Description

Separation anxiety disorder (SAD) is defined as developmentally inappropriate fear and anxiety about being away from home and/or apart from the individuals to whom a child is most attached.

• This diagnosis should be distinguished from developmentally appropriate worries, fears, and responses to stressors.

Epidemiology

• Prevalence estimates range from 4% in children aged 7 to 9 years to 1.6% in adolescents.
• Prevalence is slightly higher in females than males.
• Symptoms tend to peak between 7 and 9 years of age, but the disorder can present at any age.

Etiology

Studies show that there are genetic and environmental precursors to the development of SAD:

• A temperament of behavioral inhibition in which a child tends to approach unfamiliar situations with distress, restraint, and avoidance has been shown to be associated with development of anxiety disorders.
• Low experience of control over the environment
• Early development of stranger anxiety
• Insecure attachment between parent and child
• Increased parental anxiety
• Parenting style of being excessively controlling and overprotective
• Exposure to negative life events or stressors
• Genetic predisposition with family history of anxiety or depression

Commonly Associated Conditions

Comorbid conditions are present in up to 80% of children with SAD, most commonly including the following:

• School refusal
• Depression
• Simple phobia
• Social phobia
• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Agoraphobia