Developmentally
inappropriate and excessive anxiety concerning separation from home
or from those to whom the individual is attached, as evidenced by
three (or more) of the following
Recurrent
excessive distress when separation from home or major attachment figures
occurs or is anticipated.
Persistent
and excessive worry about losing, or possible harm befalling, major
attachment figures.
Persistent
and excessive worry that an unexpected event will lead to separation
from a major attachment figure (e.g. getting lost or being kidnapped).
Persistent
reluctance or refusal to go to school or elsewhere because of fear
of separation.
Persistently
and excessively fearful or reluctant to be alone or without major
attachment figures at home or without significant adults in other
settings.
Persistent
reluctance or refusal to go to sleep without being near a major attachment
figure or to sleep away from home.
Repeated
nightmares involving the theme of separation.
Repeated
complaints of physical symptoms, headaches, stomachaches, nausea,
or vomiting, when separated from major attachment figures occurs,
or is anticipated.
The duration of the disturbance is at least 4 weeks.
The disturbance
causes clinically significant distress or impairment in social, academic
(occupational), or other important areas of functioning.
The disturbance
does not occur exclusively during the course of a Pervasive Developmental
Disorder, Schizophrenia,
or other Psychotic Disorder and, in adolescents and adults, is not
better accounted for by Panic Disorder
With Agoraphobia.
Associated
Features:
Depressed
Mood
Somatic
or Sexual Dysfunction
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders
have similar or even the same symptom. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which he needs to rule out to establish a precise diagnosis.
Pervasive
Developmental Disorders;
Schizophrenia, or other
Psychotic Disorders;
Generalized Anxiety Disorder;
Panic Disorder with Agoraphobia;
Agoraphobia Without History of
Panic Disorder;
Conduct Disorder;
Developmentally appropriate levels of separation anxiety.
Cause:
As infants develop
and become more aware and interactive with their environment, they
experience various emotions. Trust, safety, and comfort depend on
familiarity and consistency. From 8 to 14 months, many children experience
fear when they are denied familiar and safe situations. They recognize
their parents as familiar and safe and when separated from parents,
they may feel threatened and unsafe. Separation anxiety is a normal
development stage that usually decreases around 2 years old when toddlers
begin to understand that parents may be out of sight but will return.
Even after children
have successfully mastered this developmental stage, separation anxiety
may return during periods of stress . Most children will experience
some degree of separation anxiety when in unfamiliar situations such
as a stay in hospital, when experiencing stress's. It is therefore
natural for them to seek the safety, comfort, and protection of their
parents. When parents cannot be with their children in these situations,
the child experiences distress.
Treatment:
It is helpful
for a parent to be with children during stressful occasions such as
during medical examinations or treatments. When a parent cannot accompany
the child, prior experience or exposure to the situation is helpful.
If this is not possible, the child may display severe anxiety by crying,
resisting, begging, screaming. It is always desirable to explain the
situation and experience to the child and to assure them.
