Separation Anxiety Disorder

Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following

Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.

Persistent and excessive worry about losing, or possible harm befalling, major attachment figures.

Persistent and excessive worry that an unexpected event will lead to separation from a major attachment figure (e.g. getting lost or being kidnapped).

Persistent reluctance or refusal to go to school or elsewhere because of fear of separation.

Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings.

Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home.

Repeated nightmares involving the theme of separation.

Repeated complaints of physical symptoms, headaches, stomachaches, nausea, or vomiting, when separated from major attachment figures occurs, or is anticipated.

The duration of the disturbance is at least 4 weeks.

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.

Associated Features:

Depressed Mood
Somatic or Sexual Dysfunction
Anxious or Fearful or Dependent Personality

Differential Diagnosis:

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

Pervasive Developmental Disorders;
Schizophrenia, or other Psychotic Disorders;
Generalized Anxiety Disorder;
Panic Disorder with Agoraphobia;
Agoraphobia Without History of Panic Disorder;
Conduct Disorder;
Developmentally appropriate levels of separation anxiety.

Cause:

As infants develop and become more aware and interactive with their environment, they experience various emotions. Trust, safety, and comfort depend on familiarity and consistency. From 8 to 14 months, many children experience fear when they are denied familiar and safe situations. They recognize their parents as familiar and safe and when separated from parents, they may feel threatened and unsafe. Separation anxiety is a normal development stage that usually decreases around 2 years old when toddlers begin to understand that parents may be out of sight but will return.

Even after children have successfully mastered this developmental stage, separation anxiety may return during periods of stress . Most children will experience some degree of separation anxiety when in unfamiliar situations such as a stay in hospital, when experiencing stress's. It is therefore natural for them to seek the safety, comfort, and protection of their parents. When parents cannot be with their children in these situations, the child experiences distress.

Treatment:

It is helpful for a parent to be with children during stressful occasions such as during medical examinations or treatments. When a parent cannot accompany the child, prior experience or exposure to the situation is helpful. If this is not possible, the child may display severe anxiety by crying, resisting, begging, screaming. It is always desirable to explain the situation and experience to the child and to assure them.