Disinhibited social engagement disorder

Disinhibited social involvement disorder, found in children, is a type of attachment disorder in which children relate easily and get along with strangers. They do not form deep and meaningful relationships, and they have difficulty forming loving relationships with others.

 

Understanding Attachment Disorder:

The term attachment was first used by Bowlby to mean an emotional bond between a child and a caregiver. Ainsworth divided this attachment into secure attachment and insecure attachment, and further divided insecure attachment into ambivalent-insecure attachment and avoidant-insecure attachment. Afterward, the disorganized-insecure attachment style was added by Main and Solomon. The secure attachment between the caregiver and the child enables the child to have a positive bond with a stranger and provides stability to the exploration activity toward a new place. On the other hand, attachment disorder is common in children who are abandoned by trauma experienced at a young age, such as negative experiences with parents or caregivers, or insufficient care, and it particularly causes difficulties in forming meaningful bonds with people.

Types of attachment disorders that occur based on insecure attachment include reactive attachment disorder and disinhibited social engagement disorder described here. Children with reactive attachment disorder have a negative perception of forming emotional attachment relationships with others due to insecure attachment with their parents or caregivers. They are also afraid of interacting with people and have difficulty managing and expressing their emotions. On the other hand, in children with disinhibited social engagement disorder, the symptoms of insecure attachment appear opposite to those of reactive attachment disorder. In other words, they are very friendly and outgoing towards strangers and exhibit socially uninhibited behaviors. They have the characteristic of not feeling anxious in contact with people independently without an attachment reaction to the caregiver. Unfortunately, however, these traits make it difficult for them to form stable relationships with others.

 

Causes of Disinhibited Social Engagement Disorder:

Disinhibited Social Engagement disorder may occur for the following reasons:

• Parental death or absence of a caregiver or parent during the early years of childhood
• Lack of love, care, or emotional support while growing up
• Caregiver's neglect
• Environments in which there is a persistent lack of caregivers or repeated changes in caregivers
• Negative experiences, such as childhood trauma or sexual abuse
• Growing up in an orphanage
• Growing up with a caregiver or parent with a history of substance abuse

These factors can make it difficult for children to develop deeper relationships with other people, and they can even make them behave in seemingly calm or overly friendly ways.

 

Symptoms:

Infants younger than 9 months of age may also show signs of Disinhibited Social Engagement Disorder. The disorder should be suspected if children exhibit any of the following symptoms:

• Children get excited when they meet strangers without being shy or intimidated.
• They are very friendly, talkative, or physically close to strangers.
• Acting in a socially unacceptable social norm or manner.
• Leaving a safe space with strangers.
• They do not hesitate to leave with strangers without asking their guardians.
• Impulsive and not socially restrained.
• They have not been adequately cared for or have a history of trauma or abuse.

Children with this disorder have serious difficulties in forming warm, loving relationships with other children and adults.

 

If this disorder is not treated, it is often linked to the following problems later.

• Personality disorders such as borderline personality disorder
• Behavioral disorders such as attention deficit hyperactivity disorder (ADHD)
• Substance Addiction and Substance Abuse

 

Diagnosis: 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:

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 an adult caregiver after venturing away, even

in unfamiliar settings.

4. Willingness to go off with an unfamiliar adult with minimal 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 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 caregiving 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).

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 9 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 the child exhibits

all symptoms of the disorder, with each symptom manifesting at relatively high levels.

 

Treatment:

Treatment of this disorder focuses on helping children overcome the negative experiences of infancy and childhood and grow to form meaningful relationships with caregivers and others. Therefore, consistent care by a stable caregiver is important for the treatment of this disorder, and it is important for the whole family to participate so that children can bond with their caregivers.

• Narrative therapy
• Play therapy
• Art therapy
• Sand Play Therapy
• Parenting training
• Family therapy

Therapists help and support parents or caregivers to interact with and strengthen relationships with their children or children, thereby helping children to feel secure, safe, and loved and to recover faster.