Separation anxiety disorder

Psychiatry

1. Separation Anxiety Disorder Slam 201002414 UBSoM

2. Presentation Outline Definitions Introduction Etiology DSM V Criteria Management Prognosis

3. Definitions Fear is the emotional and physiological response to real or perceived imminent threat. A nxiety is a mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune Panic group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat Panic attacks feature prominently within the anxiety disorders as a particular type of fear response Phobia is a kind of anxiety that is also defined in DMS-IV-TR as a “persistent or irrational fear.”

4. The neurotic paradox is a self-defeating behavior pattern: despite knowing there is little to be afraid of, a child is terrified and does everything possible to escape/avoid the situation Fight/flight response : immediate reaction to perceived danger or threat aimed at escaping potential harm

5. Introduction Anxiety disorder is blanket term covering several different forms of abnormal, pathological anxiety, fears, phobias and nervous conditions that are described as an irrational or illogical worry that is not based on fact The term anxiety disorder can cover a range of severities from general social anxieties to panic disorders The anxiety disorders differ from one another in the types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation.

6. Separation Anxiety Disorder Separation Anxiety D isorder (SAD) is a psychological condition in which an individual has excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment

7. Present in all age groups A dult separation anxiety is now believed to be even more common than childhood separation anxiety

8. Separation anxiety symptom School refusal behaviors Sleep disturbance Nightmares Refusal to go to sleep Refusal for a sleep over Studies show that children suffering from separation anxiety are much more likely to have ADHD, Bipolar disorder, Panic disorder, and others later in life.

9. Etiology It is normal from about age 7 months through preschool years Separation anxiety often develops after a significant stress or trauma in the child’s life, such as: stay in the hospital the death of a loved one change in the environment

10. SAD in children may be heritable There are cultural variations in the degree to which it is considered desirable to tolerate separation SAD decreases in prevalence from childhood through adolescence and adulthood and is the most prevalent anxiety disorder in children younger than 12 years.

11. Diagnostic Criteria DSM V A. 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: 1. Recurrent excessive distress when anticipating or experiencing separation from home or from 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) that causes separation from a major attachment figure. 4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation. 5. Persistent 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 .

12. 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. The disturbance must last for a period of at least 4 weeks in children and adolescents younger than 18 years and is typically 6 months or longer in adults (Criterion B).

13. 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.

14. Management Cognitive behavioral psychotherapy is the primary type of treatment used for SAD For older children who have not outgrown separation anxiety within the normal developmental timetable or who have regressed to it under stress Effective treatments may include: Anti-anxiety medications Changes in parenting techniques Counseling for the parents and child Treatments for severe cases may include: Family education Family therapy Individual psychotherapy

15. Prognosis Over 60% of children participating with their parents in CBT are successful in managing their symptoms with out medication. SAD has a poorer prognosis in environment where threat of physical harm or separation actually exist. Existence of other conditions, such as autism, decrease the like hood of a positive prognosis. SAD in children may be associated with an increased risk for suicide

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