Separation anxiety disorder: symptoms, causes and treatment.

An overview of separation anxiety disorder that occurs in some children.

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

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 is built at a time of extreme lack of protection.

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

Separation anxiety disorder supposes the appearance of a deep uneasiness during this natural process of transition, and it is undoubtedly one of the most common psychological problems in childhood.

What is separation anxiety disorder in children?

Separation anxiety disorder is present in 4% of children and 1.6% of adolescents. It involves a cervical fear of separation from attachment figures, which translates into discomfort and anxiety.which translates into discomfort in situations in which they leave the child's side. Very often it is an imaginary distancing, without objective support, with which the child projects his or her uncertainty or anguish into the future.

In the following we will describe its core symptoms, as well as the reasons why it may occur and the therapeutic approach currently available.

1. Emotional distress in anticipation of separation from attachment figures.

Children with separation anxiety disorder are sensitive to any clue that might suggest separation 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 insinuate it, but also to those that could occur in the future, anticipating "threats" that in all probability will never occur.

In this sense, it is important to consider that, in the first years of life, the projection about the future may be conditioned by 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, turning improbable events (abduction, abandonment, etc.) into real and tangible risks. real and tangible risks. Time, then, becomes an enemy and a source of stress.

As the anticipated day approaches, children experience increased emotional Pain and worry. Also, a resurgence of the behavioral aspects of the an exacerbation of the behavioral aspects of the problem can also often be seen.. Thus, it is not uncommon for them to express their fears through tantrums and outbursts of temper, which pose a conflict for parents and other caregivers (relatives, teachers, etc.).

2. Excessive and persistent worry about losing an attachment figure or being harmed.

Children suffering from generalized anxiety disorder are concerned about the health and well-being of their attachment figures, living in fear that they may be overly worried about the health and well-being of their attachment figures.living in fear of misfortune or illness. This is why they develop reassurance behaviors, which consist of inquiring about the condition of their parents by asking questions about the probability of their parents dying or being harmed (which is experienced with surprise by those alluded to).

This fear is heightened during periods when 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 his or her experience of anxiety. In the case of minor pathologies, such as colds or other transitory processes, an attitude of excessive worry and uneasiness may be shown in the face of innocuous symptoms (fever, cough, etc.). (fever, cough, etc.).

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

One of the most common phenomena in the context of this disorder is the occurrence 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 monsters.such as those related to monsters or fantastic beings, and even merges in some way with them (developing fear of Santa Claus because of the possibility that he may have evil intentions, for example).

It is also common for the child to experience with intense anguish the conflicts that occur in the scenario of family frictions. In this way, they may report discomfort during arguments between their own parents (daily quarrels over ordinary matters) or in the event that either of them shows signs of anger or disagreement regarding their way of acting. The latter can trigger the belief that one is deserving of punishment or that one is "bad," which can become deeply anchored in self-esteem and lead to 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 are away from it they experience it with an overwhelming anguish. This fact is exacerbated during moves, when moving to a new school (or institute) (or institute) and when the summer vacations arrive. Such fear can lead to an outright refusal to participate in any field trip or school trip, especially when it involves an overnight stay away from home.

The fear of moving away may persist into adolescence, although there isAlthough there is evidence that separation anxiety disorder tends to become less prevalent as time passes. In this case, the emotion that overwhelms the person may hinder the development of dyadic relationships (friendship, camaraderie, etc.) at a time in life when the first bonds outside the family framework are usually forged.

5. Concern about loneliness

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

This fear is particularly frequent at bedtime, and is intensified when parents decide to place the child's bedroom in an independent space.

During 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 he/she may even develop a sleeping problem, expectant of sounds that might come from a trusted person.The child may develop a sleep problem, expectant of the sounds that may emerge in the silence of the house while feeding fears with his or her vivid imagination.

6. Recurrent nightmares about separation from attachment figures.

Nightmares depicting harm to either parent 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 children, since there is a period in which the fear of there is a period in which the fear of separation from parents becomes normal and adaptive.. In this case, however, nightmares cause a profound impairment in the child's life and that of his family (interfering excessively in the areas of functioning).

The content of the nightmares, which the child is able to evoke as soon as the parents inquire about the subject (which sometimes happens in the middle of the night), is usually about divorce or the occurrence of some tragic event (murder, accident, etc.). In this case, the child may wake up agitated, screaming and/or sobbing.

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

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

Many children somatize physical discomfort as a consequence of separation. The most frequent symptoms are headache, abdominal pain, dizziness, nausea, cramps, palpitations and thoracic painThey may occur in isolation or in combination. In addition, they manifest themselves in the hours before going to school or other activities (during which a temporary distancing from the people with whom an attachment bond has been forged is anticipated).

This eventuality is usually of great concern to parents and motivates visits to the pediatrician, whose examinations do not find any organic cause for such a florid clinical picture. It also causes constant school absenteeism, which conditions the acquisition of knowledgeThis conditions the acquisition of knowledge foreseen in the child's curriculum and warrants the adoption of extraordinary measures (repetition of a grade, for example). When the symptoms persist at school, it is possible that they are associated with that space, producing an explicit refusal to go to school.

Causes

The scientific literature on this issue 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 one refers to the formation of an insecure attachment in any of its three subtypes: preoccupied (feeling that help will not be available if needed), fearful (parental rejection of attempts to approach) and disorganized (experience of explicit abuse or hostility).

Abrupt changes in daily life can also contribute to this problem (moving house, enrollment in a new school or institute, etc.), since 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 may also be related to this problem.

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

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

The search for a balance between freedom and protection is key to the care of a child, as this is the key to forging the first tools with which to build autonomy.

What is the 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. In the first place, a psychoeducational treatment is necessary about the problem (together with a functional analysis), so that parents understand what the most specific causes of the problem are and can tackle them at their origin.

It is advisable to to talk with the child about his or her feelings in an active way, without avoiding or subtracting themwithout avoiding them or downplaying their importance. It is also interesting to support him/her to get involved in activities shared with his/her 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.

Bibliographical 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., & Pini, S. (2016). Can Separation Anxiety Disorder Escape its Attachment to Childhood? World Psychiatry, 15(2), 113-115.