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.
• Anxiety 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 Disorder (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
• Adult 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

16. Thank You