Separation Anxiety Disorder: Symptoms, Causes And Treatment
We all come into the world as vulnerable beings, requiring up to a year of brain maturation to take our first hesitant steps, or even to communicate our will through the spoken word.
This is why relationships with attachment figures are fundamental, since the foundation of autonomy and safe exploration of the natural environment is built from them in a time of extreme lack of protection.
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 to this stage of his life and those to come (such as school or relationships with peers).
Separation anxiety disorder It involves the appearance of deep unease during this natural transition process, and is undoubtedly one of the most common psychological problems in childhood.
Separation anxiety disorder is present in 4% of children and 1.6% of adolescents. It involves a deadly fear of distancing oneself from attachment figures, which translates into discomfort in situations in which they leave their side. Very often it is some imaginary distance, without objective support, with which the child projects his uncertainty or anxiety into the future.
From now on we will describe what its core symptoms are, as well as the reasons why it may occur and the therapeutic approach we currently have available.
1. Emotional distress anticipating a separation from attachment figures
Children with separation anxiety disorder are sensitive to any cues that might suggest estrangement 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 this, but also to those that could occur in the future, anticipating “threats” that with great probability will never arise.
In this sense, it is important to consider that, in the first years of life, the projection of the future may be conditioned by magical thinking: children would formulate hypotheses about reality devoid of adult logic, but which they would give total credibility. within the framework of their personal experiences and expectations, turning improbable events (abduction, abandonment, etc.) into real and tangible risks Time, then, becomes an enemy and a source of stress.
As the anticipated day approaches, children see their emotional pain and worry increase. It can also frequently be seen 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 care figures (relatives, teachers, etc.).
2. Excessive and persistent worry about losing one of the attachment figures or suffering harm
Children with generalized anxiety disorder They are concerned about the health and well-being of their loved ones, living in fear that misfortune or illness may occur. This is why they develop reassurance behaviors, which consist of inquiring into the state of their parents by asking questions about the probability that they will die or suffer some damage (which is experienced with surprise on the part of those in question).
This fear becomes more acute during 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 may precipitate an attitude of suspicion in the child, which would end up adding uncertainty to the child’s experience of anxiety. In the case of minor pathologies, such as colds or other temporary processes, An attitude of excessive concern and distress may appear in the face of innocuous symptoms (fever, cough, etc.).
3. Fear of an event happening that could 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 parents. These include the probability of being lost or kidnapped, or of a third party accessing 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 merges in some way 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 anxiety the conflicts that occur in the context of family friction. In this way, she can report discomfort during arguments between the parents themselves (daily quarrels over ordinary matters) or in the event that any of them shows signs of anger or disagreement regarding her way of acting. The latter can trigger the belief that one deserves punishment or that one is “bad”, which can deeply anchor self-esteem and cause fear of abandonment
4. Persistent refusal to leave home
In children with separation anxiety disorder, the home may be perceived as the main space of security, so when they move away from it they experience it with overwhelming anxiety. This fact becomes more acute during moves, when you move to a new school (or institute) and when the summer holidays arrive. Such fear can motivate a flat refusal to participate in any school excursion or trip, especially when they involve spending the night away from home.
The fear of walking away can be maintained until reaching adolescence, although there is evidence that separation anxiety disorder tends to reduce its prevalence as time passes. In this case, the emotion that overcomes 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 family framework.
5. Concern about loneliness
Concern about being alone is common in this disorder, as it is a time in which the child perceives an increased probability of being kidnapped or lost, two of the most feared situations. This is why distance from attachment figures leads to an inhibition of play and other behaviors that explore the environment, recovering only when their presence is restored.
This fear is particularly common at bedtime, and intensifies when parents decide to place their child’s bedroom in a separate space.
In this transition period, the child expresses the desire to be accompanied, or sneaks into the bed of a trusted person in the middle of the night. Sometimes you can develop a problem sleeping expectant of the sounds that could emerge in the silence of the house while feeding fears with his vivid imagination.
6. Recurring nightmares about separation from attachment figures
Nightmares in which damage to either parent is represented are very common in this disorder, and one of the reasons why they may reject the idea of ​​sleeping alone. This is a more frequent phenomenon in younger kids, since There is a period in which the fear of separation from parents becomes normal and adaptive In this case, however, the nightmares cause a profound impairment in the life of the minor and that of his family (interfering excessively in 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 (which sometimes happens in the middle of the night), usually deals with divorce or the emergence of some tragic event. (murders, accidents, etc.). In this case, he may wake up agitated, screaming and/or sobbing.
Assuming you go back to sleep immediately, and also don’t remember anything about what happened the next morning, it could be a night terror (a parasomnia whose intensity increases during periods of stress).
7. Recurrent physical complaints during separation from attachment figures or when this is anticipated
Many children somatize physical discomfort as a consequence of the separation. The most frequent symptoms are headache, abdominal pain, dizziness, nausea, cramps, palpitations and chest pain ; occurring singly or in combination. Furthermore, they manifest themselves in the hours before going to school or other activities (during which a temporary distance from the people with whom an attachment bond has been forged) is anticipated.
This eventuality usually worries parents a lot and motivates visits to the pediatrician, whose examinations find no organic cause for such a florid clinic. In addition, causes constant school absenteeism, which conditions the acquisition of knowledge provided for in the child’s curriculum and warrants the adoption of extraordinary measures (repetition of a course, for example). When symptoms persist at school, it is possible that they become associated with that space, producing explicit refusal to go to school.
Causes
The scientific literature on this issue has tried to determine the risk factors for this anxiety disorder, with causes having been detected in the environment and parenting styles. The most important one refers to the formation of some insecure attachment in any of its three subtypes: worried (feeling that they will not have help if they need it), fearful (parental rejection of attempts to approach them) and disorganized (explicit experiences of abuse or hostility).
Abrupt changes in everyday life can also contribute to this problem (moving, enrolling in a new school or institute, etc.), given that predictable environments are essential for children’s emotional development.
Stress due to family situations (divorce, death of a loved one, birth of a new sibling, 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 their childhood are more likely to suffer panic attacks (episodes of acute anxiety).
Finally, an overprotective parenting style can also be related to this anxiety disorder, since it would deprive the child of safely exploring their environment and severely reduce their autonomy. This is why loneliness is experienced as an unbearable helplessness because the child believes he does not have the tools to manage it without help.
The search for balance between freedom and protection is key to caring for a child, since it depends on forging the first tools with which to build their autonomy.
What is your treatment?
There is an effective psychological treatment for this mental health problem, which involves both a cognitive and behavioral approach, as well as the articulation of a plan aimed at promoting habits that facilitate coexistence at home. First of all, psychoeducational treatment is necessary about the problem (along with a functional analysis), so that parents understand what the most specific causes of it are and can tackle them at their source.
It is advisable actively talk to your child about his or her feelings, without avoiding them or downplaying them. It is also interesting to support them to get involved in shared activities with their peer group, and to reinforce the progress that is 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.
