’s abilities to relate inter-personally to adults and peers.”

The behaviour of children with the disorder may find that the child will hold hands with a total stranger or even sit on the lap of a stranger leading to a very awkward and uncomfortable situation for the adult. Adolescents with the disorder will find themselves expressing severe familiarity and an over friendliness to their peers.

Infancy – Being held, touched and talked to by a parent or primary caregiver are primary examples and important components that will help an infant develop healthy attachments.

Treatment for Children
Play therapy provides an opportunity for children to develop healthy attachments that didn’t occur naturally during infancy. The parent or primary caregiver joins in the play therapy sessions to allow a healthy attachment to develop. Creative art therapy like painting, drawing, dancing and music is interactive therapy that is effective in treating Disinhibited social engagement disorder.

Diagnostic Criteria in the DSM-5

A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

• Reduced or absent reticence in approaching and interacting with unfamiliar adults.
• Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
• Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
• Willingness to go off with an unfamiliar adult with little or no hesitation.

B. The behaviors in Criterion A are not limited to impulsivity (as in Attention-Deficit/Hyperactivity Disorder) but include socially disinhibited behavior.

C. The child has exhibited a pattern of extremes of insufficient care as evidenced by at least one of the following:

• Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults.
• Repeated changes of primary caregivers that limit ability to form stable attachments (e.g., frequent changes in foster care).
• Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios).

D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).

E. The child has a developmental age of at least nine months.

Specify if Persistent: The disorder has been present for more than 12 months.

Specify current severity: Disinhibited Social Engagement Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Sandra Ciminelli
Cred. Dip.Couns.(Christian)

Sources
Symptoms of Disinhibited Social Engagement Disorder – Psych Central
Disinhibited Social Engagement Disorder – Theravive
CEBC – DSM-5 Criteria for Disinhibited Social Engagement Disorder

Where to Get Help

Talk to your doctor and see a mental health professional.
Visit CCAA to search for a Christian counsellor near you.
Visit ACA to search for a counsellor near you.

Studying at aifc

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