SEPARATION ANXIETY DISORDER

Separation Anxiety Disorder (SAD) is a mental health disorder that usually begins in childhood and is characterized by extreme distress when a child is away from the primary caregiver. Although separate anxiety is a developmentally appropriate phenomenon, the disorder manifests with inappropriate intensity or the inappropriateness of age and context. Children with separation anxiety disorder may become agitated at just the thought of being away from mom or dad, and may complain of sickness to avoid playing with friends or attending school.

Separation anxiety is not seen only in children. It can also be seen in adults. Adults with separation anxiety disorder struggle with situation that takes them away from their loved ones. They may have extreme fear that bad things will happen to important people in their lives such as family members.

What causes Separation Anxiety Disorder (SAD)?

Common causes of separation anxiety disorder in children include: Change in the environment or surroundings such as a new house, school, or day care situation. Stressful situations like switching schools, divorce, or the loss of a loved one including a pet can also trigger separation anxiety disorder. In some cases, separation anxiety disorder may be the manifestation of your own stress and anxiety. Parents and children can feed one another’s anxieties.

Separation anxiety in adults often develops after a loss of a loved one, or following a significant event such as moving to college. An individual may be more likely to develop adult separation anxiety disorder if he/she were diagnosed with separation anxiety disorder as a child. Adults who grew up with overbearing parents may also be at an increased risk.

What are symptoms of Separation Anxiety Disorder (SAD)?

• Individuals with SAD experience recurrent excessive distress when separation from home or major attachment figures is anticipated or occurs.
• People with SAD worry about the well-being or death of attachment figures particularly when separated from them. For example, excessive worry about losing a parent or other loved one to an illness or a disaster.
• People with SAD feel the constant need to know the whereabouts of their attachment figures or loved ones and want to stay in touch with them all the time.
• Individuals with SAD are constantly worried that something bad will happen, such as being lost or kidnapped causing separation from parents or other loved ones.
• Individuals with SAD are reluctant or refuse to go out by themselves because of separation fears. They have persistent and excessive fear or reluctance about being alone or without major attachment figures at home or in other settings.
• Children with SAD may be unable to stay or go in a room by themselves and may display “clinging behavior”, staying close to or “shadowing” the parent around the house, or requiring someone to be with them when going to another room in the house.
• Children with SAD have persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home such as refusal to attend camp, to sleep at friends’ homes, or to go on errands. They often have difficulty at bedtime and may insist that someone stay with them until they fall asleep.
• Individuals with SAD may have repeated nightmares in which the content expresses their separation anxiety (e.g., destruction of the family through fire, murder or other catastrophe)
• Physical symptoms (e.g., headaches, abdominal complaints, nausea, vomiting) are common in children when separation from major attachment figures occurs or is anticipated.
• Cardiovascular symptoms such as palpitations, dizziness, and feeling faint are rare in younger children but may occur in adolescents and adults.

How common is Separation Anxiety Disorder (SAD)?

Separation anxiety disorder (SAD) affects approximately 4% – 5% of children in the U.S., aged 7 to 11 years. It is less common in teenagers, affecting about 1.3% of American teens. The 12-month prevalence of separation anxiety disorder among adults in the U.S. is 0.9% – 1.9%. It is the most prevalent anxiety disorder in children younger than 12 years. In clinical examples of children, the disorder is equally common in males and females. In the community, the disorder is more frequent in females.

How is Separation Anxiety Disorder (SAD) diagnosed?

Child psychiatrists, child psychologists, or paediatric neurologists can diagnose and treat separation anxiety disorder in children. These trained clinicians collect information from home, school, and at least one clinical visit to make a diagnosis. The children with SAD frequently have physical complaints that may need to be medically evaluated.

To diagnose this condition in adults, the healthcare provider such as a psychiatrist or psychologist will conduct a comprehensive examination and use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. They may also talk to close family members or friends to help them better understand how your symptoms affect your daily life.

What is the treatment of Separation Anxiety Disorder (SAD)?

Treatment for separation anxiety disorder for children may include psychotherapies and medications.

• Talk Therapy provides a safe place for your child to express their feelings. Having someone to listen empathetically and guide your child toward understanding their anxiety can be extremely helpful.
• Play Therapy is a common and effective way to get kids talking about their feelings.
• Family counselling can help your child counteract the thoughts that fuel their anxiety, while you as the parent can help your child learn coping skills.
• Medications may be used to treat severe cases of separation anxiety disorder. It should be used only in conjunction with other therapy.

Treatment for adult separation anxiety disorder is similar to treatments used to treat other anxiety disorder.

• Cognitive Behavior Therapy (CBT) is the main form of treatment for separation anxiety disorder. This therapy aims to help a person identify their thoughts and behaviors that are making their separation anxiety worse.
• Group Therapy can help individuals become more aware of the people with the similar condition and find comfort in the fact that they are not alone. In each session, participants learn specific skills to help themselves feel better, cope with, and manage their difficulties and decrease the risk of future relapse.

Tips for adults with SAD

• Talking to someone you trust about what’s making you anxious could be a relief. It may be that just having someone listen to you and show they care can help in itself.
• You can try to do some breathing exercises which may help you cope and feel more in control.
• You can try to manage your worries by writing them down and keeping them in a particular place (for example, you can write them in a notebook or on pieces of paper you put in an envelope or jar).
• You can try to get enough sleep because a good sleep can give you the energy to cope with difficult feelings and experiences.
• You can try to do some physical activity such as exercise regularly as it can be really helpful for your mental wellbeing.
• You can try other alternative therapies that may help you to manage your anxiety such as yoga, meditation, massage, aromatherapy, reflexology, etc.

Tips for families and carers of a child with SAD

• Parents can educate themselves about separation anxiety disorder as this will help them in understanding and sympathizing with their child’s struggles.
• Parents can acknowledge and reinforce their child’s efforts such as if your child goes to bed without a fuss or if your child gets a good report from school, you can provide positive reinforcement to your child.
• Encourage your child to participate in healthy social and physical activities. They are great ways to ease anxiety and help your child develop friendships.
• Try to keep calm during separation. If your child sees that you can stay cool, they are more likely to be calm, too.
• Parents can create quick good-bye rituals such as giving triple kisses on cheeks, or provide a special blanket or toy as they leave. Keep the good bye short and sweet. If you linger, the transition time does too and so will the anxiety.
• When separating, give your child full attention, be loving and provide affection. Then say good bye quickly despite their antics or cries for you to stay.

Myths v/s Facts about Separation Anxiety Disorder (SAD)

References

• https://www.therecoveryvillage.com/mental-health/separation-anxiety/separation-anxiety-myths/
• https://www.helpguide.org/articles/anxiety/separation-anxiety-and-separation-anxiety-disorder.htm
• https://www.msdmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/separation-anxiety-disorder
• https://www.healthychildren.org/English/ages-stages/toddler/Pages/Soothing-Your-Childs-Separation-Anxiety.aspx
• American Psychiatric Association. Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.