Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

Astrid R Seim,Thomas Jozefiak,Lars Wichstrøm,Stian Lydersen,Nanna S Kayed

doi:10.1016/j.chiabu.2021.105141

Abstract

BackgroundLow self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. ObjectiveInvestigate global and domain-specific self-esteem in adolescents with RAD or DSED. Participants and settingAll adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12–20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12–20). MethodsSelf-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents. ResultsCompared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = −0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = −0.42, p = .005), SA (MD = −0.40, p = .015), AC (MD = −0.22, p = .038), PA (MD = −0.33, p = .048), and SW (MD = −0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = −0.42, p = .012) and SW (MD = −0.32, p = .037). More RAD symptoms were associated with lower SA (B = −0.051, p = .013), AC (B = −0.048, p = .028), RA (B = −0.053, p = .007), and CF (B = −0.052, p = .005). More DSED symptoms were associated with lower SC (B = −0.125, p = .038). ConclusionBoth global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Highlights

Adolescents with a reactive attachment disorder (RAD) diagnosis (Table 1) had lower self-esteem for scholastic competence and higher for close friendship compared to adolescents in the general population
The indiscriminate behavior intrinsic to disinhibited social engagement disorder (DSED) may give an impression of a high social self-esteem, our results indicate the contrary, namely that adolescents with a DSED disorder have lower social acceptance self-esteem even compared to other high-risk adolescents in residential youth care (RYC), including those with a RAD diagnosis
This cross-sectional study explored global and domain-specific self-esteem in adolescents living in RYC with RAD or DSED di agnoses or symptoms

Summary

Introduction

Severely insufficient care in early childhood is a diagnostic criterion and the presumed cause of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) (American Psychiatric Association, 2013). RAD and DSED frequently co-occur with emotional and behavioral problems and disorders (Seim et al, 2020a), but associations with self-esteem are unknown. Because self-esteem has been found to mediate the association between child maltreatment and emotional and behavioral problems (Flynn et al, 2014; Ju & Lee, 2018; Turner et al, 2015), it may be an important target for intervention in the prevention and treatment of mental health problems in highrisk adolescents, including those with RAD or DSED. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown. Conclusion: Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted

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