Disinhibited Social Engagement Disorder

Disinhibited social engagement disorder is a clinical diagnosis describing a pattern in young children, arising from a documented history of grossly insufficient early caregiving, of overly familiar and culturally inappropriate behavior toward unfamiliar adults, including a striking lack of normal reticence around strangers, a willingness to approach and go off with unfamiliar adults with little or no hesitation, and reduced or absent checking back with a caregiver for reassurance in unfamiliar situations, behavior that would ordinarily be considered a significant safety concern rather than simple friendliness. The diagnosis emerged from the same body of attachment research founded by the psychiatrist John Bowlby and the empirical work of Mary Ainsworth that also produced reactive attachment disorder, and it was formally separated out as its own distinct diagnosis in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, published in 2013, after earlier editions had combined the inhibited and disinhibited presentations together under a single reactive attachment disorder diagnosis with two subtypes. Like reactive attachment disorder, the diagnosis requires a documented history of pathogenic care, such as severe neglect, frequent changes of primary caregiver, or prolonged institutional rearing, but researchers have found that unlike the inhibited presentation, the disinhibited pattern can persist even after a child is subsequently placed in a stable, nurturing caregiving environment, suggesting that early severe caregiving disruption may leave a more durable imprint on the disinhibited form of the condition than on its withdrawn counterpart.