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SEPARATION ANXIETY DISORDER
 


SYNOPSIS

Separation Anxiety Disorder of Childhood F93.0 - ICD10 Description, World Health Organization

Should be diagnosed when fear of separation constitutes the focus of the anxiety and when such anxiety first arose during the early years of childhood. It is differentiated from normal separation anxiety when it is of a degree (severity) that is statistically unusual (including an abnormal persistence beyond the usual age period), and when it is associated with significant problems in social functioning.
Separation Anxiety Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with separation anxiety disorder needs to meet all of the following criteria:

  • Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

    • Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

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

    • Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.

    • Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

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

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

    • Repeated nightmares involving the theme of separation.

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

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

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

  • 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.

In this disorder, individuals display excessive anxiety when away from home or from those to whom they are emotionally attached. This separation anxiety has to be developmentally inappropriate and excessive; with onset before age 18. It must last at least 4 weeks in children and adolescents and 6 months or more in adults. This disorder must cause significant distress or life impairment. This disorder does not occur exclusively during the course of a more serious disorder like autistic spectrum disorder, schizophrenia, other psychotic disorder, agoraphobia, generalized anxiety disorder, or illness anxiety disorder.

Effective Therapies

The first-line treatment for this disorder is Cognitive Behavioral Therapy (CBT) [exposure with prevention of avoidance behavior]. If this fails, treatment with SSRI antidepressant medication is often effective.

Ineffective Therapies

Tricyclic antidepressants and benzodiazepines are ineffective.

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