- Beginning before age 5 and occurring in most situations, the patient’s social relatedness is markedly disturbed and developmentally inappropriate. This is shown by either of:
- Inhibitions. In most social situations, the child doesn’t interact in a socially appropriate way. This is shown by responses that are excessively inhibited, hypervigilant or ambivalent and contradictory. For example, the child responds to caregivers with frozen watchfulness or mixed approach-avoidance and resistance to comforting.
- Disinhibitions. The child’s attachments are diffuse, as shown by indiscriminate sociability with inability to form appropriate selective attachments. For example, the child is overly familiar with strangers or lacks selectivity in choosing attachment figures.
- This behavior is not explained solely by a developmental delay (such as Mental Retardation) and it does not fulfill criteria for Pervasive Developmental Disorder.
- Evidence of persistent pathogenic care is shown by one or more of:
- The caregiver neglects the child’s basic emotional needs for affection, comfort and stimulation.
- The caregiver neglects the child’s basic physical needs.
- Stable attachments cannot form because of repeated changes of caregiver (such as frequent changes of foster care).
- It appears that the pathogenic care just described has caused the disturbed behavior (for example, the behavior began after the pathogenic behavior).
Specify type, based on predominant clinical presentation:
- Inhibited Type. Failure to interact predominates.
- Disinhibited Type. Indiscriminate sociability predominates.
-- American Psychiatric Association DSM-IV Sourcebook, Volume III