Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Anxiety Disorders
Separation Anxiety Disorder
Although separation anxieties are normal among infants and toddlers, they are
not appropriate for older children or adolescents and may represent symptoms of
separation anxiety disorder. To reach the diagnostic threshold for this
disorder, the anxiety or fear must cause distress or affect social, academic, or
job functioning and must last at least 1 month (DSM-IV). Children with
separation anxiety may cling to their parent and have difficulty falling asleep
by themselves at night. When separated, they may fear that their parent will be
involved in an accident or taken ill, or in some other way be“lost” to the child
forever. Their need to stay close to their parent or home may make it difficult
for them to attend school or camp, stay at friends’ houses, or be in a room by
themselves. Fear of separation can lead to dizziness, nausea, or palpitations
(DSM-IV).
Separation anxiety is often associated with symptoms of depression, such as
sadness, withdrawal, apathy, or difficulty in concentrating, and such children
often fear that they or a family member might die. Young children experience
nightmares or fears at bedtime.
About 4 percent of children and young adolescents suffer from separation anxiety
disorder (DSM-IV). Among those who seek treatment, separation anxiety disorder
is equally distributed between boys and girls. In survey samples, the disorder
is more common in girls (DSM-IV). The disorder may be overdiagnosed in children
and teenagers who live in dangerous neighborhoods and have reasonable fears of
leaving home.
The remission rate with separation anxiety disorder is high. However, there are
periods where the illness is more severe and other times when it remits.
Sometimes the condition lasts many years or is a precursor to panic disorder
with agoraphobia. Older individuals with separation anxiety disorder may have
difficulty moving or getting married and may, in turn, worry about separation
from their own children and partner.
The cause of separation anxiety disorder is not known, although some risk
factors have been identified. Affected children tend to come from families that
are very close-knit. The disorder might develop after a stress such as death or
illness in the family or a move. Trauma, especially physical or sexual assault,
might bring on the disorder (Goenjian et al., 1995). The disorder sometimes runs
in families, but the precise role of genetic and environmental factors has not
been established. The etiology of anxiety disorders is more thoroughly discussed
in Chapter 4.
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