Separation Anxiety Disorder: Symptoms, Causes, and Treatment

We all come into the world as vulnerable beings, since we require up to a year of brain maturation to take our first and hesitant steps, or even to communicate our will through the word spoken.

That is why relationships with attachment figures are fundamental, since it is from them that the foundation of autonomy and the safe exploration of the natural environment at a time of extreme vulnerability.

In this sense, it is essential to progressively stimulate the child's independence, so that he can be prepared to take on the challenges inherent in this stage of their life and those to come (such as school or relationships with same).

Separation Anxiety Disorder It supposes the appearance of a deep unease during this natural transition process, and it is undoubtedly one of the most common psychological problems in childhood.

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What is separation anxiety disorder in children?

Separation anxiety disorder is present in 4% of children and 1.6% of adolescents.

It supposes a cerval fear of distancing from attachment figures, which translates into discomfort in situations in which they leave their side. Very often it is some imaginary distancing, without objective support, with which the child projects his uncertainty or her anguish into the future.

Hereinafter we will describe what its core symptoms are, as well as the reasons why it can occur and the therapeutic approach that we currently have.

1. Emotional discomfort anticipating a separation from attachment figures

Children with separation anxiety disorder are sensitive to any clues that might suggest a withdrawal from their attachment figures (especially their parents). For this reason they remain very attentive not only to the events that occur in front of them and that in their opinion suggest it, but also those that could occur in the future, anticipating "threats" that with great probability will never reach introduce oneself.

In this sense, it is important to consider that, in the first years of life, the projection on becoming can be conditioned by a magical thinking: children would formulate hypotheses about reality devoid of adult logic, but which they would endow with total credibility within the framework of their personal experiences and expectations, making unlikely events (abduction, abandonment, etc.) in real and tangible risks. Time, then, becomes an enemy and a source of stress.

As the anticipated day approaches, children see increased emotional pain and worry. It can also be seen frequently a worsening of the behavioral aspects of the problem. Thus, it is not strange that they express their fears through tantrums and outbursts of temper, which represent a conflict for parents and other caregivers (relatives, teachers, etc.)

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2. Excessive and persistent worry about losing some of the attachment figures or being hurt

Children with generalized anxiety disorder are concerned about the health and well-being of their related figures, living in fear of misfortune or illness. This is why they develop reinsurance behaviors, which consist of inquiring into the status of their parents asking questions about the probability that they will die or suffer some damage (which is experienced with surprise on the part of the alluded to).

This fear is heightened in the periods in which one of the attachment figures develops a common or more serious illness. In the latter case, the family's attempts to hide the situation can precipitate an attitude of suspicion in the child, which would end up adding uncertainty to his experience of anxiety. In the case of minor pathologies, such as colds or other transitory processes, an attitude of excessive worry and unease may be shown at innocuous symptoms (fever, cough, etc.).

3. Fear of an event happening that may lead to separation from the attachment figure

One of the most common phenomena in the context of this disorder is the appearance of thoughts about imaginary events that could precipitate an abrupt separation from the parents. These include the likelihood of being lost or abducted, or of a third party gaining access to the privacy of the home and causing harm to family members.

This fear coexists with normal fears for the age period, such as those related to monsters or fantastic beings, and even somehow merges with them (developing fear of Santa Claus due to the possibility that he has evil intentions, for example).

It is also common for the child to experience with intense anguish the conflicts that occur in the setting of family friction. In this way, they can report discomfort during discussions between their own parents (daily fights over issues ordinary) or in the event that any of them show signs of anger or disagreement regarding their Act. The latter can trigger the belief that he deserves punishment or that he is "bad", which can be deeply anchored in self-esteem and cause fear of abandonment.

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4. Persistent refusal to separate from home

In children with separation anxiety disorder, the home can be perceived as the main safe space, so when they move away from it they experience it with overwhelming anguish. This fact is exacerbated during removals, when you change to a new school (or institute) and when the summer holidays arrive. Such fear can motivate an outright refusal to participate in any field trip or school trip, especially when it involves spending the night away from home.

The fear of walking away can be maintained into adolescence, although there is evidence that separation anxiety disorder tends to decrease in prevalence as time passes. In this case, the emotion that overwhelms the person can hinder the development of dyadic relationships (friendship, camaraderie, etc.) at a time in life when the first bonds are usually forged outside the framework family.

5. Preoccupation with loneliness

The concern about being alone is common in this disorder, as it is a time when the child perceives an increased likelihood of being abducted or lost, two of the most feared situations. That is why the distance from attachment figures leads to inhibition of play and other behaviors of exploration of the environment, recovering only at the moment in which its presence.

This fear is particularly frequent at the time of going to sleep, and it intensifies when the parents decide to locate the child's bedroom in a separate space.

In this transition period, the child expresses the desire to be accompanied, or slips into the bed of a trusted person in the middle of the night. Sometimes you can develop a problem sleeping, expectant at the sounds that could arise in the silence of the house while feeding the fears with his vivid imagination.

6. Recurring nightmares about separation from attachment figures

Nightmares in which harm is done to either parent are very common in this disorder, and one of the reasons why they may reject the idea of ​​sleeping lonely. It is a more frequent phenomenon in younger children, since there is a period in which the fear of separation from the parents becomes normal and adaptive. In this case, however, the nightmares cause a profound impairment in the life of the minor and that of her family (interfering excessively with the areas of functioning).

The content of the nightmares, which the child is able to evoke at the moment in which the parents inquire about the subject (what sometimes happens in the middle of the night), it usually deals with divorce or the irruption of some sad event (murders, accidents, etc.). In this case, you may wake up agitated, screaming and / or sobbing.

In the event that you go back to sleep immediately, and also do not remember anything that happened the next morning, it could be a night terror (a parasomnia whose intensity increases during periods of stress).

7. Recurring physical complaints during separation from attachment figures or when it is anticipated

Many children experience physical discomfort as a consequence of the separation. The most frequent symptoms are headache, abdominal pain, dizziness, nausea, cramps, palpitations, and chest pain; appearing singly or in combination. In addition, they manifest themselves in the hours before going to school or other activities (during which is anticipated a temporary distancing from the people with whom a bond of attachment).

This eventuality tends to worry the parents a lot and motivate visits to the pediatrician, whose examinations find no organic cause for such a flowery clinic. In addition, causes constant truancy, which conditions the acquisition of knowledge provided in the child's curriculum and warrants the adoption of extraordinary measures (repetition of the course, for example). When the symptoms persist in school, it is possible that they are associated with that space, producing the explicit refusal to go to it.

Causes

The scientific literature on this question has tried to determine which are the risk factors for this anxiety disorder, having detected causes in the environment and in parenting styles. The most important refers to the formation of an insecure attachment in any of its three subtypes: worried (feeling that help will not be available if needed), fearful (parental rejection of attempts at approach) and disorganized (experience of abuse or hostility explicit).

Also abrupt changes in daily life can contribute to this problem (moving, enrollment in a new school or institute, etc.), given that predictable environments are essential for the affective development of kids.

Stress from family situations (divorces, death of a loved one, birth of a new brother, etc.), and the experience of rejection at school, can also be related to this problem.

In turn, there is evidence that adults who suffered from this anxiety disorder in childhood are more likely to suffer from panic attacks (episodes of acute anxiety).

Finally, an overprotective parenting style may also be related to this disorder. anxiety, since it would deprive the child of safely exploring her environment and severely reduce his autonomy. That is why loneliness is experienced as an unbearable helplessness, since the child believes he does not have the tools to manage it without help.

The search for a balance between freedom and protection is key to caring for a child, since it depends on it forging the first tools with which to build her autonomy.

What is your treatment?

There is an effective psychological treatment for this mental health problem, which involves both a cognitive and a cognitive approach as behavioral, as well as the articulation of a plan aimed at promoting habits that facilitate coexistence in the home. First of all, a psychoeducational treatment is necessary about the problem (together with a functional analysis), so that parents understand what the most specific causes of it are and can tackle them from its source.

It is advisable actively talk to the child about her feelings, without avoiding or downplaying them. It is also interesting to support him to get involved in shared activities with his peer group, and to reinforce the progress made towards the development of independence. Likewise, it is essential to face the separation situation naturally, and to be accessible at times when the child may need closeness or support.

Bibliographic references:

• Ehrenreich, J.T., Santucci, L.C. and Weiner, C.L. (2008). Separation Anxiety Disorder in Youth: Phenomenology, Assessment and Treatment. Behavioral Psychology, 16 (3), 389-412.
• Silove, D., Manicavasagar, V. and Pini, S. (2016). Can Separation Anxiety Disorder Escape its Attachment to Childhood? World Psychiatry, 15 (2), 113-115.