Separation anxiety disorder is one of the most common psychological disorders of childhood and early adolescence. It revolves around an intense and improbable fear of being separated from a close figure to which the child is attached, usually the parent. The anxiety may further perpetuate an array of mental, emotional, behavioral and somatic symptoms that impede the child’s school progress, play and recreational activities and relationships with family and peers.
The separation anxiety is experienced most of the time by the child across a range of situations and is not an intermittent phenomenon. The child is unable to achieve what they are capable of. If left untreated, children with separation anxiety disorder are likely to grow up as anxious adults and suffer from various anxiety disorders.
However, it needs to be remembered that some amount of separation anxiety is a universal, normal and developmentally appropriate phenomenon. It is only in those cases where the anxiety is too intense, causes great distress, is developmentally inappropriate and cripples normal functioning that separation anxiety has blown into a disorder.
Common symptoms of Separation Anxiety
• The child feels tremendous anxiety at the possibility of separation from the attachment figure (parent, grandparent, primary caregiver) or home even when the separation is for a brief period such as the child going to school or the caregiver going to the market. Once separated from the attachment figure, the child has a need to for repeated reassurance that they will be reunited.
• Common fears experienced by these children include: fear of some fatal accident, death or illness either happening to them or the caregiver; fear of getting kidnapped or lost and never meeting the attachment figure again and fears of animals, darkness and burglars. They also experience nightmares where they see the separation happening.
• The fear can be so crippling that some children become extremely homesick and distressed till they are reunited with the attachment figure. They feel uncomfortable going out of the house alone and try their best to avoid it. Even when inside their house at times some of these children find it difficult to stay alone in a room and may cling to the attachment figure or some other family member. They have a great difficulty in sleeping alone at night and would seek someone’s company. Some children suffering from separation anxiety may even refuse to go to school regularly and their academic performance declines although they may be otherwise capable of high achievement.
• Apart from experience of anxiety, these children are likely to suffer from vomiting, headache, dizziness, fainting spells, palpitations, excessive sweating and stomachache when they are either separated or foresee separation. If someone forces separation they may display anger or throw a temper tantrum.
Causes of Separation Anxiety
• Unconscious Rage: Some children feel a sense of loss and unconscious rage when they are physically separated from the attachment figure even for brief periods. They are unaware about the rage at a conscious level. However, in their rage and hatred they wish to harm the person whom the love the most as they feel abandoned. This wish fills their mind with images and fantasies of the attachment figure being harmed. But as this is the same person they love intensely they begin feeling scared. They do not realize that it is their own rage and anger that is making them anxious and not some prophetic thoughts.
• Distorted Cognitions: Children suffering from separation anxiety disorder have an unusual way of seeing things wherein they selectively focus on threatening information while not paying attention to the benign inputs. As a result they appraise greater danger in ambiguous situations than other children do. In addition, they have a distorted view of their own self and underestimate their competency to deal with ambiguous situations.
• Stress and Illness in Parent: If the parent suffers from a longstanding physical or mental illness, experiences unmanageable relationship conflict, family discord and occupational stress and is not optimally available for the child then this may lead to the development of an insecure attachment pattern in the child and result in separation anxiety and clingy behavior. In some cases if there is a misfit between the behavior of the parent and the temperament of the child, it may lead to the child feeling very anxious. Some parents are overprotective and feel scared of leaving the child alone. They may discourage the child from being autonomous as they begin to feel scared and rejected at the prospect of separation. The child feels motivated to be excessively circumspect and avoid any risk.
• Real Life Separation and Threats: If a child experiences an actual separation from an important attachment figure and is unable to tolerate this then they may go on to develop separation anxiety disorder. It is a common tactic in our Indian culture to threaten the child with separation in order to improve their behavior but this may also make some children excessively anxious. Therefore, while disciplining the child other forms of behavioral management should be used rather than the separation threats.
Various forms of psychotherapy and counseling are used in the treatment of separation anxiety disorder, such as cognitive-behavioral exposure based therapy, play therapy and attachment-based relational therapy. In cognitive-behavioral exposure based therapy a progressive or graded list of situations that the child is scared of is prepared and then the child is exposed to each situation while combining it with relaxation techniques or positive reinforcements. Distorted cognitions of the child that tend to exaggerate the danger and underestimate their capacity to handle ambiguous situations are modified by cognitive restructuring in older children and adolescents.
Play therapy helps in identifying and treating maladaptive thoughts, conflicts and fantasies of the child by observing repetitive patterns of play. Attachment-based relational therapy aims at transforming the underlying insecure attachment pattern which forms the foundation of separation anxiety disorder.
Author: Pulkit Sharma is Clinical Psychologist at Vidyasagar Institute of Mental Health & Neurosciences (VIMHANS), New Delhi.