Separation Anxiety Disorder
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Introduction
Separation anxiety disorder has a 3 month prevalence of about 3 percent. More common in girls than boys.
Separation anxiety disorder is the presence of at least three of the following eight symptoms for at least 4 weeks:
- fear of harm to attachment figure
- distress when separation is anticipated
- worry that something will happen to lead to separation (ie kidnapping)
- reluctance to go to school or elsewhere
- fear surrounding being alone
- reluctance to sleep without being near attachment figure
- nightmares involving separation
- complaints of physical symptoms when separation occurs or is anticipated
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Genetics, temperament, parental styles, parental anxiety, and pattern of attachment to caregivers have all been associated with separation anxiety disorder.
Behavioural inhibition, the genetically based temperamental trait in which children react to new situations, with distress, avildance, or restraint, is associated with higher rates of separation anxiety disorder.
Insecure attachment between mother and child is predictive of separation anxiety in adolescents.
Parental anxiety, perhaps through control and overprotection, may lead to the development of childhood anxiety by preventing children from having adaptive learning experiences that foster coping skills. It may also lead children to believe the world is a dangerous place
Signs and Symptoms
- history
- physical exam
History
- separation anxiety is a normal developmental stage from six months till age 3.
- school refusal
- somatic complaints are common and include stomach-ache, nausea, racing heart rate, and lightheadedness
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
- easing kids back into school, for example
- teaching breathing exercises
- SSRIs have shown some efficacy
- fluvoxamine (Lovox), fluoxetine (Prozac) have both been shown to improve symptoms
- cognitive behavioural therapy has been shown to be effecting, and includes:
- education about anxiety
- activities to increase recognition of feelings
- coping mechanisms (adaptive self-talk, muscle relaxation, deep breathing)
- exposure to anxiety-provoking situations
- family therapy is also efficacious, especially when combined with CBT
Consequences and Course
After 8 years, youths who had an anxiety disorder were functioning similarly to those who did not, except they were less likely to be living alone. Of all anxiety disorders separation anxiety disorders had the lowest remission rates.
Resources and References
Topic Development
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