Diseases & Conditions
Separation Anxiety Disorder
Separation anxiety disorder is characterized by excessive anxiety about being away from home or separated from people to whom the child is attached.
Some degree of separation anxiety is normal and occurs in almost all children, especially in very young children (see Problems in Infants and Very Young Children: Separation Anxiety ). In contrast, separation anxiety disorder is excessive anxiety that goes beyond that expected for the child's developmental level. Separation anxiety is considered a disorder if it lasts at least a month and causes significant distress or impairment in functioning. The duration of the disorder reflects its severity.
Some life stress, such as the death of a relative, friend, or pet or a geographic move or change in schools, may trigger the disorder. Genetic vulnerability to anxiety also typically plays a key role.
Children with this disorder experience great distress when separated from home or from people to whom they are attached. They often need to know the whereabouts of these people and are preoccupied with fears that something terrible will happen either to them or to their loved ones. Traveling by themselves makes them uncomfortable, and they may refuse to attend school or camp or to visit or sleep at friends' homes. Some children are unable to stay alone in a room, clinging to a parent or "shadowing" the parent around the house.
Difficulty at bedtime is common. Children with separation anxiety disorder may insist that someone stay in the room until they fall asleep. Nightmares may disclose the children's fears, such as destruction of the family through fire or another catastrophe.
Because a child who has this disorder often avoids school, an immediate goal of treatment is enabling the child to return to school. Doctors, parents, and school personnel must work as a team to ensure the child's prompt return to school. Individual and family psychotherapy and anxiety-reducing drugs may play an important role.
Effects of Stress on Children
A stressful change in a child's life, such as a geographic move, divorce of the parents, or the death of a family member or pet, can trigger an adjustment disorder. Adjustment disorder is an acute but time-limited response to environmental stress. The child may have symptoms of anxiety (for example, nervousness, worries, and fears), symptoms of depression (for example, tearfulness or feelings of hopelessness), or behavioral problems. The symptoms and problems abate as the stress diminishes.
Posttraumatic stress disorder is a much more extreme response and may occur after a natural disaster (such as a hurricane, tornado, or earthquake), an accident, death, or a senseless act of violence (see Anxiety Disorders: Posttraumatic Stress Disorder (PTSD) ), including child abuse. The child usually fails in his attempts to avoid remembering the event, suffers a persistent state of anxiety, and may reexperience the traumatic event while awake (flashback) or asleep (nightmares). Crisis intervention is usually necessary, in the form of an extended period of individual, group, or family therapy. Treatment with anxiety-reducing drugs may be needed.
Last full review/revision February 2003
Source: The Merck Manual Home Edition