Anxiety disorder in connection with separation in childhood

Anxiety disorder in children caused by separation is a persistent, intense and not corresponding to the developmental level of the child's fear of separation from the person to whom the child has great affection (usually mom). Children desperately try to avoid such separation. If a child is forcibly separated from the person to whom he feels affection, such a child will be completely absorbed in order to be again next to that person. Diagnosis is based on anamnestic data. Treatment includes behavioral therapy for the child and members of his family; In severe cases, SSRI is used.

Fear of separation is a normal emotion in children aged 8 to 24 months; it usually disappears as a child grows up and develops a sense of permanence of things, as well as a realization that the parents will return. In some children, the fear of separation lasts longer or reappears after it has disappeared, and can be sufficiently expressed to be regarded as an anxiety disorder.

ICD-10 code

F93.0 Anxiety disorder in children caused by separation.

Causes and pathogenesis of anxiety disorder in children caused by separation

Anxiety disorder in connection with separation in childhood arises, as a rule, in children vulnerable, sensitive, anxious-hypochondriac, painful, extremely attached to the mother. An important role is played by the presence of abnormal child-parent relations.

[1], [2], [3], [4]

Symptoms of anxiety disorder in children caused by separation

Like social phobias, an anxiety disorder caused by fear of separation often manifests itself as a refusal to attend school (or pre-school institutions). At the same time, the anxiety disorder caused by the fear of separation is more common in young children and rarely occurs after puberty. The fear of separation is often aggravated by the anxiety of the mother. Her own anxiety increases the anxiety of the child, which leads to a vicious circle, which can be interrupted only by careful and adequate treatment of both mother and child.

As a rule, dramatic scenes develop during the parting of the child with the parents; when separated, the child is fixed in order to be again with the person to whom he is attached (usually by his mother), and often experiences that something could happen to her (for example, an accident, a serious illness). The child can also refuse to sleep alone and may even insist on always being in the same room as the person to whom he is attached. Farewell scenes are usually painful for both mother and child. The child often cries, yells and begs not to leave him with such despair that his mother can not leave him, which leads to long episodes that are even more difficult to interrupt. The child often has somatic complaints.

The child's behavior is often normal in the presence of the mother. This normal behavior can sometimes give the wrong impression that the problem is less than it really is.

The slight anxiety arising in response to threatening or real separation from the mother is a normal reaction in infants and preschool children. The so-called anxiety department is usually observed in children from the age of 6 months, but it is possible to occur at an earlier age.

A key diagnostic symptom of separation anxiety is excessive anxiety, which is beyond the normal age range in severity. Anxiety can take many forms. For example, anxiety about the fact that the person to whom the child is attached can go and not return, manifested in a stubborn refusal to be in the kindergarten. Only waking up, the children are already beginning to be capricious, whining, complaining about poor health. On the way, children cry, resist and even show aggression towards their mother. In kindergarten they do not want to undress, cry and cry sometimes throughout their stay, refusing to obey the general regime. Often, this is accompanied by psychosomatic symptoms in the form of nausea, abdominal pain, vomiting, headache, cough, etc. This state continues for months, forcing parents to take the child out of the kindergarten. Much less common symptoms are observed in children during school adaptation.

Another form of separation anxiety is the fantasy of unhappiness that can happen to a child who has been left without parents at home or in an organized children's collective (they will steal, kill, etc.). Unrealistic fears can spread to absent parents (they will get under the car, bandits will kill, etc.).

Often children refuse to sleep in the absence of a person to whom they have great affection. Often children see repeated nightmares about separation from their parents. Having woken up at night, they in fear run to their parents' bed and refuse to return to their bed.

In more rare cases, the child becomes listless, apathetic, with an expression of suffering on his face. Usually the appetite disappears, sleep is disturbed. You can observe the above psychosomatic disorders.

Indicated for consultation of other specialists

Prolonged, protracted nature of the anxiety department, the formation of psychosomatic disorders, the presence of persistent social disadaptation - an indication for the consultation of a psychiatrist with a decision on the nature of treatment.

Diagnosis and treatment of anxiety disorder in children caused by separation

Diagnosis is based on anamnestic data and observation of the child's behavior during parting.

Treatment is conducted using behavioral therapy, in which the child's separation from the person to whom he is attached is systematically practiced. The farewell scenes should be as short as possible, and the mother of the child should be prepared to react to protests dryly and emotionally. It can be effective in helping to develop a child's attachment to one of the adult employees of a pre-school or school. In extremely severe cases, anxiolytics may be effective, for example, one of the SSRIs. However, the anxiety disorder caused by the fear of separation often develops in children aged about 3 years and even younger, and the experience of using these drugs in very young children is limited.

With successful treatment, children are prone to developing relapses after the holidays and breaks in attending school. In connection with these relapses, it is often a wise decision to schedule regular partings during these periods so that the child gets used to the lack of a mother.

[5]

Forecast

In general, favorable. With a sufficiently long flow note erased anxious, astheno-dynamic and ideator disturbances and out of separation situations.

[6], [7]