Disinhibited social relationship disorder: what is it?

It is usually common to perceive very social children who do not feel any sense of strangeness in front of other people as something positive. Friendly, affectionate and friendly people that parents are usually proud of.

Although these behaviors do not have to be a problem, when they are expressed in an excessive manner They may be a reflection or manifestation of disinhibited social relationship disorder., which is typical of the childhood stage and which we will talk about throughout this article.

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What is disinhibited social relationship disorder?

Traditionally, disinhibited social relationship disorder (DSRD) was considered part of a broader diagnosis known as Reactive Attachment Disorder of Childhood. However, in the latest update of the DSM-V it is already established as a specific and independent diagnostic label.

This type of psychological alteration occurs exclusively in childhood and is characterized by presenting a specific pattern of behavior in which

The boy or girl does not present any type of fear or discretion in relation to initiating any type of contact with unknown adults.

These children present a totally uninhibited behavior in which they feel comfortable talking, initiating physical contact or even leaving with a person who is foreign or strange to them.

This very particular pattern of behavior appears around the first five years of life, so it can only be diagnosed as such between nine months and five years of age of the child. Furthermore, these behaviors tend to persist over time regardless of circumstances or changes in the environment that surrounds them, that is, they show constancy and are expressed in a great variety of contexts and situations.

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Development throughout childhood

At the moment in which the social relationship disorder is consolidated, the boy or girl manifests a tendency to present attachment-seeking behaviors, as well as persistent behaviors that reveal a non-attachment selective. That is to say, The minor is capable of maintaining attachment bonds with any person.

Around the age of four, these types of connections are maintained. However, Attachment-seeking behaviors are replaced by constant demands for attention and for indiscriminate expressions of affection and affection.

By the last stage of childhood, it is possible that the child has established a series of bonds with certain specific people, although affection-demanding behaviors tend to be maintained. Uninhibited behavior with schoolmates or peers is common.

Furthermore, depending on the context or the reactions of the people around him, The child may also develop behavioral alterations and emotional changes..

This disorder has been observed more or less commonly in children whose parents or caregivers show frequent changes in regarding the manifestations of attachment, insufficient care, abuse, traumatic events, poor social relationships or insufficient.

Although they can also appear under other conditions, the highest incidence of this alteration usually occurs in boys and girls who have spent the first years of their lives in children's institutions.

What symptoms does it present?

The main symptoms of disinhibited social relationship disorder are behavioral in nature and They take shape in the way the child relates to others, especially with Adults.

The main symptoms of this condition include:

• Absence of feelings of fear or fear towards strangers.
• Active and uninhibited interaction with any unfamiliar or known adult.
• verbal behavior and overly familiar displays of physical affection, taking into account social norms and the age of the child.
• Tendency to not need to return or turn to parents or caregivers after staying in a strange or alien environment.
• Tendency or willingness to leave with a strange adult.

What are the causes?

Although a large number of psychological alterations typical of childhood are usually attributed to some type of defect Genetically, disinhibited social relationship disorder is a condition that is based on a conflictive history of caregiving and relationships. social.

However, there are certain theories that point towards the possibility that certain biological conditions associated with the temperament of the minor and affective regulation. According to these theories, functional alterations in some specific brain areas such as amygdala, he hippocampus, the hypothalamus or the prefrontal cortex, can lead to changes in the child's behavior and ability to understand what is happening around her.

Regardless of whether these theories are true or not, social negligence and the Deficits in the quality of care as the main causes of the development of social relationship disorder uninhibited

The contexts of family violence, the deficit of basic emotional assistance, education in non-family contexts such as orphanages or constant changes in primary caregivers They are the breeding ground for the impossibility of developing a stable attachment and the consequent development of this disorder.

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TRSD diagnostic criteria

Because children with disinhibited social interaction disorder may appear impulsive or have attention problems, the diagnosis may be confused with that of Attention deficit disorder and hyperactivity.

However, there are a series of diagnostic criteria that allow the correct detection of this syndrome. In the case of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the child must meet the following diagnostic requirements:

1. Approach behaviors and active interaction with strange adults

Two or more of the following criteria are also presented:

• Partial or complete absence of distrust to interact with adults other than the child.
• Patterns of verbal or physical behavior that are overly familiar according to social or cultural norms.
• Lack of caregiver need after exposure to unfamiliar contexts or strangers.
• Partial or complete willingness to leave with a strange adult.

Behaviors in this criterion do not have to be limited to impulsivity, but must include socially disinhibited behaviors.

2. The minor has been involved in situations or contexts of deficient care

For example:

• Deficit in meeting basic emotional needs.
• Negligence situations.
• Constant changes in custody or primary caregivers.
• Education in unusual contexts such as institutions with a large number of children per caregiver.

Furthermore, it must be deduced that the care factor of the second criterion is responsible for the behaviors of the first point.

3. The child's age must be between 9 months and 5 years

This criterion serves to delimit the age range in which this mental alteration is considered to have its own characteristics.

4. The behaviors must continue for more than 12 months

A criterion to establish the persistence of symptoms.

Is there a treatment?

Treatment of disinhibited social relationship disorder Its objective is not only to modify the behavior of the child, but also that of the parents.. We must not forget that this is an alteration based on social interactions, and therefore it is very important act not only on the patient, but also in their usual social context, in which the relevance of family.

In the case of parents or caregivers, actions must be carried out on certain aspects of the relationship with the child. Work on the transmission of security, the permanence of the attachment figure and sensitivity or emotional availability They are the three pillars to begin to perceive changes in the child.

In addition, the health professional must also carry out psychological treatment with the child that allows him or her to rebuild and restore his or her sense of security. This involves implementing "training" programs in new ways of relating to others and of establish consistent criteria to know in which situations it is advantageous to make approaches and in which it is not it is.

Bibliographic references:

• American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Morales Rodríguez, P.P., Medina Amor, J.L., Gutiérrez Ortega, C., Abejaro de Castro, L.F., Hijazo Vicente, L.F., & Losantos Pascual, R.J.. (2016). Disorders related to trauma and stress factors in the Psychiatric Expert Medical Board of the Spanish Military Health. Military Health, 72(2), 116-124.
• Zeanah C.H. (2000). Disturbances of attachment in young children adopted from institutions. J Dev Behav Pediatr. 21 (3): pp. 230 - 36.