Types of Extreme Attachment Disorders

little boy alone, sitting on stairs outdoors. Kid having sad feeling. Family problems with adoption kids.

As the world clarifies the many ways trauma can be manifested, those of us who are students of trauma need to add DSED to the list of categories. This information clarified for me how some children behave having what seems like normal behaviors of being very warm and affectionate but that actually can be symptoms of an attachment disorder.

DSED him stands for Disinhibited Social Engagement Disorder. It is categorized as one of the many attachment disorders children can experience and is related to Reactive Attachment Disorder or RAD. [It is important to note that these manifestations of experiencing extreme levels of insecure attachment are relatively rare and most often associated with children who have been adopted. You may have heard stories of children from countries like Russia who begin life in orphanages that are ill-equipped to care for them emotionally who are then adopted by Americans. Within a short period of time their adoptive parents realize these children are extremely difficult to parent because they are unable to attach to their new parents.]

In an article from Parents Magazine, the author, Kate Bayless, provides the following definition: Reactive attachment disorder and the related disinhibited social engagement disorder are rare but serious disorders that can afflict children who have failed to form normal, developmentally appropriate attachments to a caregiver. RAD causes children to become emotionally withdrawn toward adult caregivers, and children with DSED demonstrate a lack of inhibition when it comes to interacting with unfamiliar adults.

Sad school girl sitting on bench in park, lost kid, waiting for parents

Bayless shares that these two conditions are included in The Diagnostic and Statistical Manual of Mental Disorders (DSM) and describe children with RAD as demonstrating “a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers” and “a persistent social and emotional disturbance.” This manifests itself “as social withdrawal and very shallow emotional responses.” This means that when a RAD child is distressed, they do not return to their caregiver and often react very negatively when that caregiver offers warmth and comfort. 

The second diagnosis shared in this article is one that I think many of us have not heard of before. The author shares that the DSM describes DSED as “a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults in an impulsive, incautious, and overfamiliar way.” Children with DSED “approach unfamiliar adults without hesitation and may seek comfort from perfect strangers, instead of turning to their new attachment figure for comfort.”  

It’s helpful to appreciate the uniqueness of this diagnosis for children who respond to complete strangers without the kind of hesitation we expect from children as a self-protective behavior. These children can be an easy target for predators because they lack the filters that would protect them from instantly trusting and connecting. The ways they attach to others does not lead to safe and secure relationships built on trust developed over time. Rather their connections with others are superficial and lacking in the depth of meaningful relationships that are reserved for those in their inter-network of family and close friends.

Sad, depressed, unhappy schoolgirl feeling lonely and hopeless sitting on stairs with dark light.

Without supporting data, I wonder if there are degrees of this condition and some of the adult relationships that involve people who instantly connect with others without exploring how safe and trustworthy others are. These relationships would seem doomed to failure because they would be lacking in the depth and sincerity of healthy relationships.

I think it is important to put diagnoses like RAD and DSED on continuums in terms of their severity. Interventions and therapies that are provided by those well-educated in the treatment of children with these attachment disorders have the potential to help children experience healthier forms of attachment. The mind and brain of children, as well as adults, is amazing with great potential for healing and recovery from trauma, including the traumas associated with highly insecure attachment.

Invitation for Reflections:

  1. Have you ever experienced or observed a child with either Reactive Attachment Disorder or Disinhibited Social Engagement Disorder? Were you aware of the diagnosis or does this information now clarify for you what that child might be experiencing?
  2. Specifically, how does this diagnosis of DSED help you better understand how a child with severe attachment disorder might behave when meeting new people?
  3. How might this information help you relate to parents who have children with either one of these disorders?

Diane Wagenhals, Director, Lakeside Global Institute