Many children are shy when meeting new people — it’s natural to be wary of strangers. But sometimes, kids lack this fear. This is the main symptom of DSED.
Children with DSED might be overly talkative as soon as they meet a new adult, or they might be unafraid to give someone they just met a hug, kiss, or another sign of affection.
Some might not hesitate to sit in a stranger’s lap in a waiting room. These are all possible signs of something called disinhibited social engagement disorder (DSED), a behavioral disorder that occurs in young children.
DSED is believed to be relatively rare in the general population, but the risk is much higher in at-risk populations, such as children living in foster care, institutionalized settings, or orphanages.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports the prevalence in at-risk populations to be as high as 20%.
“DSED is a childhood attachment disorder that makes it difficult for children to form an emotional, stable, and meaningful bond with others,” explains Dr. Holly Schiff, a licensed clinical psychologist based in Greenwich, Connecticut.
“Children with DSED can easily talk to strangers and are extremely friendly and outgoing.”
The DSM categorized DSED as a stand-alone diagnosis for the first time in the current edition (DSM-5).
The symptoms of DSED include:
- extreme sociability
- minimal social boundaries
- a reduced or absent reluctance to approach and engage with unfamiliar adults
- overly familiar verbal or physical behavior toward an unfamiliar person
- little to no checking back with the adult caregiver after venturing away from them, even in a strange new place
- willingness to go off with an unfamiliar adult with little to no hesitation
In other words, explains Dr. John DeGarmo — author, foster parent, and founder and director of The Foster Care Institute — “there is no sense of ‘stranger danger’ in a child who has DSED.”
This makes the disorder different from other conditions, such as impulse control issues, because the child doesn’t seem to need a caregiver around to be social with a stranger. They treat both the caregiver and the stranger with the same level of affection — and they’re just as likely to turn to either one when seeking comfort.
This means that children with DSED are at great risk of harm from others because they’re so trusting.
In fact, sometimes, they’ll actively approach an unfamiliar person to interact with them — and they might not think twice about climbing into a stranger’s car or following them home.
According to the DSM-5, DSED has been reported in children from 2 years old to adolescence. It also states that there is no evidence that neglect after the age of 2 results in this disorder.
As children grow up, the symptoms of DSED might look different. For example, in preschool, children might make loud noises or try to get the attention of adults. Whereas in middle school, they might start talking to or approaching strangers.
Most children, especially if they receive treatment, will see the symptoms of DSED diminish.
In fact, there’s some controversy over whether the disorder persists into early adulthood, though several studies have found that the condition is not uncommon among teens in residential youth care. These teens might be overly familiar with peers, parents, teachers, and coaches.
Research is still ongoing regarding the effects of DSED in adults, but it appears that the disorder can affect how they form and maintain friendships and romantic relationships.
“Adults with DSED may also have a tendency to ask intrusive questions to people that they have just met and engage in other behaviors that demonstrate a lack of inhibition,” explains Schiff. “They will have difficulty trusting others and therefore not feel safe and secure in their adult relationships.”
DSED and reactive attachment disorder (RAD) are two attachment disorders that develop in children when early attachments are disrupted. In both disorders, symptoms can appear as early as a child’s first birthday.
Unlike with DSED, children with RAD are less likely to seek comfort when they feel distressed. Some symptoms of RAD might include:
- difficulty calming down
- refusal to seek comfort from caregivers
- an absence of positive emotions but the presence of disruptive emotions, such as irritability, sadness, fear, or anger
- a lack of emotional attachments
In the DSM-5, DSED is listed under “trauma- or stressor-related disorders.”
DSED is caused by neglect during infancy or early childhood. For many children, it occurs because they haven’t had a solid, long-term caregiver that meets their needs, spends time teaching them, and provides food, shelter, and emotional support.
When a caregiver is emotionally or physically available for a child — especially during early infancy — it causes the child to develop secure attachments. If this attachment doesn’t form, it can
So, childhood trauma, extreme abuse, or neglect can all put a child at risk of developing DSED. Examples of possible circumstances or events include:
- the death of a parent
- being raised by an absent parent
- being raised by a parent with a history of substance misuse or substance use disorder
- early sexual abuse
- growing up in an orphanage
- growing up in multiple foster homes
Note that DSED is not caused by being placed in daycare or being placed in the crib while crying, contrary to some damaging myths.
Before treatment can begin, children with DSED must be placed in the care of stable caregivers. So, if the child is in foster care, for example, treatment will begin once they are placed with someone who is committed to their long-term care.
This is because treatment for DSES usually involves family therapy.
“DSED treatment involves the entire family, as it is important that the child can bond with their caregivers,” explains Schiff.
“The therapy would also help the caregivers learn how to best interact with their children to care for them and support them to strengthen the bond.”
This will help the child with DSED feel stable, safe, and loved — which begins the recovery process.
“My wife and I have attended several such therapy sessions with a child in our home and I found them to be most helpful,” says DeGarmo.
Children with DSED might also benefit from play therapy or art therapy to advance their social and emotional development.
If your child has been diagnosed with DSED, the most important thing you can do for them is provide them with consistent, stable care.
“Parents should focus on the quality of their interactions with their child,” Schiff explains. “Help your child feel cared for and safe. This is necessary for healthy attachments to form.”
You might find these tips helpful:
- Set realistic expectations, so your child knows what to expect from you.
- Stay patient, since change takes time.
- Create routines.
- Find support from other parents, family members, a therapist, or support groups.
You’ll also likely want to monitor the interactions your child has with strangers or new people until treatment progresses.
DSED is a serious condition, but recovery is possible with treatment. This process takes time, though. Try not to be discouraged or lose faith in the process while you work to provide the child with a stable, safe environment.
If you’re concerned your child has DSED, reach out to your child’s pediatrician for advice. They can help refer you to the right mental health professionals. You can also use the search tools provided by the American Psychological Association and the American Psychiatric Association.