Separation Anxiety Disorder

What Causes Separation Anxiety Disorder?

Scientists don’t yet fully understand what causes separation anxiety disorder. An individual’s risk for developing anxiety or an anxiety disorder is probably due to a complex interaction of genetic and environmental factors.

Risk factors for SAD include:

• Exposure to traumatic or stressful situations involving separation (loss of a loved one, severe illness of a loved one, loss of a pet, divorce, moving, changing schools)
• Extreme shyness or inhibition in childhood
• Family history of anxiety or other mental illnesses

Is Separation Anxiety Disorder Hereditary?

People with a family history of anxiety or associated mental disorders have a higher risk of developing separation anxiety disorder themselves, suggesting an inherited component to anxiety. However, scientists have not identified a single gene definitively associated with separation anxiety or other anxiety disorders. Instead, anxiety is likely the result of a coincidence of multiple genetic and environmental factors.

How Is Separation Anxiety Disorder Detected?

Early detection and treatment of SAD can lessen the severity of symptoms and increase the likelihood of successfully controlling the disorder. Watch for signs of excessive or age-inappropriate separation anxiety at crucial points, including:

• Elementary school age (SAD commonly emerges in third or fourth grade)
• After holidays or school breaks
• After a lengthy illness
• After a loss-related life change (e.g., death of a loved one or pet, divorce, moving)

How Is Separation Anxiety Disorder Diagnosed?

Diagnosis of SAD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that SAD or another anxiety disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for separation anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for SAD include:

• Fear or anxiety about separation is excessive and inappropriate for the patient’s age.
• The anxiety lasts at least four weeks in children or adolescents or six months in adults.
• Another mental illness does not explain the symptoms.
• The symptoms cause significant distress or impairment.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Separation Anxiety Disorder Treated?

Psychotherapy is often used to treat the symptoms of separation anxiety disorder. However, in some cases, medications may help control some of the SAD’s symptoms.

Psychotherapy

Psychotherapy is often the most effective approach to controlling separation anxiety. The most common therapeutic approach is cognitive-behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them.

Medication

Antidepressant and anti-anxiety medications may be used to treat and manage SAD. Individual medication plans depend on the patient’s age, responsiveness to other treatments, and the severity of their symptoms. Medications alone, without psychotherapy, are not recommended, and drug treatments are typically not appropriate for young children.

• Selective serotonin reuptake inhibitors (SSRIs). These antidepressant drugs work by increasing the levels of serotonin, a neurotransmitter chemical in the brain. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Benzodiazepines. These anti-anxiety medications work relatively quickly to control symptoms. However, they may lose their effectiveness over time. Therefore, they are typically used only when antidepressants are not effective.

How Does Separation Anxiety Disorder Progress?

SAD typically responds well to treatment. Most children treated for the disorder see a complete resolution of symptoms within 3-4 years. However, untreated separation anxiety can lead to potentially severe complications, including:

• Depression
• Relationship problems
• Problems at school or work
• Other anxiety disorders

How Is Separation Anxiety Disorder Prevented?

There is no known way to prevent separation anxiety disorder. However, children who observe their parent’s anxiety are more likely to develop an anxiety disorder themselves. Because of this, parents with anxiety disorders should get treatment from a mental health professional to reduce the likelihood that their children will develop the condition.

Some strategies may also help parents control or prevent episodes of their child’s separation anxiety:

• First: seek help from a mental health professional as soon as possible.
• Second: adhere to the treatment plan prescribed.
• Third: help your child plan for situations that cause anxiety.
• Fourth: encourage your child to be independent as appropriate for their age.

Separation Anxiety Disorder Caregiver Tips

Separation anxiety disorder often exists alongside other mental health and brain-related conditions, a situation called co-morbidity. Here are a few of the disorders commonly associated with SAD:

• Depression and anxiety are among the most common comorbid mental disorders.
• SAD and panic disorder are often comorbid.
• People with SAD may have other anxiety disorders as well.
• Obsessive-compulsive disorder (OCD) and SAD are often associated with one another.
• Post-traumatic stress disorder (PTSD) shares many symptoms with other anxiety disorders, including SAD.
• Alcoholism and substance abuse have been linked to SAD by some studies.

Separation Anxiety Disorder Brain Science

Scientists believe that anxiety symptoms come from activity in the parts of the brain that control emotions and our reactions to them. These parts of the brain are collectively called the limbic system. The limbic system is associated with anxiety in several ways:

• The amygdala, the part of the brain responsible for detecting threats, may be hyperactive and may misidentify causes for fear or worry when none exist.
• An overactive amygdala may persistently cause the hypothalamus to trigger the hormonal response that produces the physical symptoms of anxiety.
• Communication between the amygdala and the prefrontal cortex (PFC) may be impaired. The PFC is responsible for triggering a rational response to threats, and it may not be able to do so when it is unable to communicate with the amygdala effectively.
• The hippocampus, the part of the brain responsible for processing long-term memory, may be underdeveloped or dysfunctional in the case of anxiety. As a result, it may have a preference for retaining stress-related memories rather than more rational memories.

Separation Anxiety Disorder Research

Title: Brain Response Associated With Parent-based Treatment for Childhood Anxiety Disorders

Stage: Recruiting

Contact: Eli R. Lebowitz, PhD

Yale University Child Study Center

New Haven, CT 

This study aims to investigate whether a parent-based treatment for childhood anxiety disorders engages child brain circuitry implicated in children’s reliance on parents to reduce anxiety (R61) and whether a change in child brain circuitry is associated with a reduction in child anxiety (R33).

Anxiety disorders impact up to one-third of children, cause tremendous suffering, increase the risk for psychiatric and medical morbidity, impair school and social functioning, and cost billions of dollars each year. Data consistently show that child anxiety is characterized by amygdala hyperactivity and deficits in prefrontal control of the amygdala. Emerging data link these disruptions to anxious children’s over-reliance on parents for amygdala-medial prefrontal cortex (mPFC) engagement and anxiety reduction.

In the first phase of this study, the aim is to demonstrate that an entirely parent-based psychosocial treatment with no child involvement, Supportive Parenting for Anxious Childhood Emotions (SPACE), engages an amygdala-mPFC target in anxious children, lessening child reliance on parents to reduce amygdala reactivity.

Cross-species neurobiological evidence indicates that parental presence reduces amygdala reactivity and activates the mPFC to reduce offspring anxiety. In humans, it has been recently demonstrated that parental presence increases functional connectivity between their child’s mPFC and amygdala, reducing their amygdala reactivity and anxiety. In a healthy sample, parental engagement of child amygdala-mPFC connectivity was linked to the child’s reliance on parents for help with anxiety. Data from clinically anxious children likewise show parental presence engages child mPFC. Data collected since the previous submission demonstrate that parental presence reduces amygdala reactivity in clinically anxious children.

Title: Parent-based Treatment for Youth With Anxiety and Obsessive-compulsive Disorder

Stage: Recruiting

Contact: Saira Weinzimmer

Baylor College of Medicine

Houston, TX 

Anxiety and obsessive-compulsive disorders are the most common mental health disorders in childhood and adolescence. Parental accommodation of their children’s avoidance, escape, and safety behaviors is a set of parenting behaviors most strongly associated with child anxiety and obsessive-compulsive disorder. Developing and testing parent-led interventions that target accommodation and parenting styles associated with anxiety has the potential to improve treatment outcomes and reach families who may not otherwise access care (for example, for youth who refuse to attend therapy). A parenting intervention for youth with anxiety has been recently developed to address these goals called Supportive Parenting of Anxious Childhood Emotions (“SPACE”). In this intervention, therapists meet individually with parents to help them reduce accommodation and support adaptive behaviors in their children. SPACE was recently shown to be non-inferior to individual cognitive-behavioral therapy, with 88% of youth being classified as responders to SPACE. The purpose of the proposed study is to demonstrate the treatment efficacy of SPACE compared to a low-contact, therapist-supported bibliotherapy version of this intervention, providing efficacy evidence for SPACE as delivered by an independent investigatory group.

Title: Threat Interpretation Bias as Cognitive Marker and Treatment Target in Pediatric Anxiety

Stage: Recruiting

Principal investigator: Michelle S. Rozenman, PhD

University of Denver

Denver, CO

Anxiety is the most common mental health problem in children and adolescents. This two-phased study will test the effects of an experimental computerized intervention to reduce threat-based thinking (i.e., interpretation bias) in anxious youth. Participants in both the R61 (N=46) and R33 (N=72) trials will be youth ages 10 to 17 with a primary anxiety disorder (Separation, Social, Generalized). In the R61 trial, youth will be randomly assigned to receive 16 sessions over four weeks of either a personalized cognitive bias modification program for interpretation bias (CBM-I) or a computerized control condition (ICC). If CBM-I reduces interpretation bias significantly more than the ICC, the R33 trial will commence. In the R33, youth will be randomly assigned to either CBM-I or an equal amount of time in a cognitive restructuring intervention, which also aims to reduce threat-based thinking in anxiety.