Separation anxiety disorder

Separation anxiety in children represents a crucial stage in their psychological and emotional development. This type of anxiety manifests itself as a deep distress in situations of estrangement from parental figures, especially the mother.

It is an emotional distress triggered by the fear of abandonment and the fear of loneliness that is activated when the child loses visual and physical contact with the caregivers.

This disorder occurs at the time of separation, with unrealistic and persistent fears about the occurrence of catastrophic events (e.g., serious accident, abduction, murder, or illness) that may separate them from family members forever.

Separation anxiety can lead to a strong reluctance to go to school because it implies separation from parents or, more generally, from the primary figure of reference. Often these children have difficulty falling asleep alone and may insist that someone stay with them.

Separation anxiety is also associated with physical symptoms such as headaches, sweating, rapid heartbeat, palpitations, feeling of airlessness, vomiting, and abdominal pain.

When separated from their parents, children tend to be sad and ask to call their parents and be taken home. Patients may exhibit behavioral symptoms such as crying and tantrums.

Separation anxiety may develop after a particularly stressful life event (e.g., death of a relative or pet, hospitalization of the child or illness of a family member, separation or divorce of parents, change of school or move, etc.).

The disorder may also result from affective deficits or, conversely, from overprotective or intrusive behavior on the part of the parents, which may discourage the child’s independence. If left untreated, these individuals may develop panic attacks, agoraphobia, or personality disorders in adolescence and forms of affective dependence in emotional relationships in adulthood.

Adults can also be overwhelmed by separation anxiety in a disabling way. In adulthood, the death of a loved one, such as a partner, the loss of a parent, a move, or any event that takes us away from our reference points, all act as triggers.

Under these circumstances, we speak specifically of DASA, or adult-specific separation anxiety. It occurs at any age and is not necessarily related to a developmental separation anxiety disorder. Unfortunately, being able to grieve well is not so obvious.

Separation anxiety in children as a developmental stage

Separation anxiety is a normal stage in a child’s intellectual and social development, also known as “fear of strangers”. It occurs around 8-9 months of age (third trimester of the first year), a time when the child begins to recognize different faces and to react positively to familiar faces and negatively to unfamiliar and strange ones. During this time, it is common for children to react with some anxiety to separation from their mother (or other caregiver). Children’s reactions can vary greatly: the anxiety can be mild or quite severe until it develops into a disorder. There is usually a child’s protest the moment a parent leaves him or her, even briefly, if only to shower or cook. Or he does not want others to take care of him and complains at times of inevitable separation, such as bedtime or naptime.

What is triggered during this period is related to the child’s strong attachment to the primary caregiver and the fear of losing her when she disappears, a fear of abandonment. When the child cannot see the caregiver, it is as if that person ceases to exist in the child’s mind because the child has not yet reached the stage of object permanence, i.e., the knowledge that others exist permanently independent of the child’s perception of them.

This stage can last until about 14 to 18 months of age, when the attachment bond with the caregiver figure has occurred, the child begins to realize that he is a separate person from his mother, and he begins to develop his own personality. Separation anxiety tends to subside spontaneously after the age of 2 and disappear completely before puberty.

What happens is a process of processing the separation from the caregiver that manifests as fear and anxiety of the stranger. The child moves between two needs: the desire to explore the world around him or her on his or her own, and the need to remain safe and return to the caregiver (what Bowlby called the “secure base”). If the child can understand that others exist outside of his or her perception and that parents will return to him or her, then the child will be able to experience and accept separation and detachment more peacefully.

When separation anxiety becomes a disorder

The child or adolescent who suffers from separation anxiety may exhibit an exaggerated fear at the mere thought of being separated from his or her primary caregiver (whether a parent, grandparent, or babysitter). This fear turns into real distress and anxiety when it actually happens. For example, the child may no longer want to sleep alone in his or her own bed, or may throw a tantrum at the entrance to school upon separation from the parent.
Fear and anxiety about loss can manifest in a variety of ways:

  • Angry outbursts
  • Screaming and crying
  • Attempting to physically restrain the parent to keep him or her from leaving
  • Physical symptoms such as headaches, stomachaches, nausea, vomiting, heart palpitations, and sweating.

As they grow up, separation anxiety may also be expressed through negative thoughts about the possibility of something bad (an accident or illness) happening to them or their parents, or an event that could separate them forever.

As they grow up, the manifestations of separation anxiety may invade the social and school environment and develop into other disorders or turn into social withdrawal and difficulty relating to other children, refusal to go to school, and poor school performance.

Separation anxiety disorder may be the result of a developmental failure, or it may develop as a result of stressful events such as parental separation, death of a loved one, illness (precisely because separation anxiety is related to abandonment anxiety), or events that seem less relevant and “traumatic” but can disrupt the child’s life and routine, such as moving or changing schools.

Separation anxiety what to do

The first thing to do to deal with separation anxiety when it manifests as a disorder is to recognize and accept it. This is crucial for parents because the child’s anxiety is influenced by the behaviors, conscious or unconscious, of the people who care for the child. For example, when leaving the house or dropping the child off at school, it is best to greet the child lovingly but neutrally, without excessive emotional involvement, so as not to complicate the separation. It may be helpful to establish a routine for greeting the child that is stable and reassuring for both the child and the parent.

Very protective and anxious parents will tend to behave in ways that increase and reinforce the child’s anxiety and discomfort, e.g., overprotective or intrusive parental behaviors may discourage the child’s independence and overly reinforce dependence on the parent.
The best way to deal with this relationship and family issue is to talk openly and clearly with the child, explaining what has happened or is happening in the family (separation, bereavement, starting school, moving), reassuring the child that nothing bad will happen, that things will settle down, and that they will get used to the new daily routine.

It is also important to help the child recognize his or her feelings and put them into words. In fact, being able to turn an uncomfortable emotion into something that can be defined in words means being able to understand it, set limits on it, and find a place for it in one’s life.

As with all difficulties and problems that any of us experience, it is always possible to seek help from an expert, a therapist who can help not only the child but the whole family deal with this difficulty through psychotherapy. There is no one-size-fits-all treatment, but since this is a relationship problem, it can be very effective to have family therapy or parenting support to help from a behavioral standpoint and to restore balance and well-being within the family.

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