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

Background: Low 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. Objective: Investigate global and domain-specific self-esteem in adolescents with RAD or DSED. Participants and setting: All 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). Methods: Self-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. Results: Compared 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). 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 accordingly.