Separation Anxiety Disorder (309.21)

DSM-IV-TR criteria

• A. Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:
  • recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
  • persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
  • persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
  • persistent reluctance or refusal to go to school or elsewhere because of fear of separation
  • persistent and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
  • persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
  • repeated nightmares involving the theme of separation
  • repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, and vomiting) when separation from major attachment figures occurs or is anticipated
• B. The duration or the disturbance is at least 4 weeks.
• C. The onset is before age 18 years.
• D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
• E. 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.
• Specify if:
  • Early Onset: if onset occurs before age 6 years

Associated features

• When separated from the home of family, people with Separation Anxiety Disorder may exhibit sadness, apathy, social withdrawal, difficulty concentrating on play and/or work. Also, depending on one’s age, they may be scared of animals, monsters, darkness, plane travel, burglars, kidnappers and other situations that might be dangers to their family or themselves. Because the child might be scared of leaving their family, they may refuse to attend school which my cause school and academic difficulties and social avoidance. When left alone, young children may report seeing people strangers entering their room, seeing monsters and other creatures, and also seeing eyes following them around.
• Studies show that children suffering from separation anxiety disorder are much more likely to have ADHD, bipolar disorder, panic disorders, and other disorders later in life.

Child vs. adult presentation

• Separation Anxiety Disorder is seen in all age groups, but adult separation anxiety disorder is seen in about 7% of adults. Childhood separation anxiety disorder is seen in about 4% of children.
• The manifestations of the disorder may vary with age. Younger children may not express specific fears of definite threats to parents, home, or themselves. As children get older, worries or fears are often of specific dangers. Anxiety and anticipation of separation become manifest in mid-childhood.
• Adults with this disorder are typically overly concerned about their offspring and spouses and experience marked discomfort when separated from them.

• * The prevalence of separation anxiety disorder is slightly more frequent in females than males; the prevalence of school refusal is approximately equal between males and females.

Epidemiology

• The prevalence of this disorder is estimated to have an average of about 4% in children and young adolescents. For children age 7-11, it is seen in about 4.1%. Children between the ages 12-14 show a prevalence of about 3.9%, and teens from 14-16 have about 1.3% that suffer from separation anxiety disorder.
• In clinical samples, the disorder is apparently equally common in males and females.
• In epidemiological samples, the disorder is more frequent in females.

Etiology

Studies have shown that children who are raised by a parent having anxiety disorders are more likely to develop anxiety disorders themselves. Experts have postulated that early and traumatic separation from the attachment figure may increase the likelihood of the child and, later on, the adolescent or adult developing separation anxiety disorder. Also traumatic experiences, a serious separation, stress in the family, a significant change, and an illness are all possible cause that might trigger Separation Anxiety Disorder.

Empirically supported treatments

One of the treatments used for this disorder is social skills training. This treatments deals with things like skill awareness, situational awareness, practice and role play. Another form of treatment is cognitive behavioral therapy, where the therapist teaches the child to challenge negative thoughts, develop new, positive thoughts, and practice alternative behaviors. Furthermore, reassurances of love, safety, and preparation for the child for upcoming separations will benefit the child in the long run.

A brief explanation of Separation Anxiety Disorder