The separation anxiety disorder is a disorder that is characterized by excessively high levels of anxiety when the child is separated from his parents. It is one of the most common psychopathology that occur during childhood.
Having this disorder during childhood usually causes a lot of discomfort in the child, who at some time or another will be forced to separate from their parents, also, it is also a problem difficult to manage by their parents.
Separation Anxiety Disorder
In this article we will explain the characteristics of separation anxiety, we will review what its possible causes may be and what strategies should be performed to treat it adequately.
What is separation anxiety?
In general, most children experience certain levels of anxiety , nervousness and discomfort whenever they are separated from their parents, especially if they are separated from both and their care is left to other people.
However, this fact in itself does not explain the presence of a separation anxiety disorder, and said responses of the children are considered normal and adaptive.
In this way, separation anxiety (AS) is considered an emotional response in which the child experiences distress by physically separating from the person with whom he has an emotional bond, that is, with his mother and / or father figures.
This anxiety experienced by children is considered a normal and expected phenomenon, which is subject to children’s own development, and their psychological and social characteristics.
Normally, a child, starting at 6 months of age begins to manifest this type of anxiety every time he is separated from his parents, since he already has a mental structure sufficiently developed to link the figure of his parents to feelings of protection and security.
Thus, the discomfort experienced by the child to separate from their parents is understood as an adaptive response in which the child, faced with the anticipation of not being able to adequately protect himself without the help of his parents, responds with anguish and anxiety when these are they separate from him.
Thus, this separation anxiety allows the child to gradually develop his ability to be alone and to modulate the attachment relationship he has with his parents.
As we can see, the delimitation of separation anxiety disorder can be more complicated than expected, since its main characteristic (separation anxiety) can be a totally normal phenomenon.
Thus, the appearance of separation anxiety should not always be automatically associated with separation anxiety disorder, that is, experiencing this type of anxiety does not always constitute a psychological disorder of childhood.
We are going to define the characteristics of separation anxiety disorder to clarify a bit what this psychological alteration refers to.
Separation anxiety disorder (ASD) is a psychopathological manifestation characterized by the inability of the child to stay and be alone.
Thus, a child who has a separation anxiety disorder differs from a child who simply suffers from separation anxiety because of being unable to properly separate from the person with whom he or she has a significant emotional bond.
This fact can be confusing, but is manifested mainly by the presentation of anguish and excessive anxiety for what would be expected for the level of development of the child.
Thus, the main difference between a child who has separation anxiety disorder and a child who is not based on the fact that the former experiences excessive anxiety for what would be expected based on their level of development, and the latter does not.
Obviously, quantifying what type and what levels of anxiety are appropriate for a child when separated from their parents is a rather complicated and controversial task.
What level of anxiety corresponds to each stage of development of a child or each stage of childhood to be considered normal?
To what extent can the experimentation of anxiety in a 3-year-old child be considered normal? And in a child of 4? Should it be different?
All these questions are difficult to answer, since there is no manual that specifies what kind of anxiety should all children of 3 years show equally or what kind of anxiety they should manifest 7.
Likewise, there are multiple individual differences, as well as multiple factors that can appear and modulate the appearance of symptoms.
Will it be the same if the child separates from his parents but stays with the grandfather, person with whom he also lives, if he separates from the parents and stays in the care of a “babysitter” he does not know?
Obviously, both situations will not be comparable, so attempts to quantify anxiety to establish whether it is normal or pathological can be useless.
In order to clarify what separation disorder is and what is a normal separation reaction, we will now specify the characteristics of both phenomena.
|Variable||Separation anxiety (AS)||Separation anxiety disorder (ASD)|
|Age of appearance||Between 6 months and 5 years.||Between 3 years and 18 years.|
|Evolutionary development||The anxiety experienced is in accordance with the mental development of the child and has an adaptive character||Anxiety is disproportionate to the child’s level of mental development|
|Anxiety intensity||The expression of separation anxiety of the parents is of intensity similar to that which occurs in other stressful situations for the
|The expression of separation anxiety of the parents is of great intensity and greater than the anxiety expressed in other situations.|
|Thought||The ideas of harm or death in relation to attachment figures are less intense and more tolerable.||The child has many disturbing and relevant thoughts about what will happen to parents something catastrophic and suffer damage
irreversible or even death.
|Attachment styles||Secure attachment style, appropriate and harmonic bonding.||Insecure attachment style, inadequate and disharmonic bonding.|
|Reaction of the dyad to separation||The mother-child dyad is harmonious and quiet in the face of separation.||The mother-child dyad is stressed and over-activated in the face of separation situations.|
|Functioning||Anxiety does not interfere with the child’s normal functioning even though he may be more tense than usual.||The anxiety interferes remarkably in the normal functioning of the child.|
|Scholarship||There is no school refusal and if there is, it is transitory.||There can be an obvious and often insurmountable school refusal.|
|Forecast||Tendency to regression and spontaneous remission of anxiety symptoms.||Separation anxiety appears in childhood and tends to last for years, even in adulthood.|
As we have seen, there are several differences that distinguish a normal separation anxiety from a separation anxiety disorder.
In general, SAD is differentiated by witnessing excessively high and cognitively inappropriate anxiety levels, in response to the child’s mental development.
Likewise, the separation anxiety disorder appears after 3 years, so the separation anxiety that is previously experienced can be considered as a relatively normal phenomenon.
In addition, the TAS is characterized by producing a cognitive alteration through disproportionate thoughts about possible misfortunes that may happen to their parents, as well as producing a clear deterioration in the child’s functionality.
At a specific level, the criteria according to the diagnostic manual DSM-IV-TR that are required to make a diagnosis of separation anxiety disorder are the following.
A. Excessive and inappropriate anxiety for the level of development of the subject, concerning his separation from the home or the people with whom he is linked. This anxiety is revealed through a minimum of 3 of the following circumstances:
- Recurrent excessive discomfort when it occurs or anticipates a separation from the home or the main linked figures.
- Excessive and persistent concern about the possible loss of the main linked figures or that they suffer a possible damage.
- Excessive and persistent concern about the possibility that an adverse event results in the separation of a linked figure (eg being sequestered).
- Persistent resistance or refusal to go to school or any other place for fear of separation.
- Persistent or excessive resistance or fear to be at home only in the main linked figures.
- Negative or persistent resistance to going to sleep without having a linked figure nearby or going to sleep outside the home.
- Repeated nightmares with separation themes.
- Repeated complaints of physical symptoms (such as headache, abdominal pain, nausea or vomiting) when separation occurs or is anticipated.
B. The duration of the disorder is at least 4 weeks.
C. The onset occurs before 18 years of age.
D. The disturbance causes clinically significant distress or social, academic, or other important areas of the child’s impairment.
E. Alteration does not occur exclusively in the course of a generalized developmental disorder, schizophrenia or other post-psychotic disorder, and in adults it is not better explained by the presence of an anxiety disorder with agoraphobia.
Currently, there seems to be no single cause that gives rise to the development of CAS, but rather the conjunction of different factors.
Specifically, 4 factors have been identified that seem to play an important role in the development of this psychopathology.
It has been shown as a character and inhibited behavior can increase the risk of developing anxious pathology.
In general, these characteristics have a high genetic load, especially in girls and elderly. Therefore, environmental factors could play a more important role in children and young infants.
2. Attachment and regulation of anxiety
The attachment is all those behaviors that the person performs with the aim of seeking proximity with other people considered stronger and safer.
In this way, according to the theoretical perspective of attachment, the ability of parents to respond adequately to the needs of the child would be a fundamental aspect to constitute a secure attachment and prevent the child from experiencing a separation anxiety disorder.
3. Family system
A study by Weissman showed that children raised in families with parents with anxious and overprotective styles had a higher risk of suffering from SAD.
4. Neurobiological findings
A study conducted by Sallie objected that deregulation’s of the nor-epinephrine system are strongly related to the development of excessive anxiety, so alterations in brain functioning could explain the presence of TAS.
To treat a separation anxiety disorder, it is first important to properly perform the diagnostic process.
Many times an anxiety for normal separation can be confused with a SAD, and while the psychological treatment may be very appropriate for the second, it is not for the first.
Once the diagnosis is made, it is convenient to treat the TAS through psychosocial and pharmacological interventions.
Psychotherapy is the treatment of first choice for this type of problem, since controlled studies have shown how cognitive behavioral therapy is highly effective to intervene this type of problems.
This treatment can be both individual and group, as well as involving parents within the therapy.
Psychotherapy is based on carrying out an affective education so that the child learns to identify and understand their anxiety symptoms, apply cognitive techniques to restructure distorted thoughts about separation, train the child in relaxation and expose him gradually to the feared situations.
The pharmacological treatment should only be used in cases of very severe anxiety with which psychotherapy has not managed to mitigate the symptoms.
The drugs that can be used in these cases are the selective inhibitors of serotonin reuptake (SSRI), especially fluoxetine , a drug that has shown efficacy and safety in the treatment of anxiety problems in children.