RAD vs. DSED: DSM-5 Changes Through a Humanistic Lens
This paper examines the DSM-5 decision to reclassify the disinhibited subtype of Reactive Attachment Disorder (RAD) as a distinct condition—Disinhibited Social Engagement Disorder (DSED)—arguing that the separation is both clinically and theoretically justified. Drawing on a review of recent literature and the humanistic psychological tradition, the paper traces the intellectual roots of humanistic psychology from Freud and Jung through Adler to Erikson. It then applies Erikson's stages of psychosocial development to explain how RAD and DSED emerge from different developmental conflicts and caregiver interactions. The paper concludes that because the two disorders differ in etiology, presentation, and developmental pathway, classifying them as separate diagnoses rather than subtypes of a single disorder represents a meaningful and defensible advance in psychiatric nosology.
- The DSM-5 Change: RAD and DSED Diagnostic Criteria: DSM-5 diagnostic criteria for RAD and DSED
- Literature Review: Research on prevalence, comorbidity, and adolescent diagnosis
- The Humanistic Approach: From Freud to Adler: Historical roots of humanistic psychology
- RAD and DSED Viewed Through the Stages of Development: Erikson's stages applied to RAD and DSED onset
- Conclusion: Justification for DSM-5 separation of RAD and DSED
✍️ How to write this paper — guide, tools & examples ▾
What makes this paper effective
- The paper anchors a clinical classification debate (DSM-5 nosology) in a coherent theoretical framework—Eriksonian humanistic psychology—giving the argument both empirical and conceptual support.
- It moves logically from diagnostic criteria, through a literature review, to historical psychological theory, and finally to a stage-by-stage developmental analysis, creating a well-scaffolded argument.
- The comparison of Freud, Jung, and Adler efficiently establishes the intellectual lineage of humanistic psychology before applying it to the specific clinical question, demonstrating disciplinary depth.
Key academic technique demonstrated
The paper exemplifies theoretical application: it takes an established developmental model (Erikson's eight stages) and applies it systematically to two clinical diagnoses to explain why their separation in the DSM-5 is warranted. This technique—using existing theory to illuminate a real-world clinical or policy question—is a hallmark of graduate-level psychology writing and shows how theoretical frameworks generate practical insights.
Structure breakdown
The paper opens by framing the DSM-4 to DSM-5 reclassification as the central question, then presents the diagnostic criteria for both disorders. A literature review surveys prevalence, comorbidity, and adolescent presentations. The theoretical section traces humanistic psychology from Freud through Jung to Adler and Erikson. The analysis section maps each of Erikson's early developmental stages onto the divergent pathways that produce RAD versus DSED. The conclusion synthesizes the clinical and theoretical evidence to affirm the DSM-5 separation.
The DSM-5 Change: RAD and DSED Diagnostic Criteria
The DSM-5 made many changes to its classification of disorders and diagnostic criteria from the DSM-IV. One of those changes was reclassifying one subtype of Reactive Attachment Disorder (RAD) as Disinhibited Social Engagement Disorder (DSED). Was the DSM-5 correct to do so? In the DSM-IV, RAD was defined in one of two ways—as an inhibited type of selective attachment to caregivers or as a disinhibited type of selective attachment (American Psychiatric Association, 2000). In the DSM-5, the two ways of defining RAD were altered. No longer is RAD viewed as a disorder with two subtypes; instead, it has been separated into two distinct disorders. In the DSM-5, RAD as an inhibited type of selective attachment remains; RAD as a disinhibited type of selective attachment is gone and is now characterized as DSED. This paper discusses this alteration and explains it from the humanistic perspective, tracing that perspective to its historical origins. It also shows why it makes sense that DSED should be separated from RAD in the DSM-5 from a humanistic tradition of psychological assessment.
In the DSM-5, RAD is diagnosed in children who are 9 months or older but under the age of 5. They must meet the criteria of failing to develop appropriate attachments to caregivers and failing to respond in an expected or appropriate way to comfort provided by caregivers. Children with RAD must also display at least two of the following characteristics: little to no social or emotional responsiveness to other people; little to no positive affect; and episodes of unexplainable irritation, sadness, fear, or anxiety that become apparent even when there is no threat from an adult care provider. At the same time, there must be an evident pattern of neglect, inadequate stimulation, or lack of affection from a caregiver; repeated rotation among care providers that prevents stable attachments from forming; or raising of the child in an environment that is unusual and prevents selective attachments from developing. Some examples of situations in which RAD can occur include a foster child who is frequently moved from one caregiver to another, and institutionalized care where there is no opportunity for the child to develop an attachment. Delays in cognitive and behavioral development often co-exist with RAD. Malnutrition and depression are also common co-occurring symptoms.
In the DSM-5, DSED is diagnosed in children who show little to no reticence in engaging adults who are unknown to them, or who act overly familiar with unfamiliar adults and demonstrate a willingness to wander away from caregivers without checking back with them—even to the point of going off with unfamiliar adults without hesitation. This kind of behavior should not be associated with impulsivity but rather should represent a consistent pattern of socially disinhibited behavior. The same pattern of neglect in terms of proper care must also be evident, as with cases of RAD. Children with DSED tend to have shallow relationships with peers and multiple conflicts with peers (American Psychiatric Association, 2013). However, DSED has not been identified in individuals who have experienced neglect from caregivers past the age of 2—and that is the main difference between it and RAD (Gleeson et al., 2011).
References
Allen, B. (2018). Misperceptions of reactive attachment disorder persist: Poor methods and unsupported conclusions. Research in Developmental Disabilities, 77, 24–29.
Allen, B., & Schuengel, C. (2020). Attachment disorders diagnosed by community practitioners: A replication and extension. Child and Adolescent Mental Health, 25(1), 4–10.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Arlington, VA: American Psychiatric Publishing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Darling-Fisher, C. S. (2019). Application of the modified Erikson psychosocial stage inventory: 25 years in review. Western Journal of Nursing Research, 41(3), 431–458.
Doran, C. (2017). Rage and anxiety in the split between Freud and Jung. Humanities, 6(3), 53.
Gleason, M. M., Fox, N. A., Drury, S., Smyke, A., Egger, H. L., Nelson, C. A., Gregas, M. C., & Zeanah, C. H. (2011). Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child and Adolescent Psychiatry, 50(3), 216–231.
Hornor, G. (2019). Attachment disorders. Journal of Pediatric Health Care, 33(5), 612–622.
Iurato, G. (2015). A brief comparison of the unconscious as seen by Jung and Lévi-Strauss. Anthropology of Consciousness, 26(1), 60–107.
Lehmann, S., Breivik, K., Heiervang, E. R., Havik, T., & Havik, O. E. (2016). Reactive attachment disorder and disinhibited social engagement disorder in school-aged foster children—A confirmatory approach to dimensional measures. Journal of Abnormal Child Psychology, 44(3), 445–457.
Mayes, S. D., Calhoun, S. L., Waschbusch, D. A., Breaux, R. P., & Baweja, R. (2017). Reactive attachment/disinhibited social engagement disorders: Callous-unemotional traits and comorbid disorders. Research in Developmental Disabilities, 63, 28–37.
Mayes, S. D., Calhoun, S. L., Waschbusch, D. A., & Baweja, R. (2017). Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation. Clinical Child Psychology and Psychiatry, 22(4), 620–631.
Minnis, H., Messow, C. M., McConnachie, A., Bradshaw, P., Briggs, A., Wilson, P., & Gillberg, C. (2020). Autism and attachment disorder symptoms in the general population: Prevalence, overlap, and burden. Developmental Child Welfare, 2(1), 37–51.
Seim, A. R., Jozefiak, T., Wichstrøm, L., & Kayed, N. S. (2019). Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence. European Child & Adolescent Psychiatry, 1–12.
Waschbusch, D. A., Mayes, S. D., Calhoun, S. L., & Baweja, R. (2018). Response to Allen (2018): Points of agreement and disagreement on reactive attachment disorder. Research in Developmental Disabilities, 83, 190–193.
Already a member? Log in
Unlock the rest of this paper
135,000+ research papers · AI writing tools · Plagiarism & AI detection
7-Day Pass
Does not renew
Get 7-Day PassMonthly
Renews at $12.99/month until canceled
Start MonthlyAnnual
Renews at $99/year until canceled
Start Annual- Unlimited AI writing tools
- Plagiarism and AI text detection tool
Plan details
Unlimited AI writing tools are for individual, non-automated use and are subject to our Terms of Service and abuse-prevention measures.
TextChecker scans: 3 during the 7-Day Pass, or 5 per month with Monthly and Annual.
Prices exclude applicable tax.
Always verify citation format against your institution’s current style guide requirements.