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Separation Anxiety Disorder Counseling in Broken Arrow for Tulsa Area Residents

By Alina Morrow, LPC

Disclaimer: The article below is for informational purposes only and should not be considered as direct advice, a personal diagnosis, or as an individual treatment plan. Always consult with a mental health professional or medical doctor if you have concerns.

Introduction and Overview

Separation anxiety disorder (SAD) is a disorder that mostly affects children and adolescents, although there is evidence that even adults can develop this condition. Separation anxiety disorder is an anxiety disorder characterized by excessive anxiety that exceeds the normal level expected for the child's developmental stage and is triggered by the separation from home or "major attachment figures" such as parents or caregivers.

Separation anxiety is an expected and normal developmental phase in infants and toddlers age 3 to 4, and represents a healthy response in young children confronted with separation from their home, parents, or attachment figures. It usually causes a mild level of distress (the baby or toddler gets upset or starts to cry) and clinging behaviors that usually disappear shortly after the separation moment. Separation anxiety at younger ages indicates the development of a healthy attachment, and it should not interfere with normal functioning.

However, when the separation causes severe, persistent anxiety and a significant clinical distress that affects the social, academic, or other areas of functioning, the child may suffer from separation anxiety disorder.

In order for a separation anxiety disorder diagnosis to be established, the severe distress and fear caused by separation from attachment figures must last for a period of 4 weeks.

Separation anxiety disorder is a condition that affects a child's life by limiting their ability to engage in age-related daily activities. Children with separation anxiety disorder become extremely upset when they have to be separated from their parents and display significant clinical distress. Even the anticipation of a possible separation triggers a severe level of anxiety and agitation in the children. When separated from their parents or attachment figures, children need to know where their parents are, they need to stay in touch with them, and they fear possible fatal accidents or illnesses that can happen to them or to their parents. When away from home, these children become homesick or experience high levels of discomfort to the point of misery, and they strongly desire to return home.

Children with separation anxiety disorder often experience the fear of being lost and never being reunited with their family, and when away from home and their attachment figure, they become preoccupied with the reunion fantasy. They also fear traveling by themselves and avoid participating in activities that involve being away from home (such as camps, visiting and sleeping over to friend's houses, or even running errands).

In some cases, children refuse to be alone in the room requesting somebody to keep them company or they prefer to stay close to the parents even if inside the home. Some children have difficulties falling asleep unless somebody stays with them and during the night they might try to sneak into the parents or sibling bed.

Some children can have nightmares during the night, which are the expression of their fears.

Separation anxiety disorder can develop after the experience of a traumatic event such as the death of a parent, attachment figure, or pet, the illness of the child or significant figure in the child's life, changing schools or moving into a new area, neighborhood, or country. The onset can be as early as preschool age or any time before the age of 18, although a late onset (around teenage years) is not common.

In the United States, the prevalence of separation anxiety disorder ranges between 1.3 percent in teenagers age 14-16 to 4.1 to 4.7 percent in children age 7-11. Girls seems to be more affected by this disorder than boys.

Signs and Symptoms

Separation anxiety disorder is a psychological condition diagnosed mostly in children and rarely in adolescents. It can be recognized when the following symptoms are present:

1. Psychological symptoms, include:

  • Recurrent anxiety and severe distress when separated from attachment figures or safe environments (such as home) or when anticipating the separation.
  • Persistent and excessive worry of losing their parents or caregivers, or that something bad could happen to them.
  • Fears of getting lost or being kidnapped.
  • Excessive worry concern their own safety.
  • Fear and reluctance to be alone.
  • Low self esteem in social and academic settings.
  • Depression.

2. Behavioral symptoms, include:

  • Crying or whining when they have to be separated from parents or caregivers.
  • Clinging behaviors when separated from their parents.
  • Refusal to sleep alone and requesting to sleep in the parent's bed.
  • Refusal to go to school or be involved in age-related activities away from home.
  • Repeated nightmares involving the separation theme.
  • Panic or temper tantrum when separated from the parents.
  • The need to constantly stay in touch with loved ones.
  • Requesting reassurance that the loved ones are safe.
  • Difficulties concentrating.

3. Physiological symptoms are displayed when the separation occurs or is anticipated. They include:

  • Headaches
  • Stomach aches
  • Nausea or vomiting
  • Muscle ache or tension

Causes and Risk Factors

The causes of separation anxiety disorder are not known. However, separation anxiety disorder, like any other anxiety disorder, is believed to be triggered by biological, psychological, social, and environmental factors.

Biological Factors
Anxiety disorders seem to be connected to a chemical imbalance of two neurotransmitters in the brain, norepinephrine and serotonin. This imbalance can be caused by external factors or can be inherited, which makes the individual more vulnerable to developing the disorder. Genetic studies suggest a possible connection between children with separation anxiety disorder and parents that have suffered or are affected by panic disorder, anxiety, agoraphobia, or depression.

Psychological Factors
Separation anxiety disorder can be triggered by a dysfunctional attachment developed between the child and parents. The child may display separation anxiety when sensing an emotional distance between them and parent(s) in order to draw attention.

Social Factors
Children learn how to behave and feel in different situations imitating or observing the behavior of those around them, especially family members. When important figures in a child's life display increased anxiety, the child might also learn to feel anxiety when confronted with stressful situations.

Environmental Factors
Separation anxiety disorder may develop after major changes or stressful/traumatic events in the child's life, such as the death or illness of an attachment figure or pet, changing in the family structure due to divorce or the birth of another sibling, moving to a new area, neighborhood, country, continent, or school. Some studies suggest that traumatic events such as physical or sexual abuse may also trigger the disorder.

Counseling & Treatment Options

Separation anxiety is an expected and normal response in young children when separated from parents, caregivers or safe environments. However, when the anxiety occurs at older ages and exceeds the normal, expected level for the child's age to the point of interfering with normal functioning, the problem requires special attention. Children with separation anxiety disorder are deprived of the normal experiences of the childhood stage and can develop additional problems that can affect their future life.

Some of the problems triggered by separation anxiety disorder include: social isolation and detachment from others (because children perceive their fears as unusual and different), other anxiety disorders (panic disorder, agoraphobia, and generalized anxiety disorder), and difficulties developing healthy relationships (because these individuals learn to not trust and feel secure around others). Therefore, treatment is essential in avoiding further complication.

Separation anxiety disorder treatment focuses on helping the child to reduce and keep under control their fears and enjoy a normal life for their age where interaction with the surrounding environment and people outside the home and family is essential. However, children cannot comprehend the severity of their problem and do not have the capacity to understand that their problem can be treated, therefore the responsibility relies on parents. Parents can have access to resources that educate them about the disorder and where they can find professional help.

There are two major treatment approaches for children with separation anxiety disorder: psychotherapy and medication.

Psychotherapy
Psychotherapy is a treatment approach that may focus only on the child through such approaches as cognitive behavioral therapy, play therapy, and group therapy, or on the entire family, such as family therapy.

Cognitive behavioral therapy is a short term therapy with effective results in children with separation anxiety disorder. The goal of this form of therapy is to restructure the child's pattern of thoughts and actions and implement more assertive and adaptive behavioral and cognitive skills. Cognitive behavioral therapy uses systematic desensitization, exposure, cognitive restructuring, and role-playing techniques to reduce the symptoms. Children learn to identify negative thoughts that trigger and maintain the anxiety, to develop new, positive thoughts and to implement more adaptive behaviors.

Play therapy is another form of psychotherapy used to treat children with separation anxiety disorder. It is developed for children age 3 to 11 and involves using toys, puppets, and games to help the child express their experience and feelings.

Group therapy is another form of therapy used to treat children with separation anxiety disorder. Group therapy brings together children with similar problems and encourages them to share their experiences and practice new behaviors in a safe environment.

Family therapy is a form of therapy designed for the entire family, where parents learn to play an active role in their child's rehabilitation. During family therapy, parents are being educated about their child's disorder and learn effective parenting skills to cope with certain situations.

Medication
Medication is prescribed for those children that display persistent symptoms, moderate to severe functional impairments, and do not respond to psychotherapy. The FDA has not approved a specific medication to treat children with separation anxiety disorder.

Controlled studies have reported good results when anti-depressant medication is prescribed. Some of the anti-depressants prescribed for children with separation anxiety disorder include Selective Serotonin Reuptake Inhibitors and tricyclic antidepressants. However, some results may be noticed after 2 to 4 weeks of treatment, but in order to know whether the treatment is effective for each particular individual, it requires at least 12 weeks of treatment. Some of the most prescribed antidepressant are: Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft.

When children are treated with medication, the results require time, can be accompanied by side effects, and unfortunately, the symptoms are reduced but not eliminated.

Related Information:

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Do you or someone you know suffer from separation anxiety? Contact Tulsa Therapist Alina Morrow, LPC, today to make an appointment and get the help and relief you deserve. You can reach me by texting or calling 918-403-8873 or by Email.

Page Last Updated: October 30, 2016

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