Post on 06-Apr-2018
8/2/2019 Separation Anxiety Disorder1
http://slidepdf.com/reader/full/separation-anxiety-disorder1 1/5
Separation anxiety disorder 1
Separation anxiety disorder
Separation anxietydisorder
Classification and external resources
ICD-10F93.0
[1]
ICD-9309.21
[2]
DiseasesDB34361
[3]
eMedicinearticle/916737
[4]
MeSHD001010
[5]
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. SAD may appear after a major stress in your child's life. This may come from the loss of
a loved one or pet, or from an illness. Moving to a new neighborhood or school may also cause stress to your child.[6]
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.
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.[7][8]
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.[9]
8/2/2019 Separation Anxiety Disorder1
http://slidepdf.com/reader/full/separation-anxiety-disorder1 2/5
Separation anxiety disorder 2
Separation Anxiety Disorder in Children
Separation Anxiety Disorder (SAD) is usually first reported during the preschool years.[10]
The condition can begin
at any age up to 18, but onset during late adolescence is not common.[11]
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.[12]
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.[13]
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.
The prevalence of SAD is usually cited as between 3.5% and 5.4%. However, a much higher percentage of children
suffer from a smaller amount of separation anxiety, and are not actually diagnosed. Multiple studies have found
higher rates of SAD is girls than in boys, and that paternal absence may increase the chances of SAD in girls.[14]
Onset of SAD can either be acute or insidious. Children with acute onset usually make a full recovery, with no
apparent long-term effects. Acute onset is usually due to a significant stressor in the child's life such as moving to a
new house, moving to a new school, or the divorce of their parents.[15]
[16]disorder.http:/ / bf4dv7zn3u. search. serialssolutions. com. myaccess. library. utoronto. ca/ ?ctx_ver=Z39.
88-2004& ctx_enc=info%3Aofi%2Fenc%3AUTF-8& rfr_id=info:sid/ summon. serialssolutions. com&
rft_val_fmt=info:ofi/
fmt:kev:mtx:journal&
rft.
genre=article&
rft.
atitle=Separation+
anxiety+
disorder&
rft. jtitle=CareNotes& rft. date=2011-02-01& rft. pub=Thomson+ Healthcare%2C+ Inc& rft. externalDBID=n%2Fa&
rft. externalDocID=246451290
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."[17]
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.[18]
Other sources report a peak from 18 –36 months.[19]
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:[20]
•• 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.
8/2/2019 Separation Anxiety Disorder1
http://slidepdf.com/reader/full/separation-anxiety-disorder1 3/5
Separation anxiety disorder 3
•• 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.
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. Research has shown that CBT is the best-proven treatment for children with
SAD today. Pharmacotherapy should be used in conjunction with CBT only when the child's symptoms have not
responded to CBT interventions alone. Treatment for SAD is often time limited, however very problem-focused -
focus is placed on changing current behaviors and improving functioning. The beginning of treatment consists of
psycho-education of parent and child and further treatment planning. In psycho-education both parent and child are
taught about the factors that maintain SAD over time and what will be done to eliminate the problem throughout the
treatment process. Parent training: You may be given special training to help you cope and handle your child's
anxieties. This training can also help you control your own anxiety.[21]
In treatment, the child, parents, and therapist
work as a team in order to help the infant face feared situations gradually through special behavioral exercises called
exposures. The goal of exposures is to help children form new beliefs about their feared situations and about their
abilities to cope.[22]
The exact cause of SAD is not known. SAD may appear after a major stress in your child's life.
This may come from the loss of a loved one or pet, or from an illness. Moving to a new neighborhood or school may
also cause stress to your child [23]
References
[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F93. 0
[2] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=309. 21
[3] http:/ / www. diseasesdatabase. com/ ddb34361. htm
[4] http:/ / emedicine. medscape. com/ article/ 916737-overview
[5] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D001010
[6] http:/ / bf4dv7zn3u. search. serialssolutions. com. myaccess. library. utoronto. ca/ ?ctx_ver=Z39. 88-2004&
ctx_enc=info%3Aofi%2Fenc%3AUTF-8& rfr_id=info:sid/ summon. serialssolutions. com& rft_val_fmt=info:ofi/ fmt:kev:mtx:journal& rft.
genre=article& rft. atitle=Separation+ anxiety+ disorder& rft. jtitle=CareNotes& rft. date=2011-02-01& rft. pub=Thomson+ Healthcare%2C+
Inc& rft. externalDBID=n%2Fa& rft. externalDocID=246451290
[7] Adult Separation Anxiety Often Overlooked Diagnosis - Arehart-Treichel 41 (13): 30 - Psychiatric News (http:/ / psychnews.
psychiatryonline. org/ newsarticle. aspx?articleid=110129)
[8] 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 (http:/ / ajp. psychiatryonline. org/ cgi/ content/ full/ 163/ 6/ 1074)
[9] Link Between Separation Anxiety In Children And Subsequent Onset Of Panic Disorder In Adulthood, Testing The Hypothesis (http:/ / www.
medicalnewstoday. com/ medicalnews. php?newsid=59727& nfid=crss)
[10][10] When your child has SAD, he becomes worried, nervous, or fearful at the thought of being separated. This can be separation from people or
places that he knows and is comfortable with. He may get homesick easily, try to avoid going to school, or get a school phobia (strong,
ongoing fear). He may show his emotions very easily or have problems getting along with friends. He may be very demanding, forward, or
pushy, and in need of your undivided attention all the times. He may throw tantrums when he starts to feel that he will get separated. He may
show anger or try to hit the person forcing the separation. Your child may also react by being well behaved, obedient, and eager to please.
[11] Rapaport, Judith L.; Deborah R. Ismond (1996). DSM IV Training Guide for Diagnosis of Childhood Disorders. New York: Brunner/Mazel.[12] 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.
8/2/2019 Separation Anxiety Disorder1
http://slidepdf.com/reader/full/separation-anxiety-disorder1 4/5
Separation anxiety disorder 4
[13] 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.
[16][16] How is separation anxiety disorder diagnosed? Your child's caregiver will ask you and your child questions. These include information
about your child's health history, behavior, and fears and worries. He will ask if any other family members have had anxiety disorders or other
mental health problems. He may want to know how your child is doing at school and with other activities. Different tests may be done to
check for medical conditions that may be causing your child's symptoms.
Your child's caregiver will assess your child's behavior, fears, and worries in looking for signs and symptoms of
SAD. If your child has three or more of the signs or symptoms of SAD, he may have this disorder. To have this
disorder the signs and symptoms must have been present for at least four weeks. They must also be bad enough to
cause problems in his learning, social skills, and other areas of life. Your child's anxiety should not be caused by
another mental health
[17] Separation Anxiety - DrGreene.com (http:/ / www. drgreene. org/ body. cfm?id=21& action=detail& ref=993)
[18] 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.
[19] 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.
[20] Diagnostic and Statistical Manual of Mental Disorders (http:/ / online. statref. com. ezproxy. bu. edu/ Document.
aspx?docAddress=4PNCnYvddqP04-isS-3QEw==& SessionId=179A2A5UVWOKIBKY#H& 1& ChaptersTab&
8WO7vWQzZ97llebtEyfAWg==& & 37). Washington, D.C.: American Psychiatric Association. 2000. ISBN 978-0890420188. .
[21] http:/ / bf4dv7zn3u. search. serialssolutions. com. myaccess. library. utoronto. ca/ ?ctx_ver=Z39. 88-2004&
ctx_enc=info%3Aofi%2Fenc%3AUTF-8& rfr_id=info:sid/ summon. serialssolutions. com& rft_val_fmt=info:ofi/ fmt:kev:mtx:journal& rft.
genre=article& rft. atitle=Separation+ anxiety+ disorder& rft. jtitle=CareNotes& rft. date=2011-02-01& rft. pub=Thomson+ Healthcare%2C+
Inc& rft. externalDBID=n%2Fa& rft. externalDocID=246451290
[22][22] Weems CF, Carrion VG 2003
[23] http:/ / bf4dv7zn3u. search. serialssolutions. com. myaccess. library. utoronto. ca/ ?ctx_ver=Z39. 88-2004&
ctx_enc=info%3Aofi%2Fenc%3AUTF-8& rfr_id=info:sid/ summon. serialssolutions. com& rft_val_fmt=info:ofi/ fmt:kev:mtx:journal& rft.
genre=article& rft. atitle=Separation+ anxiety+ disorder& rft. jtitle=CareNotes& rft. date=2011-02-01& rft. pub=Thomson+ Healthcare%2C+
Inc& rft. externalDBID=n%2Fa& rft. externalDocID=246451290
Weems CF, Carrion VG. The treatment of separation anxiety disorder employing attachment theory and cognitive
behavior therapy techniques. Clinical Case Studies. 2003;2(3): 188-198.
Links
• What is Separation Anxiety? (http:/ / www. abct. org/ sccap/ ?m=sPublic& fa=pub_Anxiety_Separation)
• What is CBT?" (http:/ / www. abct. org/ sccap/ ?m=sPublic& fa=pub_WhatIsCBT)
• School Refusal in Children and Adolescents (http:/ / www. aafp. org/ afp/ 2003/ 1015/ p1555. html=pub_School)
• Separation Anxiety Disorder (http:/ / www2. massgeneral. org/ schoolpsychiatry/ info_separationanxiety.
asp=pub_SAD)
• Children Who Won't Go to School (Separation Anxiety) (http:/ / www. aacap. org/ cs/ root/ facts_for_families/
children_who_wont_go_to_school_separation_anxiety=pub_School)
8/2/2019 Separation Anxiety Disorder1
http://slidepdf.com/reader/full/separation-anxiety-disorder1 5/5
Article Sources and Contributors 5
Article Sources and ContributorsSeparation anxiety disorder Source: http://en.wikipedia.org/w/index.php?oldid=483478571 Contributors: 1000Faces, 28bytes, AdamAly, Alpha Ursae Minoris, Andycjp, Anna Lincoln,
Anti-Anonymex2, Aranel, Arcadian, Arvm, Carlvincent, C arrite, Closedmouth, CloudSurfer, Coder Dan, DanielCD, Destynova, Doczilla, Ecrone, EoGuy, Ephilei, Feisty.gibbon, Flamurai,
FreplySpang, Ghobadi07, Gurko, Ianthegecko, Ironcito, J.delanoy, JarodRoland, Jeff Silvers, Koavf, LadyofShalott, Levintsa, Lmdonnan, Lordofthe9, M.nelson, M. v.pekary, Mahanga,
Mathiastck, Mattisse, Missmidge, Oda Mari, Pedant, Pine, Poeticaesthetic, Quetzapretzel, Qwerty Binary, R Lowry, SHintzen, Scifiradioguy, Secretlondon, Shawnc, Sir Lewk, Tagishsimon, The
Anome, TheJJJunk, Theelf29, Thmaho, Thumperward, Tiptoety, Wapcaplet, Wavelength, Zachlipton, 83 ,55דוד anonymous edits
License
Creative Commons Attribution-Share Alike 3.0 Unported //creativecommons.org/licenses/by-sa/3.0/