Separation anxiety disorder

Separation anxiety disorder

Separation anxiety disorder
Classification and external resources ICD-10 ICD-9 DiseasesDB eMedicine MeSH F93.0 [1] [2] [3] [4]

309.21 34361

article/916737 D001010 [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]

Separation anxiety disorder

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 childs 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 selfhoodor understand that they are a separate person from their primary caregiver. At the same time, the concept of object permanence emergeswhich 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 1315 months, when it begins to decline.[18] Other sources report a peak from 1836 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.

Separation anxiety disorder 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] [2] [3] [4] [5] [6] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F93. 0 http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=309. 21 http:/ / www. diseasesdatabase. com/ ddb34361. htm http:/ / emedicine. medscape. com/ article/ 916737-overview http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D001010 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] 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.

Separation anxiety disorder

[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] 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. ISBN0-07-146300-3. [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. ISBN978-0890420188. . [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] 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)

Article Sources and Contributors

Article Sources and Contributors

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