Disinhibited Social Engagement Disorder 269
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Cri-
terion A (e.g., the disturbances in Criterion A began following the pathogenic care in
Criterion C).
E. The child has a developmental age of at least 9 months.
Specify if:
Persistent:  The disorder has been present for more than 12 months.
Specify current severity:
Disinhibited social engagement disorder is specified as severe  when the child exhibits
all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Diagnostic Features
The essential feature of disinhibited social en gagement disorder is a pattern of behavior
that involves culturally inappropriate, overl y familiar behavior with relative strangers
(Criterion A). This overly familiar behavior violat es the social boundaries of the culture. A
diagnosis of disinhibited social engagement d isorder should not be made before children
are developmentally able to form selective attachments. For this reason, the child must
have a developmental age of at least 9 months.
Associated Features Supporting Diagnosis
Because of the shared etiological association with social neglect, disinhibited social en-
gagement disorder may co-occu r with developmental delays, especially cognitive and lan-
guage delays, stereotypies, and other signs of severe neglect, such as malnutrition or poor
care. However, signs of the disorder often per sist even after these other signs of neglect are
no longer present. Therefore, it is not uncomm on for children with the disorder to present
with no current signs of neglect. Moreover , the condition can present in children who
show no signs of disordered attachment. Th us, disinhibited social engagement disorder
may be seen in children with a history of neglect who lack attach ments or whose attach-
ments to their caregivers range from disturbed to secure. 
Prevalence