If left untreated, disinhibited social engagement disorder (DSED) can cause behavioral problems in adolescence and possibly increase the risk for substance abuse.

Disinhibited social engagement disorder (DSED) is a childhood disorder characterized by a lack of fear of strangers and overly friendly behavior that violates societal or cultural norms. Children with this condition may hug or try to receive comfort from an unknown individual without showing preference to their parent or caregiver.

This disorder is seen most often in children who have faced severe cases of neglect, inadequate care and childhood trauma. Children who are in institutions such as orphanages, or who have a high turnover of caregivers, such as in foster care, appear to be at a higher risk for the condition. 

DSED is usually diagnosed after the age of 9 months, but symptoms may persist into later childhood. Additional co-occurring problems that can be seen with this disorder include behavioral problems and other disorders related to childhood trauma. 

The relationship between DSED and substance use is complex. Therefore, it is important to explore how a caregiver’s substance use can increase the risk of DSED, and how having DSED can impact a person’s risk of developing substance use disorders

Effects of Parental Drug Use on DSED in Children

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), DSED is an attachment disorder that stems from neglect and inadequate care, especially in the form of necessary social attachments. The relationships an infant forms with its caregivers are essential for healthy emotional development. If the parent is absent or neglectful, or if caregivers are changed frequently and there is little opportunity for meaningful attachment to occur, the risk for DSED increases.

Research confirms that having a mother with a substance use disorder can increase a child’s chances of developing DSED. This relationship between maternal addiction and DSED likely occurs because the use of drugs can inhibit healthy attachments from forming and promote chronic situations of neglect. Substance use can limit a caregiver’s availability, sensitivity and ability to respond to a child’s emotional, social and physical needs. Therefore, parental drug use decreases the opportunity for attachment to occur and increases the risk of neglect.

Risk Factors for Disinhibited Social Engagement Disorder and Addiction

While it’s clear that a caregiver’s addiction can increase a child’s risk of developing DSED, research concerning the relationship between DSED and a child’s likelihood of developing an addiction later in life is limited. What is known is that DSED is a disorder seen in childhood through adolescence, and risk factors for the development of DSED are rooted in inadequate caregiving. Other mental health disorders, including substance use disorders, can also result from neglectful caregiving during these formative years of life. 

According to the National Institute on Drug Abuse, people are more vulnerable to drug use in their youth, and drug use typically starts during adolescence. Some of the risk factors for substance use disorders specifically involve childhood stress and the inability to appropriately adapt to environmental challenges. Attachments disorders can make it hard for adolescents to build the resilience and coping skills needed to deal with these difficulties.

Are Children with DSED Prone to Substance Abuse?

Children with DSED can go on to develop behavioral problems such as hyperactivity, aggression and difficulty establishing meaningful relationships. Studies have shown that conduct and behavioral disorders in childhood are a significant predictor of substance use disorders in adolescents.

Other risk factors that may make a child with DSED prone to substance use involve parents or caregivers. If parents display signs of psychological deficits, mental health conditions or substance use disorders while caring for their child, the risk of their child developing a substance use disorder is significantly higher.

Treating DSED and Co-Occurring Substance Use Disorders

Treating DSED is vital for the physical, emotional and social well-being of a child. Left unaddressed, DSED can put a child at risk of harm from unknown individuals and difficulty forming healthy relationships later in life.

Treatment for DSED in children must first involve the introduction of a safe environment with a stable caregiver. Symptoms of DSED that persist can be treated through behavioral management techniques, art therapy and play therapy. Addressing DSED in early childhood can help reduce the risk of substance use disorders in later adolescence. 

If you or someone you know has signs of DSED and is struggling with a substance use disorder, contact The Recovery Village.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Dr. Karen Vieira, PhD
Dr. Karen Vieira has a PhD in Biomedical Sciences from the University of Florida College of Medicine Department of Biochemistry and Molecular Biology. Read more

Lehmann, S., Breivik, K., Heiervang, E.R., Havik, T., Havik, O.E. “Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in School-Aged Foster Children–A Confirmatory Approach to Dimensional Measures“>Reactive[…]onal Measures.” Journal of Abnormal Child Psychology, July 2, 2015. Accessed May 12, 2019.

Parolin, M., Simonelli, A. “Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions“>Attachme[…]Interventions.” Frontiers in Psychiatry, August 30, 2016. Accessed May 12, 2019.

National Institute on Drug Abuse. “Part 1: The Connection Between Substance Use Disorders and Mental Illness.“>Part 1: […]ntal Illness.” February 2018. Accessed May 12, 2019.

Thatcher, D.L., Clark, D.B. “Adolescents at Risk for Substance Use Disorders.” Alcohol Research Current Reviews, 2008. Accessed May 12, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.