Psychological Disorders: Separation Anxiety Disorder
American
Description
A. Developmentally inappropriate and excessive anxiety concerning
separation from home or from those to whom the individual is attached,
as evidenced by three (or more) of the following:
recurrent
excessive distress when separation from home or major attachment figures
occurs or is anticipated
persistent
and excessive worry about losing, or about possible harm befalling,
major attachment figures
persistent
and excessive worry that an untoward event will lead to separation
from a major attachment figure (e.g., getting lost or being kidnapped)
persistent
reluctance or refusal to go to school or elsewhere because of fear
of separation
persistently
and excessively fearful or reluctant to be alone or without major
attachment figures at home or without significant adults in other
settings
persistent
reluctance or refusal to go to sleep without being near a major attachment
figure or to sleep away from home
repeated
nightmares involving the theme of separation
repeated
complaints of physical symptoms (such as headaches, stomachaches,
nausea, or vomiting) when separation from major attachment figures
occurs or is anticipated
B. The duration of the disturbance is at least 4 weeks.
C. The onset is before age 18 years.
D. The disturbance causes clinically significant distress or impairment
in social, academic (occupational), or other important areas of functioning.
E. The disturbance does not occur exclusively during the course of
a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic
Disorder and, in adolescents and adults, is not better accounted for
by Panic Disorder With Agoraphobia.
Specify
if:
Early Onset: if onset occurs before age 6 years
European
Description
It is normal for toddlers and preschool children to show a degree
of anxiety over real or threatened separation from people to whom
they are attached. Separation anxiety disorder should be diagnosed
only when fear over separation constitutes the focus of the anxiety
and when such anxiety arises during the early years. It is differentiated
from normal separation anxiety when it is of such severity that is
statistically unusual (including an abnormal persistence beyond the
usual age period) and when it is associated with significant problems
in social functioning. In addition, the diagnosis requires that there
should be no generalized disturbance of personality development of
functioning; if such a disturbance is present, a code from F40-F49
should be considered. Separation anxiety that arises at a developmentally
inappropriate age (such as during adolescence) should not be coded
here unless it constitutes an abnormal continuation of developmentally
appropriate separation anxiety.
Diagnostic
Guidelines
The key diagnostic feature is a focused excessive anxiety concerning
separation from those individuals to whom the child is attached (usually
parents or other family members), that is not merely part of a generalized
anxiety about multiple situations. The anxiety may take the form of:
(a)
an unrealistic, preoccupying worry about possible harm befalling major
attachment figures or a fear that they will leave and not return;
(b) an unrealistic, preoccupying worry that some untoward event, such
as the child being lost, kidnapped, admitted to hospital, or killed,
will separate him or her from a major attachment figure;
(c) persistent reluctance or refusal to go to school because of fear
about separation (rather than for other reasons such as fear about
events at school);
(d) persistent reluctance or refusal to go to sleep without being
near or next to a major attachment figure;
(e) persistent inappropriate fear of being alone, or otherwise without
the major attachment figure, at home during the day;
(f) repeated nightmares about separation;
(g) repeated occurrence of physical symptoms (nausea, stomachache,
headache, vomiting, etc.) on occasions that involve separation from
a major attachment figure, such as leaving home to go to school;
(h) excessive, recurrent distress (as shown by anxiety, crying, tantrums,
misery, apathy, or social withdrawal) in anticipation of, during,
or immediately following separation from a major attachment figure.
Many
situations that involve separation also involve other potential stressors
or sources of anxiety. The diagnosis rests on the demonstration that
the common element giving rise to anxiety in the various situations
is the circumstance of separation from a major attachment figure.
This arises most commonly, perhaps, in relation to school refusal
(or "phobia"). Often, this does represent separation anxiety
but sometimes (especially in adolescence) it does not. School refusal
arising for the first time in adolescence should not be coded here
unless it is primarily a function of separation anxiety, and that
anxiety was first evident to an abnormal degree during the preschool
years. Unless those criteria are met, the syndrome should be coded
in one of the other categories in F93 or under F40-F48.
Excludes:
* mood [affective] disorders (F30-F39)
* neurotic disorders (F40-F48)
* phobic anxiety disorder of childhood (F93.1)
* social anxiety disorder of childhood (F93.2)