Disinhibited Social Engagement Disorder (DSED): Symptoms and Risk Factors

With the surge of interest in attachment theory and what it can mean for adult relationships, the question What is disinhibited social engagement disorder? may have crossed your mind.

When children have a consistently loving and supportive caregiver who provides mental stimulation and cares for their emotional and physical needs, they are more likely to bond with them securely. In contrast, disinhibited social engagement disorder (DSED) is a condition that children can develop as a result of neglect and deprivation during their early years.^[1]

Our early experiences of care can have a big influence on the ways our brains develop. Therefore, when children are chronically neglected, psychological and neurological harm can lead to the development of attachment disorders like DSED.^[2]

Unfortunately, symptoms of DSED might persist into adulthood if a child’s attachment wounds aren’t treated sufficiently when they’re young. These DSED symptoms and behaviors can impact adult relationships, emotional regulation, and overall mental health.^[2]

However, people with attachment trauma can recover if they have the right support. A mental health professional can guide you in the right direction if you’re concerned about yourself or someone you care about. This article can also work as a useful tool, as it discusses:

• Disinhibited social engagement disorder and its symptoms
• What childhood conditions increase the risk of developing DSED
• The challenges DSED can cause
• Treatment options for recovering from DSED

What Is Disinhibited Social Engagement Disorder?

DSED is a disorder caused by deprivation and severe social neglect in the first five years of life.^[2] DSED used to be classified as a subtype of reactive attachment disorder (RAD) (another attachment disorder), but is now a separate diagnosis.^[3]

When considering DSED vs RAD, their causes can look similar, but they have very different symptoms. For instance, symptoms of RAD include children withdrawing from caregivers, finding it difficult to be soothed, and having a strong desire to be independent.^[3] In contrast, the symptoms of DSED typically include:

• Inappropriate over-familiarity with strangers
• Lack of wariness around strangers
• Crossing of appropriate physical and verbal boundaries in social interactions
• Having an overly trusting nature

For example, a child with DSED might ask overly intrusive questions or seek out physical touch with someone they don’t know. Similarly, an adult with DSED might be very willing to divulge information about themselves that someone without DSED may deem too private, personal, or confidential to share.^[2] Clearly, this over-trusting nature can put people with DSED at risk, which we’ll explore later.

These signs of DSED in children and adults can be seen as a way to adapt to the poor caregiving and neglect they likely experienced. For example, if a child is in a foster home with neglectful conditions, the symptoms of DSED may “help” them cultivate a sense of closeness with staff or fellow children.^[2] In other words, DSED symptoms are often an attempt to get needs met.

The next section discusses the causes of DSED in more depth.

Causes of Disinhibited Social Engagement Disorder

The main cause of a condition like DSED is known as “psychosocial deprivation.” This is when children aren’t given rewarding social interaction, like emotional support, soothing, loving care, and mental stimulation.^[1]

Institutional care settings like foster homes and orphanages are a common risk factor for developing DSED. This is because there may be limited personalized care for each child in these settings, making it harder for them to form close, loving, and stable bonds. For instance, research finds that children are more likely to show DSED symptoms if they’ve spent more than six months in such institutions.^[2] Of course, many of these systems offer adequate care and support, so not every child in care settings develops DSED.

Neglect can also include failing to meet children’s hygiene, nutritional, and mental stimulation needs.^[4] Children might experience this form of neglect if parents are physically or mentally ill, dependent on substances, or unable to provide consistent nurturing for another reason.^[3]

This information is not about placing blame – it’s about highlighting how difficult circumstances can create undesirable outcomes. However, with the right support, children and adults can heal from DSED.

Social Vulnerabilities Caused by DSED

Since DSED causes people to be overly familiar and trusting of others, it can actually impair children and adults and make them more vulnerable.^[2] For instance, while DSED symptoms may help children in institutionalized settings get a sense of intimacy from staff, their lack of inhibition can also put them at risk.

In particular, DSED can put people at risk of exploitation within relationships.^[2] For example, if someone has a poor understanding of social boundaries, they might allow contact they don’t want, overshare personal information, and fail to recognize warning signs that they’re unsafe. Additionally, people might take advantage of their trusting nature and friendliness, leaving them at risk of manipulation and abuse.

In young adulthood and beyond, people with DSED may miss out on genuine friendship and connection. They might try to be friends with as many people as possible or mistakenly stick with “friends” that aren’t a good connection for them. This is how DSED affects social interactions and undermines the development of genuine bonds.^[2]

Additionally, intensity and lack of personal boundaries can make other people uncomfortable; they might interpret the behavior as pushy or threatening.^[2] Even though the person with DSED has an attachment wound, and doesn’t intend to come across any particular way, people won’t always understand this.

Academic Challenges of DSED

People with DSED may struggle with school and work. This is because the lack of intellectual stimulation that’s typical of psychosocial neglect can halt the development of memory and language skills –  hindering their academic performance.^[4]

As a result, children with DSED tend to be behind their peers at school, which can bring a new set of challenges. Namely, they may be prevented from excelling, developing independence, and growing in confidence.^[4]

Research finds that children who were diagnosed with DSED struggle with certain areas of life once they reach adolescence. 60% of children who were psychosocially neglected struggled with peer and family relationships, academic performance, mental health, substance use, and risk-taking.^[1]

Difficulties in areas such as relationships, academic performance, mental health, and risk-taking can pose significant social and emotional challenges for children and adults with DSED.^[1] Fortunately, there’s a lot of support out there for attachment trauma, which we’ll explore next.

Treatment Options for Children with DSED

At this point in time, only children can be diagnosed with DSED, even though symptoms of DSED can persist into adulthood unless childhood interventions are put in place. So, as we know that DSED symptoms and behaviors can cause a lot of anguish, what kind of support do these children need?

Firstly, children with DSED should be placed into a high-quality caregiving environment as soon as possible. For instance, new caregivers of children with DSED should be familiar with attachment theory and be made aware of the child’s history.^[3]

From this point, treatments that can increase attachment security should be considered. These could be ones that focus on healthy child-parent relationships and teaching the child good emotional regulation techniques.^[1]

Some evidence-based treatment options for children with DSED include child-parent psychotherapy, attachment and biobehavioral catch-up, and the circle of security.^[1] These therapies focus on enhancing the caregiver’s behavior to understand and respond to a child’s attachment needs. They’re also particularly relevant if the child is under the age of 6.

Additionally, play or art therapy might help children express themselves, but trauma-informed talking therapy for disinhibited social engagement can be a more direct way to support older children. It can help them process their experiences, cultivate good emotional regulation, learn appropriate social boundaries, and reduce risk-taking behaviors.

Treatment Options for Adults with DSED

While the above approaches can help caregivers support and deal with DSED behaviors in children, sometimes symptoms can persist into adulthood and require treatment.

One study found that people with DSED who had self-awareness of their symptoms were in a better position to develop coping and defensive strategies.^[2] Though this isn’t the only skill they need to heal, it still suggests that undergoing self-reflection in therapy is part of a successful recovery.

Adults with DSED should also consider trauma-informed therapy. These therapists are trained to speak about traumatizing events in a way that keeps people emotionally safe, preventing re-traumatization.

Trauma-informed therapy might use a range of different techniques to address traumatic experiences. These include creating a safe and supportive relationship, informing about attachment dysfunction, teaching emotional regulation and coping skills, and targeting feelings of shame, grief, anger, and sadness.^[5]

A therapist with specialist knowledge of attachment can also work with a client on developing secure attachments. Further, they can identify parts of the social and emotional life that are being dictated by symptoms of DSED.

Get Support for DSED Today

At Mission Connection, we offer a range of therapy options for DSED recovery. Our trauma treatment is informed by a deep understanding of the significant impact distressing events can have on your life.

Your assessment helps us create a personalized treatment plan, allowing us to provide evidence-based therapies to develop coping skills and support you emotionally – especially in forming healthy and happy relationships.

If you’re curious to find out more about how we can help you or a loved one form healthier, more stable bonds, contact our team today. No question is too big or too small.