Disorders Specifically Associated with Stress: Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Two disorders defined as reaction to early experiences of social neglect are reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Despite sharing a common etiology, these disorders differ from one another with regard to their clinical presentation, course, correlates, and response to enhancement of the child’s caregiving environment. Reactive attachment disorder is characterized by emotionally inhibited and socially unresponsive behaviors. Its features are characteristic of young children who lack a preferred attachment figure, despite having the cognitive capacity to form attachments. Disinhibited social engagement disorder is characterized by lack of reticence with unfamiliar adults and violation of social boundaries reflected in physically or verbally intrusive behaviors. Although signs of reactive attachment disorder typically resolve when children are removed from deprived environments, less clear is whether RAD in early childhood predisposes the child to subsequent interpersonal difficulties even after the disorder is no longer detectable. Signs of disinhibited social engagement disorder, by contrast, sometimes remit following placement of the child in an enhanced caregiving environment but oftentimes do not. There are no known predictors of persistence versus desistance of the disorder following placement in a healthier environment. There is preliminary evidence that signs of DSED in early childhood are associated with decreased competence in early adolescence, even if signs of the disorder are no longer present.