The Symptoms of Disinhibited Social Engagement Disorder

Disinhibited Social Engagement Disorder (DSED) is a childhood-onset disorder that falls under the umbrella of Reactive Attachment Disorder (RAD). RAD is a complex disorder that affects a child’s ability to form healthy attachments and relationships with caregivers. DSED is characterised by children not having the ability to show caution or restraint around strangers or people that they do not know well. This can result in excessive friendliness and a lack of discernment between safe and unsafe individuals. Children with DSED commonly display the following symptoms:

Inappropriate Behaviour with Strangers

Children with DSED often show inappropriate behaviour when interacting with strangers. This may include approaching them without hesitation, hugging them, or chatting animatedly with them. These children often do not register that strangers should be approached with caution, and they are not able to distinguish between safe and unsafe individuals.

Indiscriminate Friendliness

Children with DSED may show an excessive level of friendliness towards strangers, even if these individuals are not immediately responsive to their advances. These children may approach strangers with the assumption that they will be liked and treated kindly regardless of the stranger’s response.

Lack of Stranger Anxiety

Typically, children experience an age-appropriate level of anxiety when interacting with strangers. Children with DSED often display a lack of anxiety or shyness when interacting with unfamiliar people. They may approach strangers with ease, without exhibiting any signs of apprehension or concern.

No Fear of Separation

Most young children experience fear or anxiety around being separated from their parents, especially when in unfamiliar or unknown situations. However, children with DSED do not show concern or anxiety around separation, regardless of the situation. They are often quite content to be with any caregiver or in any environment and do not display distress when a primary caregiver is absent or unresponsive.

Overly-Friendly Behaviour, Even with Dangerous Individuals

Children with DSED do not differentiate between safe individuals and potentially dangerous ones. This can result in these children displaying excessive friendliness with individuals that could potentially cause them harm. Children with DSED may interact with abusive or neglectful caregivers with the same overt friendliness, and without exhibiting any caution or recognition of danger.

Easily Forming Relationships with Strangers

Children with DSED often show a high level of trust and openness around strangers. They may disclose personal information, take physical risks, or willingly accept physical touch, hugs, and other forms of physical contact from strangers or individuals they have just met. They may also form close relationships with strangers, even when these relationships are not appropriate or safe.

Causes of DSED

The cause of DSED is not yet fully understood. However, it is believed that this condition develops as a result of a lack of consistent, supportive, and nurturing relationships in the child’s early life. Children with DSED often have a history of unstable or inconsistent caregiving and may have experienced multiple placements in foster care or adoption.

It is also possible that genetics may play a role in the development of DSED. There may be genetic factors that make some children more susceptible to this condition, particularly when combined with adverse childhood experiences.

Treatment of DSED

The main goal of treatment for DSED is to help the child form healthy, secure, and lasting relationships with caregivers. For young children with this condition, early and consistent intervention is critical in helping them develop the necessary social skills to form healthy attachments. Treatment for DSED often includes the following strategies:

  • Therapeutic Play: Children with DSED may have difficulty expressing their thoughts and feelings. The therapeutic play can help them develop communication and emotional regulation skills, which are essential for forming healthy relationships.
  • Attachment-based Therapy: This type of therapy focuses on developing secure attachment patterns between caregivers and the child. It emphasises the importance of empathic, responsive caregiving to help the child heal from early attachment disruptions.
  • Family Therapy: Family therapy can help parents and other caregivers understand the child’s needs and develop effective strategies to support healthy attachment and development.
  • Training for Caregivers: Caregivers may need training and support to develop the necessary skills to provide sensitive, appropriate, and consistent caregiving to children with DSED.


Disinhibited Social Engagement Disorder is a complex disorder that affects a child’s ability to form healthy attachments and relationships with caregivers. Children with DSED often display excessive friendliness and a lack of discernment between safe and unsafe individuals. Early intervention is critical in helping these children form healthy social and emotional connections. Therapeutic play, attachment-based therapy, family therapy and training for caregivers are all effective strategies in treating this condition. With consistent and supportive care, children with DSED can form meaningful and lasting relationships that will help them thrive and succeed throughout their lives.


FAQ 1: What Are The Symptoms Of Disinhibited Social Engagement Disorder?

Disinhibited Social Engagement Disorder (DSED) is a condition that is usually displayed in children who have experienced severe neglect, abuse, or multiple placements. The most common symptoms of DSED include a lack of inhibition, excessive friendliness towards strangers, an inability to understand social boundaries, and demonstrating overly trusting behaviors towards unfamiliar people.

FAQ 2: How Is Disinhibited Social Engagement Disorder Diagnosed?

A diagnosis of DSED typically involves a thorough examination of the child’s medical history and symptoms by a mental health professional. To diagnose DSED, the clinician will typically look for a pattern of behaviors that indicate the child’s lack of inhibition and ability to interact comfortably with strangers. Additionally, the clinician will usually search for any underlying causes of the child’s condition, such as a history of neglect or abuse.

FAQ 3: What Are The Available Treatments For Disinhibited Social Engagement Disorder?

Treatment options for DSED typically involve a combination of therapy and medication. Play therapy is especially effective, as it helps children learn to develop attachments and trust bonds with their caregivers. Additionally, interventions such as cognitive-behavioral therapy and parent-child interaction therapy may be used to help teach children how to establish healthy interpersonal relationships. Medications such as antidepressants, mood stabilizers, and antipsychotics may be prescribed in more severe cases.


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