What Is Disinhibited Social Engagement Disorder (DSED)?

Written by WebMD Editorial Contributors
Medically Reviewed by Jabeen Begum, MD on July 24, 2025
6 min read

‌Disinhibited social engagement disorder (DSED) is an attachment disorder that happens in young children, causing them to easily approach and talk to strangers. They are also comfortable seeking comfort from unfamiliar people.

Here is all you need to know about DSED, from causes to treatments, and more.

‌Attachment disorders are common in children who are abandoned or experience trauma at a young age, such as having negative experiences or not getting enough care from their parents or guardians. This can prevent a child from forming meaningful or close bonds with people. 

Attachment disorders can be of two types based on the affected child's behavior:

Reactive attachment disorder (RAD). Children with RAD find it difficult to have an emotional attachment to their parents or guardians and other people. These children fear interactions with others and have trouble managing or expressing their feelings.‌

DSED. Unlike children with RAD, those with DSED appear to be extremely friendly and outgoing. They exhibit socially disinhibited behavior. This means they are impulsive and can easily talk to unknown people and random strangers. However, they may have trouble forming stable or meaningful bonds with others. 

Children with attachment disorders require proper treatment and care. If left untreated, attachment disorders can result in mental disorders at later stages in life.

‌DSED can occur in children for the following reasons:‌

  • Absence of a caregiver or parent in the first few years of childhood
  • Lack of love, care, or emotional support while growing up
  • Neglect or abandonment by caregivers
  • Lack of a constant caregiver or repeated changing of caregivers
  • Negative experiences such as childhood trauma or sexual abuse
  • Growing up in foster care or orphanages

‌These factors can make it difficult for children to connect more deeply with other people. It can also make them behave in a seemingly carefree or overly friendly manner.

‌Children as young as 9 months old can develop signs of DSED. If a child shows even two of the following symptoms, they may have DSED:‌

  • They are not shy or scared but excited when they meet strangers or unknown people.
  • ‌They are extremely friendly, chatty, or physically close with strangers.
  • ‌They behave in a socially unacceptable manner according to social norms.
  • ‌They leave a safe space and go away with a stranger.
  • ‌They don't ask their caregiver or hesitate before going away with a stranger.
  • ‌They are impulsive and socially disinhibited.
  • ‌They have not been cared for adequately or have a history of trauma or abuse.

Children with DSED have severe difficulty in forming warm, affectionate, or close bonds with other children or adults. If DSED goes undiagnosed, it can cause the following issues later in life:‌

Certain care settings and conditions can put a child at risk of developing DSED. These include:

  • Being abandoned, neglected, restricted, or deprived
  • Many changes in primary caregivers, which don't allow for making connections
  • Being raised in different centers, such as orphanages or foster care, which may not allow for attachments

DSED can affect your child's ability to form healthy relationships with other children and adults, and their ability to be socially aware. Children with DSED are also at risk of peer conflict and mistreatment.

Remember that not all children who are friendly with strangers have DSED. Your child may be naturally outgoing and talkative with others. However, they will still seek your approval for safety at all times. 

A child with DSED is usually detached and doesn't seek their caregiver's approval. If your child is not at all afraid of leaving with strangers, you may want to take them to a doctor. ‌

The Diagnostic and Statistical Manual (DSM)-5 criteria for disinhibited social engagement disorder include repeated behavior of a child going up to and interacting with an adult stranger, and also showing at least two of the following:

  • reduced or no resistance to approach an unfamiliar adult
  • less or no resistance to go off with an unfamiliar adult
  • reduced or absent need for reassurance from caregiver when stepping away, even in settings that are new
  • greater physical or verbal behavior than typical within age range 

The criteria for DSED diagnosis also include evidence of extreme neglect or lack of care, shown by at least one of the following:

  • repeated lack of emotional needs being met
  • consistent changes in primary caregivers
  • upbringing in abnormal settings that limit ability for attachment

If these conditions are present for more than 12 months, the DSED is considered to be persistent. If symptoms are continuously seen at a higher level, the condition is considered to be severe.

A pediatrician or therapist can diagnose DSED. They observe your child and conduct mental health tests. This helps them understand your child’s history, emotions, mental state, and social behavior.

At what age is DSED diagnosed?

Children with DSED usually show symptoms of the condition by at least 9 months of age.

‌If diagnosed with DSED, your child will be given all the care they need through a specific treatment plan. This will help your child overcome negative experiences and grow up to form meaningful relationships with you and others.

‌DSED treatment involves the entire family so that the child can bond with their caregivers. Treatment can include the following therapies, depending on the child's age:‌

  1. Talk therapy 
  2. Play therapy with toys and games
  3. Art therapy

The therapist also helps parents interact with their children to care for and support them, making their bond stronger. This can help children feel stable, safe, and loved so that they recover sooner.

‌DSED can be a serious problem if it remains untreated. Although therapy can take time, it is the most effective treatment for DSED. If you are a caregiver, ensure that you give your child all the love, care, and emotional support they need.

Being present for your child, talking with them, and setting clear rules to keep them safe are important, too. Some tips include:

  • Being a source of comfort and structure
  • Teaching normal social behaviors and boundaries
  • Taking steps to ensure their safety, such as teaching them their telephone number and address, or dressing them in bright clothes
  • Engaging in stress-relieving activities for yourself

Disinhibited social engagement disorder is an attachment disorder where children feel unusually comfortable approaching and interacting with strangers. Symptoms usually appear by the age of 9 months. Treatment options include counseling, certain therapies, and medications for co-occurring conditions such as ADHD.

What is the difference between DSED and RAD?

While both conditions are attachment disorders, children with DSED are very affectionate with others, and those with RAD have trouble forming an emotional attachment with others and appear withdrawn.

What does DSED look like in adults?

Symptoms of DSED that continue into adulthood include hyperactivity and lack of focus.

What medications are used for DSED?

There aren't specific medications for DSED, but your doctor may prescribe certain medications for co-occurring conditions. These may include stimulants for ADHD or SSRIs for mood and anxiety disorders.