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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
slide6
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
slide7
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
slide33
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
slide37
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
ad