A girl without stranger danger
Disinhibited social engagement disorder (DSED) is a rare disorder of childhood affecting a small number of children who experience extreme neglect or abuse in early childhood such as institutional rearing. The characteristic feature of DSED is disinhibited, socially indiscriminate social behavior that begins prior to the age of five years. Children with DSED exhibit reduced reticence in approaching unfamiliar adults, overly familiar behavior, lack of checking back with their caregiver after venturing away, and willingness to leave with an unfamiliar adult. The assessment includes a psychiatric evaluation and observation of how the child interacts with their caregiver and unfamiliar adults. There are no medication treatments for DSED; however, psychiatric comorbidities may benefit from psychopharmacology. The cornerstone of treatment for DSED is providing the child with an emotionally available attachment figure. It may be necessary to limit the child’s exposure to strangers for several months to reduce socially indiscriminate behaviors.