He Separation anxiety disorder Is an alteration characterized by excessively high levels of anxiety when the child is separated from his parents. It is one of the most common psychopathologies that occurs during childhood.
Having this disorder during childhood usually causes much discomfort in the child, who at some time or another will be forced to separate from their parents, in addition, is often also a problem difficult to manage by their parents.
In this article we will explain the characteristics of separation anxiety, we will review its possible causes and what strategies should be performed to treat it properly.
What is separation anxiety?
Usually, most children experience Certain levels of anxiety , Nervousness and malaise whenever they separate from their parents, especially if they separate from both and their care is in the hands of other people.
However, this fact does not in itself explain the presence of a separation anxiety disorder, and such responses of children are considered normal and adaptive.
Thus, separation anxiety (AS) is considered an emotional response in which the child experiences anguish When separating physically from the person with whom he has an emotional bond, that is, with his maternal and / or paternal figures.
This anxiety experienced by the small is considered a normal and expected phenomenon, which is subject to children's own development, and to 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 safety.
In this way, the child's discomfort to separate from his parents is understood as an adaptive response in which the child, given the prediction of not being adequately protected without the help of their parents, responds with anguish and anxiety when they are Separate from it.
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 see, the delineation of separation anxiety disorder may be more complicated than anticipated, since its main characteristic (separation anxiety) may be a totally normal phenomenon.
Thus, the occurrence of separation anxiety should not always be automatically related to separation anxiety disorder, ie experiencing this type of anxiety is not always a psychological disorder of childhood.
Let us then define the characteristics of the separation anxiety disorder to clarify a little to what this psychological alteration refers to.
Separation anxiety disorder (SAD) is a psychopathological manifestation characterized by the child's inability to stay and be alone.
Thus, a child with a separation anxiety disorder differs from a child who simply suffers from separation anxiety because he is unable to detach himself properly from the person with whom he or she has a significant emotional bond.
This may be confusing, but it is manifested mainly by the presentation of anguish and excessive anxiety about what would be expected for the child's level of development.
Thus, the main difference between a child with separation anxiety disorder and a child who is not based on the fact that the former experiences excessive anxiety about what one would expect based on their level of development, and the second 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 task that can lead to controversy.
What level of anxiety corresponds to each stage of development of a child or to each stage of childhood to be considered normal?
To what extent can anxiety testing be considered normal in a 3-year-old child? And in a child of 4? Should it be different?
All of these questions are difficult to answer, since there is no manual that specifies what type of anxiety all 3-year-olds should manifest, or what kind of anxiety 7 should manifest.
Likewise, there are multiple individual differences, as well as multiple factors that may appear and modulate the onset of symptoms.
Will it be the same if the child separates from his parents but stays with the grandfather, person with whom he also coexists, that if he separates from the parents and stays in the care of a"kangaroo" ???? Who does not know?
Obviously, both situations will not be comparable, so attempts to quantify anxiety to establish whether it is normal or pathological may prove useless.
In order to clarify what is the separation disorder and what is a normal separation reaction, we will then specify the characteristics of both phenomena.
Variable | Separation anxiety (AS) | Separation anxiety disorder (SAD) |
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 child's mental development and has an adaptive character | Anxiety is disproportionate to the child's level of mental development |
Intensity of anxiety | The expression of parental separation anxiety is similar in intensity to what occurs in other stressful situations for the boy. | The expression of parental separation anxiety is of great intensity and greater than the anxiety expressed in other situations. |
Thought | Ideas of harm or death in relation to attachment figures are less intense and more tolerable. | The child has multiple disturbing and relevant thoughts about the fact that parents will experience something catastrophic and will suffer damages Irreversible or even death. |
Attachment Styles | Secure attachment style, proper bonding and harmonic. | Unsafe attachment style, inappropriate and disharmonic attachment. |
Dyad reaction to separation | The mother-child dyad is harmonious and calm in the face of separation. | The mother-child dyad is stressed and overactivated 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. | Anxiety significantly interferes with the child's normal functioning. |
Scholarship | There is no school rejection and if there is, it is transitory. | There may be obvious and often insurmountable school rejection. |
Forecast | Tendency to regression and spontaneous remission of anxiety symptomatology. | Separation anxiety appears in childhood and tends to persist for years, even in adulthood. |
Diagnosis
As we have seen, there are several differences that distinguish a normal separation anxiety from a separation anxiety disorder.
In general, SAD is distinguished by witnessing excessively high and cognitively inappropriate anxiety states attributing to the child's mental development.
Separation anxiety disorder also appears as early as age 3, so the separation anxiety experienced previously may be considered a relatively normal phenomenon.
In addition, SAD is characterized by producing a cognitive impairment through disproportionate thoughts about possible misfortunes that may occur 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 as follows.
A. Excessive anxiety and inappropriate for the level of development of the subject, concerning his separation from the household or the persons with whom he is linked. This anxiety is evidenced by a minimum of 3 of the following circumstances:
Recurrent excessive discomfort when a separation from the household or the main connected figures occurs or is anticipated.
Excessive and persistent concern about the possible loss of the main connected figures or that they suffer a possible damage.
Excessive and persistent concern about the possibility of an adverse event leading to the separation of a related figure (eg, have been removed).
Resistance or persistent refusal to go to school or to any other place for fear of separation.
Resistance or persistent or excessive fear to be at home only in the main connected figure.
Negative or persistent resistance to going to sleep without having a related figure close 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 the age of 18 years.
D. The disturbance causes clinically significant discomfort or social, academic, or other significant impairment of the child.
E. The alteration does not occur exclusively in the course of a generalized developmental disorder, schizophrenia or other postpsychotic disorder, and in adults it is not better explained by the presence of an agoraphobia with agoraphobia.
Causes
At present there seems to be no single cause that leads to the development of SAD, but to the conjunction of different factors.
Specifically, 4 factors have been identified that appear to play an important role in the development of this psychopathology.
1. Temperament
It has been shown as a character and inhibited behavior can increase the risk to develop anxious pathology.
Generally, these characteristics possess a high genetic load, especially in girls and advanced ages. Therefore, environmental factors play a more important role in children and infants.
2. Attachment and regulation of anxiety
Attachment constitutes all those behaviors that the person performs in order to seek closeness with others considered stronger and safer.
Thus, 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 of establishing a secure attachment and preventing 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 were at increased risk for SAD.
4. Neurobiological findings
A study by Sallee objected as deregulation of the system of Noradrenaline Are strongly related to the development of excessive anxiety, so alterations in brain functioning could explain the presence of SAD.
Treatment
To treat a separation anxiety disorder, it is first and foremost important to properly perform the diagnostic process.
Often an anxiety for normal separation can be confused with a SAD, and while psychological treatment may be very suitable for the latter, it is not for the former.
Once the diagnosis is made, it is advisable to treat SAD through psychosocial and pharmacological interventions.
Psychotherapy is the first-choice treatment for this type of problem, since controlled studies have demonstrated how cognitive behavioral therapy is highly effective in intervening in this type of problem.
This treatment can be both individual and group, as well as involving the parents within the therapy.
Psychotherapy is based on an affective education so the child learns to identify and understand their anxiety symptoms, apply cognitive techniques to restructure distracted thoughts about separation, train the child in relaxation and gradually expose him to feared situations.
Pharmacological treatment should only be used in cases of very severe anxiety with which psychotherapy has failed to mitigate the symptoms.
The drugs that can be used in these cases are the Selective serotonin reuptake inhibitors (SSRIs), especially the Fluoxetine , A drug that has shown efficacy and safety in the treatment of anxiety problems in children.
References
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV). Ed. Masson, Barcelona 1995.
- Barlow D. and Nathan, P. (2010) The Oxford Handbook of Clinical Psychology. Oxford University Pres.
- Leckman J, Vaccarino FM, Lombroso PJ: Development of the symptom of anxiety. In: Child and Adolescent Psychiatry: A Comprehensive Textbook (3rd ed.) Lewis M (Ed.), Williams & Wilkins, 2002.
- Weissman MM, Leckman JE, Merikangas KR, Gammon GD, Prusoff BA: Depression and anxiety disorders in parents and children: results from the Yale Family Study. Arch Gen Psychiatry 1984; 41: 845-52.
- Sallee FR, Sethuraman G, Sine L, Liu H: Yohimbine challenge in children with anxiety disorders. Am J Psychiatry 2000; 157: 1236-42.
GO. Horse. (1997). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. I. Anxiety, sexual, affective and psychotic disorders i Vol. Clinical formulation, behavioral medicine and relationship disorders, II. Madrid: 20th Century.