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Separation Anxiety Disorder. An Anxiety Disorder. Anxiety Disorders . Separation Anxiety Disorder Selective Mutism Specific Phobia Social Anxiety Disorder (social phobia) Panic Disorder Agoraphobia Generalized Anxiety Disorder Substance/Medication-Induced Anxiety Disorder

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Separation anxiety disorder

Separation Anxiety Disorder

An Anxiety Disorder


Anxiety disorders
Anxiety Disorders

  • Separation Anxiety Disorder

  • Selective Mutism

  • Specific Phobia

  • Social Anxiety Disorder (social phobia)

  • Panic Disorder

  • Agoraphobia

  • Generalized Anxiety Disorder

  • Substance/Medication-Induced Anxiety Disorder

  • Anxiety Disorder Due to Another Medical Condition

  • Other Specified Anxiety Disorder

  • Unspecified Anxiety Disorder


Anxiety disorders1
Anxiety Disorders

  • Similarities

  • Differences


History of separation anxiety disorder in the dsm
History of Separation Anxiety Disorder in the DSM

  • Introduced DSM-III, 1980

  • 3 of 9 symptoms @ least 2 weeks

  • Anxiety Disorders of Childhood

  • DSM-III to DSM-IV

    • 3 of 8 criteria @ least 4 weeks

    • No more Anxiety Disorders of Childhood

  • IV to IV-TR

    • Prevalence and Course sections were updated

  • IV-TR to DSM-5

    • Anxiety Disorder

    • Wording

    • No more specific onset of 18yo

    • Addition of 6mo or more duration criterion


  • Separation anxiety disorder dsm 5
    Separation Anxiety Disorder: DSM-5

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

      • (1) Recurrent excessive distress when separation from home or major attachment figures

      • (2) Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death

      • (3) Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill)

      • (4) Persistent reluctance or refusal to go out, away from the home, to school, to work, or elsewhere because of fear of separation

      • (5) Persistently and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

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

      • (7) Repeated nightmares involving the theme of separation

      • (8) Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

    • B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults

    • C. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

    • D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder

    • Specify if: Early Onset: if onset occurs before age 6 years


    Criterion for Separation Anxiety Disorder

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

      • (1) Recurrent excessive distress when separation from home or major attachment figures

      • (2) Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death

      • (3) Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill)

      • (4) Persistent reluctance or refusal to go out, away from the home, to school, to work, or elsewhere because of fear of separation

      • (5) Persistently and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

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

      • (7) Repeated nightmares involving the theme of separation

      • (8) Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated


    Criterion for Major Depressive Disorder

    • B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults

    • C. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

    • D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder

    • Specify if: Early Onset: if onset occurs before age 6 years


    Prevalence
    Prevalence

    • Little controlled research on SAD

    • Prevalence rate of 2-4 %

    • One study did report 2.8% [2.8%, 95% confidence interval (CI) 2.1-3.8, for current disorder]

    • 15-35% prevalence rate in samples of children with anxiety disorders

    • Suggestion that SAD occurs more frequently in girls but there is very little support

    • Prevalence rate does NOT increase with age




    Development onset course duration
    Development, Onset, Course, Duration

    https://www.youtube.com/watch?v=jEkFp0Ux4OQ


    Development onset course duration cont
    Development, Onset, Course, Duration cont…

    • Course is marked by exacerbation and remission over a period of years

    • As many as 30-44% of children with SAD show evidence of psychological problems that continue into adult life

    • May precede the development of conditions such as panic disorder and agoraphobia


    Associated features
    Associated Features

    • Behavioral

      • Social withdrawal

      • Difficulty concentrating on work or play

      • Homesick and Uncomfortable

      • Anger or Aggression

    • Emotional

      • Apathy

      • Sadness

    • Physical Symptoms

      • Nausea/Vomiting

      • Headaches

      • Stomaches


    Associated features cont
    Associated Features cont.

    • Cognitive

      • Evening or dark perceptual experiences

      • Fears

        • Accidents

        • Illness

        • Monsters

        • Of getting lost

        • Of being kidnapped


    What do children with separation anxiety disorder look like
    What do children with Separation Anxiety Disorder look like?

    • Demanding

    • Intrusive

    • Frustration

    • Resentment

    • Conflict


    Difference in expression between younger and older children
    Difference in expression between younger and older children

    • Younger Children 5-8yo

      • More symptoms

      • Unrealistic worry

      • School refusal

    • Older Children 9-12yo

      • Excessive distress

    • Adolescence

      • Somatic complaints

      • School refusal more common



    Models of separation anxiety
    Models of Separation Anxiety

    • Environmental Change

    • Genetic

    • Parent-Child Attachment

    • Developmental Considerations

    • Cognitive Factors

    • Behavioral Factors

    • Stress Factors


    Environmental change
    Environmental Change

    Environmental Change

    Separation Anxiety Disorder

    STRESS


    Genetic influence
    Genetic Influence

    History of panic disorder, anxiety, or depression

    Predisposition toward later development of anxiety disorders


    Parent child attachment
    Parent-Child Attachment

    …Emotional distance

    Behaviors


    Developmental considerations
    Developmental Considerations

    Between and Within

    Slower rate of development can foster separation anxiety


    Cognitive factors
    Cognitive Factors

    Anxiety

    &

    Irrational Behaviors


    Behavioral factors
    Behavioral Factors

    Crying and

    Clinging Behavior

    = distract attention away

    Nurtures anxiety and fear


    Stress factors
    Stress Factors

    Change

    (stress factor)

    Feel uncomfortable

    Anxious Response


    Neurobiology of separation anxiety disorder
    Neurobiology of Separation Anxiety Disorder

    • Research done on the neurobiology of SAD has not been exclusively conducted on SAD. Literature has included SAD when analyzing all anxiety disorders in groups of children.

    • They amygdala has been one of the most prominent structures identified as being involved in anxiety disorders.

    • Until more research has been conducted solely on SAD any conclusions drawn would be an extrapolation of the findings from the other anxiety disorders


    Accounting for variance genetics bolton d eley tc o connor tg et al
    Accounting for Variance: Genetics Bolton D, Eley TC, O’Connor TG, et al.

    • Twin pair study of 6-6.5yo

    • N = 854

    • MZ and DZ




    Accounting for variance hpa axis and hormonal influences during pregnancy
    Accounting for Variance: HPA-Axis and hormonal influences during pregnancy

    Maternal endocrine activation during pregnancy and/or early separation or loss

    Lower cortisol levels

    Anxiety, learned helplessness, depression


    Accounting for variance hpa axis and cognitive appraisal
    Accounting for Variance: HPA-Axis and Cognitive Appraisal

    • Cognitive processes may trigger the stimulation of the HPA axis activity

      • The interpretation of a situation as being stressful or not

      • Separation anxiety disorder is derived from theories of anxiety disorders generally, which are predominately cognitive theories


    Accounting for variance hpa axis and cognitive appraisal and gender
    Accounting for Variance: HPA-Axis and Cognitive Appraisal and Gender

    • The pattern of results from the previous findings suggests there may be some gender-related differences with regard to the cognitive appraisal and anticipation of threat


    Accounting for Variance: Family DynamicCronk, N. J., Slutske, W. S., Madden, P. a F., Bucholz, K. K., & Heath, A. C. (2004). Risk for separation anxiety disorder among girls: paternal absence, socioeconomic disadvantage, and genetic vulnerability. Journal of abnormal psychology, 113(2), 237–47. doi:10.1037/0021-843X.113.2.237

    • N=1,887

    • Female MZ and DZ twin pairs

    • Looking across 4 SAD Categories @

      • Attachment

      • Paternal Absence

      • Socioeconomic Disadvantage


    4 categories of sad
    4 Categories of SAD

    • SAD-Symptoms

      • Presence of 3 or more symptoms

    • SAD-Cluster

      • Presence of 3 or more symptoms occuring together for a period of at least 1 month

    • SAD-Impair

      • Presence of 3 or more symptoms causing impairment in functioning and/or treatment seeking

    • SAD-Full

      • Presence of 3 or more symptoms with clustering and impairment/treatment seeking, consistent with DSM-IV


    Race income paternal absence
    RaceIncomePaternal Absence


    a=additive genetic factorc=shared environmental factorp=paternal absence effects=socioeconomic disadvantage effect


    What this study says
    What this study says…

    • Effects of paternal absence on SAD are rather robust.

    • As predicted, paternal absence appears to be an important predictor of all categories of SAD

      • Suggesting that the loss or threat of loss of a father figure has important consequences for separation anxiety in girls.

    • Attachment theory, suggest that the loss of a parent (or attachment figure) in the preschool years or younger would be most detrimental to subsequent development.


    What this means
    What this means…

    • Socioeconomic disadvantage

      • 0.1%-1.0% total variance

      • 0.4%-2.7% shared environmental effects

    • Paternal Absence

      • 1.0%-3.0% total variance

      • 4.3%-8.7% shared environmental effects

    • “Important role for genes”

    • High Heritability estimates for parent-reported symptoms of SAD in girls


    Maddie marks model
    Maddie Marks’ Model




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