Disinhibited Social Engagement Disorder
Disinhibited Social Engagement Disorder
Disinhibited Social Engagement Disorder is an emotional disorder which begins in childhood, it is classed as a Stressor-related disorder in the newest guide to diagnosing mental disorders, the DSM-5. ,  Social neglect during childhood (a lack of adequate care-giving) is a diagnostic requirement. Disinhibited Social Engagement Disorder is similar to Reactive Attachment Disorder but presents with externalizing behavior and disinhibition rather than internalizing and withdrawn behavior with depressive symptoms. :265 The DSM-5 gives the following diagnostic criteria:
DSM-5 Diagnostic CriteriaCode 313.89
- A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
- Reduced or absent reticence in approaching and interacting with unfamiliar adults.
- Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
- Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
- 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:
- Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
- 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 (APA, 2013a)." :265-266
As with childhood psychiatric diagnoses, information from a variety of sources should be considered, including parental report, teacher questionnaires and clinician observation (Follan, 2011). The DSM-IV criteria were altered after criticism that they focused on socially abhorrent behavior rather than reflecting attachment disorder behaviors (Zeanah, 2010).
ICD Diagnostic Criteria
The most recent approved version of the International Classification of Diseases, the diagnostic guide published by the World Health Organization is the ICD-10, published in 1992. The draft ICD-11 criteria for Disinhibited Social Engagement Disorder gives this description:
ICD 11 draftCode 7B25
"Disinhibited social engagement disorder is characterized by grossly abnormal social behaviour, occurring in the context of a history of grossly inadequate child care (e.g., severe neglect, institutional deprivation). The child approaches adults indiscriminately, lacks reticence to approach, will go away with unfamiliar adults, and exhibits overly familiar behaviour towards strangers. Disinhibited social engagement disorder can only be diagnosed in children, and features of the disorder develop within the first 5 years of life. However, the disorder cannot be diagnosed before the age of 1 year (or a mental age of less than 9 months), when the capacity for selective attachments may not be fully developed, or in the context of Autism spectrum disorder."  Last updated December 2014.
Alternative names include Affectionless psychopathy, Institutional syndrome, childhood disinhibited attachment disorder, disinhibited attachment disorder of childhood, institutionalization; disinhibited attachment and disinhibited attachment.
Exclusions: Asperger syndrome, hospitalism in children, hyperkinetic disorders and reactive attachment disorder of childhood.
ICD 10 Diagnostic Criteria - Disinhibited attachment disorder of childhoodCode F94.2
"A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, e.g. diffuse, nonselectively focused attachment behaviour, attention-seeking and indiscriminately friendly behaviour, poorly modulated peer interactions; depending on circumstances there may also be associated emotional or behavioural disturbance."
Alternative names include Affectionless psychopathy and Institutional syndrome.
Exclusions: Asperger syndrome, hospitalism in children, hyperkinetic disorders and reactive attachment disorder of childhood