Disinhibited social relationship disorder: symptoms, causes and treatment.

A pattern of behavior that appears in very young children.

It is common to perceive children as very social and not feeling any sense of strangeness in front of other people as something positive. Affable, affectionate and friendly people of whom parents are often proud.

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

What is disinhibited social relationship disorder?

Traditionally, Disinhibited Social Relationship Disorder (DSRD) was considered as part of a broader diagnosis known as Reactive Attachment Disorder of Childhood. However, in the latest update of the DSM-V it is now established as a specific and independent diagnostic label.

This type of psychological disturbance occurs exclusively in childhood and is characterized by a specific behavioral pattern in which the child has no fear or discretion in relation to initiating any kind of contact with unfamiliar adults..

These children present a totally uninhibited behavior in which they feel comfortable talking, initiating physical contact or even leaving with a stranger.

This very particular pattern of behavior appears around the first five years of lifeThe child can only be diagnosed as such between the ages of nine months and five years of age. In addition, these behaviors tend to persist over time regardless of circumstances or changes in the surrounding environment, i.e., they show constancy and are expressed in a wide variety of contexts and situations.

Development throughout childhood

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

Around the age of four years, these types of attachments are maintained. However, attachment-seeking behaviors are replaced by constant demands for attention and indiscriminate displays of affection and affection. and by indiscriminate displays of affection and affection.

By late childhood, the child may have established a number of attachments to specific individuals, although attachment-seeking behaviors tend to be maintained. Disinhibited behaviors with schoolmates or peers are common.

In addition, depending on the context or the reactions of the people around him/her, the child may also develop behavioral disturbances, 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 attachment manifestations, insufficient care, mistreatment, traumatic events, poor or insufficient social relations.

Although they can also appear under other conditions, the highest incidence of this disorder tends to occur in children who have spent the first years of their lives in institutions for children. children who have spent the first years of their lives in institutions for children..

What are the symptoms?

The main symptoms of disinhibited social relationship disorder are of a behavioral nature and they are specified in the way the child relates to others, especially to adults.

The main symptomatology of this condition includes:

• Absence of feelings of fear or dread of strangers.
• Active and uninhibited interaction with any unfamiliar or known adult.
• Excessive verbal behavior and verbal behavior and physical displays of affection that are overly familiarExcessively familiar verbal behavior and physical displays of affection, taking into account social norms and the child's age.
• Tendency not to need to return or turn to parents or caregivers after being in a strange or foreign environment.
• Tendency or willingness to leave with an adult stranger.

What are the causes?

Although a large number of childhood psychological disturbances are usually attributed to some kind of genetic defect, disinhibited social relationship disorder is a condition based on a troubled history of caregiving and social relationships.

However, there are some theories that point to the possibility that certain theories point to the possibility that certain Biological conditions associated with the child's temperament and affective regulation. and affective regulation. According to these theories, functional alterations in specific brain areas such as the amygdala, hippocampus, hypothalamus or prefrontal cortex may lead to changes in the child's behavior and ability to understand what is going on around him/her.

Regardless of whether these theories are true or not, for the time being social neglect and deficits in quality of care have been established as the main causes of the development of disinhibited social relationship disorder.

Contexts of family violence, deficits in basic emotional support, upbringing in unfamiliar contexts such as orphanages, or constant changes in terms of caregivers have been established as the main causes of the development of disinhibited social relationship disorder. constant changes in primary caregivers are the breeding ground for the development of disinhibited social relationship disorder. are the breeding ground for the impossibility of developing a stable attachment and the consequent development of this disorder.

Diagnostic criteria for TRSD

Because children with disinhibited social relationship disorder may appear impulsive or attention impaired, the diagnosis may be confused with Attention Deficit Hyperactivity Disorder.

However, there are a number 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 present the following diagnostic requirements:

Approaching behaviors and active interaction with adult strangers 2.

Two or more of the following criteria are also present:

• Partial or complete absence of distrust Partial or complete absence of distrust of interacting with adults outside the child.
• Overly familiar verbal or physical behavior patterns according to social or cultural norms.
• Lack of caregiver need following exposure to unfamiliar or strange contexts. or strange contexts.
• Partial or complete willingness to leave with a strange adult.

Behaviors in this criterion need not be limited to impulsivity, but should include socially uninhibited behaviors.

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

For example:

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

In addition, it must be inferred that the caregiving factor of the second criterion is responsible for the behaviors of the first item.

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

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

4. The behaviors must persist for more than 12 months.

A criterion to establish the persistence of symptoms.

Is there a treatment?

Treatment of disinhibited social relationship disorder aims not only at modifying the child's behavior, but also that of the parents.. It should not be forgotten that this is an alteation based on social interactions, and therefore it is very important to act not only on the patient, but also on his or her usual social context, in which the relevance of the family stands out.

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

In addition, the health professional should also carry out a psychological treatment with the child that will allow him/her to rebuild and recompose the child's sense of security. This involves implementing "training" programs in new ways of relating to others and establishing consistent criteria for knowing in which situations it is advantageous to make approaches and in which it is not.

Bibliographical 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). Trauma-related disorders and stress factors in the Psychiatric Medical Expert Board of the Spanish Military Health. Sanidad Militar, 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.