Download Separation Anxiety Disorder

SEPARATION ANXIETY
DISORDER
Caroline Bacon
Define Separation Anxiety Disorder
• Separation Anxiety is characterized by an abnormal reactivity to real or imagined separation from
an attachment figure resulting in significant interference of daily activities and developmental
tasks.
• Separation Anxiety Disorder is defined in the DSM-5 as the development of excessive fear or
anxiety in an individual concerning separation from home or those to whom the individual is
attached.
Separation Anxiety in Children
• Separation Anxiety Disorder most commonly develops in children - beginning as early as 6 to 7
months.
• Separation Anxiety Disorder manifests in children when the parent or caregiver leaves for an
errand or for work. A child who has separation anxiety disorder experiences such extreme distress
when away because he or she is unable to tolerate periods of separation that are expected at his or
her age.
• Approximately 4-5% of children and adolescents suffer from the disorder.[Robinson, L.]
• Sometimes referred to as School Phobia. [MTL Staff]
Causes of Separation Anxiety Disorder
• The cause of SAD is physically being left by an attachment figure; however, there are risk factors
that could increase the likeliness that an individual develop the disorder. [Dryden-Edwards, R.]
• SAD risk factors are a combination of genetic and environmental vulnerabilities.
• Low socioeconomic status
• Families with histories of anxieties
• Untrusting, fearful, and/or timid personality
• Overprotective parents or lack of parental interaction
• Change (moving, switching schools, divorce, death of an attachment figure)
Effects/Symptoms of Separation Anxiety Disorder
• Refusal to attend school or work and/or sleep alone
• Poor school performance
• Refusal to be separated from attachment figure
• Failure to interact appropriately with other children
• Nightmares
• Extreme and severe crying
• Physical illness (headaches, vomiting)
• Violent, emotional temper tantrums [Johnson, S.]
Diagnostic Criteria
A) Developmentally inappropriate and excessive fear or anxiety concerning separation from those
to whom the individual is attached, as evidenced by at least three of the following
Recurrent excessive distress when anticipating or experiencing separation from home or from major
attachment figures.
• Persistent and excessive worry about losing major attachment figures or about possible harm
to them, such as illness, injury, disasters, or death.
• Persistent and excessive worry about experiencing an untoward event that causes separation
from a major attachment figure.
Diagnostic Criteria Continued
• Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere
because of fear of separation.
• Persistent and excessive fear of or reluctance about being alone or without major attachment
figures at home or in other settings.
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near
a major attachment figure.
• Repeated nightmares involving the theme of separation.
Diagnostic Criteria Continued
• Repeated complaints of physical symptoms when separation from major attachment figures
occurs or is anticipated.
B) The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents
and typically 6 months or more in adults.
C) The disturbance causes clinically significant distress or impairment in social, academic,
occupational, or other important areas of functioning. [5th edition; DSM-5]
Quotations from Individuals
• “They’re my babies. There’s some Separation Anxiety when they get adopted, but I’m always so
glad they find homes.”–Janet Foster
• “This we can all bear witness to, living as we do plagued by unremitting anxiety. It becomes more
and more imperative that the life of the spirit be avowed as the only firm basis upon which to
establish happiness and peace.” – Dalai Lama
Journals
• Confidence was not equivalent to a low level or absence of fear, but rather to self-confidence that
makes public-speaking a reinforcing activity. Likewise, children differ not only in their level of
separation anxiety, but also in their degree of security and enjoyment when they are home alone
or they go away on a trip without their parents. [Ehrenreich, J. T.]
• Childhood SAD may also be associated with a heightened risk for the development of other
anxiety and depressive disorders in adolescence and adulthood, such as panic disorder and
agoraphobia, though research findings are conflicting. Individuals with current PDA frequently
report childhood histories of SAD. Furthermore, biological studies have found similar respiratory
physiology among patients with SAD and PDA. [Children’s Separation Anxiety Scale.]
Distinctions Between
• Separation Anxiety Disorder is more intense than Separation Anxiety.
• To be diagnosed with SAD the individual must have reoccurring symptoms.
• It is normal for children to experience Separation Anxiety when starting school; however,
sometimes if the Separation Anxiety lasts for an extended period of time, it could become SAD.
• If the fears last longer than 3 weeks, then an adolescent could be diagnosed with Separation Anxiety
Disorder. [Dryden-Edwards, R.]
Separation Anxiety in Twins
• Twins are more likely to develop SAD because their individuality and uniqueness as individuals
is at times a challenge.
• In some instances the twins will develop a dependency on each other rather than the caregiver.
• The Separation Anxiety Disorder between the twins is thought to be a proxy (a figure that can be
used to represent the value of something in a calculation) for the anxiety they feel for the
separation with a parent/caregiver. [MTL Staff]
Treatment for SAD
• Types of psychotherapy (specifically cognitive-behavioral psychotherapy) are most common in
treating SAD. The earlier the intervention, the more likely for success.
• A form of “play” therapy is ideal to treat SAD in younger children.
• Family therapy may sometimes be appropriate to solve the family problems that are causing the
Separation Anxiety Disorder to occur in the child.
• Sometimes systematic desensitizing to separation could be used or relaxation techniques.
[Ponton, L.]