Separation anxiety disorder
| Separation anxiety disorder | |
|---|---|
| Classification and external resources | |
| ICD-10 | F93.0 |
| ICD-9 | 309.21 |
| DiseasesDB | 34361 |
| eMedicine | article/916737 |
| MeSH | D001010 |
Separation anxiety disorder is a psychological condition in which an individual experiences excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (like a father, mother, grandparents, and brothers or sisters). Separation Anxiety Disorder (SAD), is characterized by significant and recurrent amounts of worry upon (or anticipation of) separation from a child or adolescent's home or from those to whom the child or adolescent is attached.
Those suffering from SAD may worry about losing their parents and/or getting lost or kidnapped. They often refuse to go to certain places (e.g., school) because of fears of separation, or become extremely fearful when they are left alone without their parents. These children and adolescents may also refuse to sleep alone, experience nightmares about separation, or experience various physical complaints (e.g., body-aches, nausea) when separated from their parents. Separation anxiety may cause significant impairment in important areas of functioning, (e.g., academic and social). The duration of this problem must last for at least four weeks and must present itself before the child is 18 years of age.
Contents |
[edit] Background
Present in all age groups, adult separation anxiety disorder (affecting roughly 7% of adults) is more common than childhood separation anxiety disorder (affecting approximately 4% of children). Separation Anxiety can also occur in dogs, which can lead to chewing for relieving stress.[1][2] Separation anxiety disorder is often characterized by some of the following symptoms:
- Recurring distress when separated from the subject of attachment (such as significant other, the father or the mother, or home)
- Persistent, excessive worrying about losing the subject of attachment, and/or that some event will lead to separation from a major attachment
- Excessive fear about being alone without subject of attachment
- Persistent reluctance or refusal to go to sleep without being near a major attachment figure, like a significant other or mother
- Recurrent nightmares about separation
- Crying
Often, separation anxiety disorder is a symptom of a co-morbid condition. Studies show that children suffering from separation anxiety disorder are much more likely to have ADHD, bipolar disorder, panic disorder, and other disorders later in life.[3]
[edit] Separation Anxiety Disorder in Children
Separation Anxiety Disorder (SAD) is usually first reported during the preschool years. The condition can begin at any age up to 18, but onset during late adolescence is not common.[4] Children with SAD become very anxious when separated from figures of attachment (e.g. parents, siblings, or other caregivers) and upon leaving their homes. In anticipation of the separation, they may have somatic complaints and symptoms, such as headaches or stomachaches. While separated from a loved one, children with SAD often fear that something catastrophic may happen to the attachment figure, and they may desire to keep in contact with this person by phone or other means of communication. When these children are away from their homes, they can become extremely homesick and distraught.
As with other anxiety disorders, children with SAD face more obstacles at school than those without anxiety disorders. Adjustment and relating school functioning have been found to be much more difficult for anxious children.[5] Additionally SAD is a common cause of a child’s refusal to attend school. This is a serious problem because as children become further behind in course work, it becomes increasingly hard for them to return to school.[6] There may also be longer term effects of school refusal behaviors associated with SAD. These children are found to have higher rates of psychiatric consultation and lower incidence of parenting when they reach adulthood, suggesting a deficit in social skills.
[edit] Separation anxiety disorder versus separation anxiety
Separation anxiety disorder should not be confused with separation anxiety, which occurs as "a normal stage of development for healthy, secure babies."[7] Separation anxiety occurs as babies begin to understand their own selfhood—or understand that they are a separate person from their primary caregiver. At the same time, the concept of object permanence emerges—which is when children learn that something still exists when it is not seen or heard. As babies begin to understand that they can be separated from their primary caregiver, they do not understand that their caregiver will return, nor do they have a concept of time. This, in turn, causes a normal and healthy anxious reaction.
Some sources state that separation anxiety typically onsets around 8 months of age and increases until 13–15 months, when it begins to decline.[8] Other sources report a peak from 18–36 months.[9]
Compared to separation anxiety, separation anxiety disorder is when the symptoms of separation anxiety becomes problematic for day-to-day living.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (2000) lists the following as criteria that must be fulfilled for a patient to be diagnosed with separation anxiety disorder:[10]
- At least three separate symptoms displaying excessive anxiety concerning separation from home or from people to whom the child is attached.
- The disturbance is endured at least four weeks.
- The onset is before age 18 years.
- The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
- The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia.
[edit] Psychosocial Treatment
Cognitive Behavioral Therapy is used to help treat separation anxiety disorder. Cognitive and Behavioral Therapies for children and adolescents usually are short-term treatments (i.e., often between 6-20 sessions) that focus on teaching young people and their parents specific skills. CBT is different from many other therapy approaches by focusing on the ways that a person's cognitions (i.e., thoughts), emotions, and behaviors are connected and how they affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at different points in the cycle.
[edit] See also
[edit] References
- ^ Adult Separation Anxiety Often Overlooked Diagnosis - Arehart-Treichel 41 (13): 30 - Psychiatric News
- ^ Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication - Shear et al. 163 (6): 1074 - Am J Psychiatry
- ^ Link Between Separation Anxiety In Children And Subsequent Onset Of Panic Disorder In Adulthood, Testing The Hypothesis
- ^ Rapaport, Judith L.; Deborah R. Ismond (1996). DSM IV Training Guide for Diagnosis of Childhood Disorders. New York: Brunner/Mazel.
- ^ Mychailyszyn, M. P.; Mendez, J. L. & Kendall, P. C. (2010). "School functioning in youth with and without anxiety disorders: Comparisons by diagnosis and comorbidity". School Psychology Review 39 (1): 106-121.
- ^ Doobay, A. F. (2008). "School refusal behavior associated with separation anxiety disorder: A cognitive-behavioral approach to treatment". Psychology In The Schools 45 (4): 261-272. doi:10.1002.
- ^ Separation Anxiety - DrGreene.com
- ^ Siegler, Robert (2006). How Children Develop, Exploring Child Develop Student Media Tool Kit & Scientific American Reader to Accompany How Children Develop. New York: Worth Publishers. ISBN 0716761130.
- ^ Robin R Deterding; Hay, William Winn; Myron J. Levin; Judith M. Sondheimer (2007). Current pediatric diagnosis & treatment. New York: Lange Medical Books/McGraw-Hill. pp. 200. ISBN 0-07-146300-3.
- ^ Diagnostic and Statistical Manual of Mental Disorders. Washington, D.C.: American Psychiatric Association. 2000. ISBN 978-0890420188. http://online.statref.com.ezproxy.bu.edu/Document.aspx?docAddress=4PNCnYvddqP04-isS-3QEw%3d%3d&SessionId=179A2A5UVWOKIBKY#H&1&ChaptersTab&8WO7vWQzZ97llebtEyfAWg%3d%3d&&37.
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