Robert is a school -aged child who is eager to get familiar with strangers. He asks strangers many personal questions and is happy to join them in various activities. What kind of disorder most likely characterizes Robert?
The correct answer and explanation is:
Correct Answer: Disinhibited Social Engagement Disorder (DSED)
Explanation:
Robert’s behavior — being overly familiar with strangers, asking many personal questions, and willingly joining unknown individuals in various activities — most closely aligns with Disinhibited Social Engagement Disorder (DSED), a condition categorized under trauma- and stressor-related disorders in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).
DSED typically develops in children who have experienced severe social neglect or deprivation, such as those raised in institutions or in environments where emotional needs were unmet. The hallmark feature of this disorder is a pattern of behavior that is culturally inappropriate and overly familiar with unfamiliar adults, which can include:
- Lack of hesitation in approaching or interacting with strangers
- Reduced or absent checking back with caregivers after venturing away
- Willingness to go off with unfamiliar adults with minimal or no hesitation
This disorder differs from normal friendly behavior in children because it involves a lack of appropriate social boundaries and poses safety risks, such as wandering off with strangers without understanding potential danger. The behavior is not due to impulsivity (as in ADHD), nor is it explained by developmental delays like autism spectrum disorder.
In Robert’s case, his eagerness to interact with strangers and lack of social restraint suggest an attachment disorder rooted in early adverse caregiving experiences. For a diagnosis of DSED, a history of insufficient care, such as frequent changes in caregivers or neglect, must be present. These conditions impair a child’s ability to form stable attachments, leading to indiscriminate sociability.
Treatment for DSED typically involves psychotherapy, consistent caregiving, and creating a stable and nurturing environment. Early intervention is crucial, as persistent symptoms can affect a child’s safety, relationships, and emotional development into adolescence and adulthood.