Criteria for the Diagnosis of Disinhibited Social Engagement Disorder

By Leah S. Robbins, Ph.D.

This article is copyrighted and posted with permission of the author.

 

Disinhibited Social Engagement Disorder occurs when infants or children have not been able to form healthy bonds with at least one caregiver before age 5 and present after 9 months of age. The disorder is considered persistent when symptoms are present for more than 12 months. The disorder is specified as severe when a child exhibits all symptoms of the disorder at relatively high levels. The signs and symptoms listed in the DSM-V are:

• A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries.
3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
• The behaviors are not limited to impulsivity, but include socially disinhibited behavior.

According to the DSM-V criteria, this develops as a direct result of parenting that either did not meet the child’s basic needs such as severely neglectful environments, or not having a stable caregiver to attach to:

• The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by care giving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
• The criteria is differentiated from Attention-deficit/hyperactivity disorder.

Disinhibited Social Engagement Disorder will have a serious impact on the children’s future mental health and relationships throughout their lifetime if they don’t receive treatment.

References

Disinhibited Social Engagement Disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association, 2013.