Separation anxiety disorder

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Definition

Like many childhood concerns, separation anxiety is normal at certain developmental stages. For example, when a child between the ages of eight and 14 months is separated from her mother or other primary caretaker, she may experience distress. This is normal. However, separation anxiety that occurs at later ages is considered a disorder because it is outside of normal developmental expectations, and because of the intensity of the child's emotional response. Separation anxiety disorder occurs most frequently from the ages of five to seven and from 11 to 14.

Environmental stimuli and internal cues from the child himself interact in the presentation of separation anxiety disorder. Separation anxiety disorder is defined by the primary expression of excessive anxiety that occurs upon the actual or anticipated separation of the child from adult caregivers—most often the parents. Significant problems in daily functioning for the child and parents can result from the disorder. Common fears observed in the presentation of separation anxiety include concerns about the parents' health or well-being (less frequently the child's own health), general catastrophes, natural disasters, or the child becoming lost/separated from the parents. Disrupted sleep, difficulty falling asleep alone, fear of monsters, or nightmares are also commonly experienced by children with separation anxiety disorder.

Family routines, parents' work schedules, and siblings' activities may all be negatively affected by the excessive anxiety and demands of the child with separation anxiety disorder. Family life is often disrupted by efforts to soothe the child. Parents can become stressed themselves as they try to maintain their daily routines and obligations, while attempting to manage their child's anxiety. The family's adjustment is often made more difficult due to the sudden appearance of symptoms.

Description

Children experiencing separation anxiety disorder display significant distress upon separation from the parent or other primary caregiver. Separation anxiety disorder often becomes problematic for families during elementary school, although it can also occur in older or younger children. The child appears fearful because he or she thinks something horrible will happen to the child or parent while they are apart. The child's responses to separation may include crying or becoming angry with the adult in an attempt to manipulate the situation. When thwarted by the adult's appropriate boundaries, expectations, and structure (the child must attend school, for example), the child's distress may become displaced into other maladaptive or negative behaviors. The child may begin to exhibit behavioral problems at school or at home when there has been no previous history of such problems. The child may seek out a new, negative peer group in order to gain attention or avoid separation.

Many children are unable to describe their specific fear. The feelings may seem more general and engulfing, especially to the younger child, making description more difficult and the feelings more overpowering. Children, and even adolescents, may experience difficulty describing their internal thoughts and feelings, which is normal. The ability to self-monitor, or observe one's own behavior or decision-making process, does not develop until late in adolescence for some individuals. When caregivers press the child experiencing separation anxiety for explanations, the feelings of anxiety can actually become more overwhelming. The intensity of the child's emotional response, accompanied by a lack of explanation, can become very frustrating for parents. Children or adolescents with an angry or frustrated parent may create a reasonable explanation for their fears to appease caregivers, and to keep them from leaving. Lying to take the emphasis off their strong feelings may be one of the early behavioral changes that can accompany separation anxiety.

Although exposure to a specific stressor is not required for the development of separation anxiety disorder, in many cases, a specific incident may precipitate the onset of the disorder (the traumatic events of September 11, 2001, for example). Another common precipitant is the holiday or summer break from school. Some children experience significant difficulty returning to school after a relatively short break, but certainly after summer and holidays.

Causes and symptoms

Causes

• Environmental change. Separation anxiety disorder is often precipitated by change or stress in the child's life and daily routine, such as a move, death or illness of a close relative or pet, starting a new school, a traumatic event, or even a return to school after summer vacation.

• Genetic influence. Evidence suggests a genetic link between separation anxiety disorders in children and a history of panic disorder, anxiety, or depression in their parents. Infants with anxious temperaments may have a predisposition toward later development of anxiety disorders.

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