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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]

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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.

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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.

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[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)

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Article Sources and Contributors 5

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