Disinhibited social engagement disorder (DSED) is characterized by socially abnormal actions including straying from a caregiver, agreeing to travel with a stranger, and engaging in excessively familiar physical activities (such as hugging strangers) with strangers.

The frequency range of symptoms for DSED is found to be between 4% and 11% and its prevalence rate of diagnosis is found to be 8%.

Empirical evidence reveals that children diagnosed with Disinhibited Social Engagement Disorder (DSED) regularly exhibit worse social skills compared to their classmates who are not maltreated and to a control group from a normal household. Consistently, higher levels of peer difficulties have been seen, which might be associated with low self-esteem or a negative self-perception in terms of social acceptance. The results concerning social interaction and communication abilities are found to be inconclusive. Moreover, children diagnosed with Disruptive Social Emotional Dysregulation (DSED) exhibit difficulties in social relationships that go beyond the main symptoms of the disease. However, how much co-existing neurodevelopmental issues contribute to these difficulties is still uncertain. The diagnostic criteria and features of Disinhibited Social Engagement Disorder in light of DSM 5 TR are discussed next:

Diagnostic Criteria

A. A behavioral pattern in which a child proactively seeks and engages with people they don’t know and shows at least two of the following:
1. Fewer or no fears about approaching and talking to people they don’t know.
2. Overly familiar verbal or physical behavior (that is not consistent with nationally sanctioned and with age-appropriate social limits).
3: Less or no checking back with an adult helper after going somewhere, even if it’s somewhere new.
4. Being willing to go off with an adult they don’t know with little or no doubt.
B. The behaviors listed in Criterion A don’t just include acting on impulse (like in attention-deficit/hyperactivity disorder), they also include acting without inhibitions around other people. C. The child has had a trend of extremes of not getting enough care, as shown by at least one of the following:
1. Social neglect or deprivation in the form of long-term not getting basic emotional needs like safety, excitement, and love met by adults who care for them.
2. Changing main providers a lot, which makes it hard to form stable bonds (for example, a lot of changes in foster care).
3. Growing up in strange places that make it hard to form appropriate bonds, like institutions with high child-to-caregiver ratios.
D. It is likely that the care in Criterion C caused the behavior problems in Criterion A (for example, the problems in Criterion A started after the harmful care in Criterion C).
E. The kid is at least 9 months in terms of developmental age.
Specify if:
Persistent: The problem has been going on for more than a year.
Specify current severity:
If a child has all of the signs of disinhibited social engagement disorder and shows them at pretty high levels, then the disorder is considered serious.

Diagnostic Features

• Disinhibited social engagement disorder is characterized by a pattern of behavior that includes acting too familiarly and culturally inappropriately with people they don’t know well.
• This behavior that is too common breaks the social rules of society.
• It is not advisable to diagnose disinhibited social engagement disorder in kids before they are fully developed and able to choose which ties to make.
• The child must have at least 9 months of developmental age for this purpose.