Separation anxiety disorder: symptoms, causes and treatment

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

That is why relationships with attachment figures are fundamental, since from them the foundation of autonomy and safe exploration of the natural environment is built in a moment of extreme vulnerability.

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 in this stage of his life and those that will have to come (such as school or relationships with peers).

Separation anxiety disorder involves the onset of profound distress during this natural transition process, and is undoubtedly one of the most common psychological problems in childhood.

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What is separation anxiety disorder in children?

Separation anxiety disorder is present in 4% of children and 1.6% of adolescents. It supposes a deer fear to the distance of the attachment figures , which is translated in discomfort before situations in which these move away from their side. Very often it is an imaginary distancing, without objective support, with which the child projects his uncertainty or anguish into the future.

In the following we will describe what its nuclear symptoms are, as well as the reasons why it may occur and the therapeutic approach that we currently have.

1. Emotional discomfort anticipating a separation of attachment figures

Children with separation anxiety disorder are sensitive to any clues that withdrawal from their attachment figures (especially their parents) might suggest. For this reason, they remain very attentive not only to the events that occur in front of them and that they suggest, but also to those that could occur in the future, anticipating “threats” that, with great probability, will never occur.

In this sense, it is important to consider that, in the first years of life, the projection on becoming may be conditioned by magical thinking : children would formulate hypotheses about reality devoid of adult logic, but which they would give full 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 experience increased emotional pain and worry. A flare-up of the behavioral aspects of the problem can also often be seen . Thus, it is not strange that they express their fears through tantrums and explosions of bad temper, which pose a conflict for parents and for other caregivers (relatives, teachers, etc.).

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2. Excessive and persistent concern about losing any of the attachment figures or suffering harm

Children with generalized anxiety disorder are concerned about the health and well-being of their bond figures , living in fear that misfortune or illness may ensue. This is why they develop reinsurance behaviors, which consist of inquiring into the state of their parents by asking questions about the probability that they will die or suffer harm (which is lived with surprise on the part of the aforementioned).

This fear is exacerbated in the periods when some of the attachment figures develop a common or more serious illness. In the latter case, the family’s attempts to hide the situation may precipitate a suspicious attitude in the child, which would end up adding uncertainty to his anxiety experience. In the case of minor pathologies, such as colds or other transitory processes, an attitude of concern and excessive distress may appear in the face of innocuous symptoms (fever, cough, etc.).

3. Fear of an event happening that may lead to separation of 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 the 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 comes to merge with them in some way (developing fear of Santa Claus at 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 arise in the setting of family friction. In this way, he may report discomfort during discussions between the parents themselves (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 be deeply anchored in self-esteem and cause fear of abandonment .

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4. Persistent refusal to leave home

In children with separation anxiety disorder, the home can be perceived as the main safe space, so when they move away from it they experience it with overflowing anguish. This fact is exacerbated during the moves, when you move to a new school (or institute) and when the summer holidays arrive. Such fear can motivate a resounding refusal to participate in any field trip or school trip, especially when they involve an overnight stay outside the home.

Fear of walking away can be maintained as you reach adolescence , although there is evidence that separation anxiety disorder tends to decrease in prevalence as time passes. In this case, the emotion that overwhelms the person can hinder the development of dyadic relationships (friendship, camaraderie, etc.) at a time in life when the first ties are often forged outside the family framework.

5. Concern for loneliness

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

This fear is particularly frequent at the time of going to sleep, and is intensified when the parents decide to locate the child’s bedroom in a separate space.

In this period of transition, the child expresses the desire to be accompanied, or runs off in the middle of the night in a trusted person’s bed. Sometimes you can develop a sleeping problem , expectant at the sounds that may come out in the silence of the house while feeding fears with your vivid imagination.

6. Recurring nightmares about separation of attachment figures

Nightmares representing harm to either parent are very common in this disorder, and one of the reasons why they may reject the idea of ​​sleeping alone. It 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 in that of his family (interfering excessively with the areas of operation).

The content of the nightmares, which the child is capable of evoking at the moment when the parents inquire about the subject (which sometimes happens in the middle of the night), is usually about the divorce or the irruption of some fatal event (murders, accidents, etc.). In such a case, you may wake up agitated, between screaming and / or sobbing.

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

7. Recurring physical complaints during the separation of attachment figures or when it is anticipated

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

This eventuality often worries parents and motivates visits to the pediatrician, whose explorations find no organic cause for such a florid clinic. Likewise, it causes constant school absenteeism , which conditions the acquisition of knowledge foreseen in the child’s curriculum and merits the adoption of extraordinary measures (repetition of the course, for example). When symptoms persist in school, it is possible that they are associated with that space, producing an explicit refusal to go to it.

Causes

The scientific literature on this matter has tried to determine what are the risk factors for this anxiety disorder, having detected causes in the environment and in parenting styles. The most important refers to the formation of an insecure attachment in any of its three subtypes: worried (feeling that they will not have help if they need it), fearful (parents’ rejection of approach attempts) and disorganized ( experience of explicit abuse or hostility experiences).

Abrupt changes in everyday life can also contribute to this problem (moving, enrollment in a new school or institute, etc.), given that predictable environments are essential for the affective development of children.

Stress due to family situations (divorces, death of a loved one, birth of a new brother, 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 childhood are more likely to have 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 his environment and severely reduce his autonomy. That 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 a balance between freedom and protection is key to caring for a child, since it depends on forging the first tools with which to erect 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. In the first place, a psychoeducational treatment of the problem is necessary (along with a functional analysis), so that the parents understand what the most specific causes are and can tackle them from their origin.

It is advisable to talk to the child about his feelings actively , without avoiding or downplaying them. It is also interesting to support him to get involved in shared activities with his 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.

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