Related Disorders
The Pennsylvania Child Welfare Resource Center 303: Understanding Reactive Attachment Disorder
Handout #7, Page 1 of 3
Disinhibited Social Engagement Disorder
A. A pattern of behavior in which the child actively approaches and
interacts with unfamiliar adults by exhibiting at least 2 of the following:
• Reduced or absent reticence to approach and interact with unfamiliar
adults
• Overly familiar behavior (verbal or physical violation of culturally
sanctioned social boundaries)
• Diminished or absent checking back with adult caregiver after
venturing away, even in unfamiliar settings
• Willingness to go off with an unfamiliar adult with minimal or no
hesitation
B. The behavior in A. is not limited to impulsivity as in ADHD but includes
socially disinhibited behavior
C. Child has experienced a pattern of extremes of insufficient care
(pathogenic care) as evidenced by at least one of the following:
• Persistent failure to meet the child’s basic emotional needs for
comfort, stimulation, and affection (i.e., neglect)
• Repeated changes of primary caregiver that limit opportunities to
form stable attachments (e.g., frequent changes in foster care)
• Rearing in unusual settings that limit opportunities to form selective
attachments (e.g., institutions with high child to caregiver ratios)
D. The care in Criterion C is presumed to be responsible for the disturbed
behavior in Criterion A
E. The child has a developmental age of at least 9 months
(Source: DSM-5)
Posttraumatic Stress Disorder
Posttraumatic stress disorder symptoms are generally grouped into three
types: intrusive memories, avoidance, and alterations in cognitions and
mood.
Symptoms of avoidance and emotional numbing may include (one or both):
• Trying to avoid memories, thoughts, or feelings related to event(s)
• Avoidance of external reminders (people, places, conversations,
activities, objects, situations) associated with the event(s)
