Demystifying the DSM: Separation Anxiety

Dr. B here with our series on demystifying the DSM and we're going into anxiety disorders, which is a huge bucket or cluster of symptoms. Oftentimes, I'll be saying, we really need to be assessing and looking at what's going on because these really are not, many of them, are not isolated individual diagnosis. Okay, so the order, I'm going to just stick with consistency and go in the order of the DSM, but it's not necessarily in the order of importance or how frequently we're seeing it. But the next, or the first one in the anxiety disorders is separation anxiety. We often talk about this and see this in children, and it can be, it can actually be normal. So again, to meet criteria for a DSM diagnosis there has to be a pretty significant impediment in function. And it has to be persistent, so you know a kid going to school for the first time, or the first time that year, a new school, or something has changed in the child’s life, and you see this anxiety about getting up and going to school, that could be normal. And so, let's wait it out. Maybe talk to your pediatrician. Talk to someone about it, but it could potentially be very normal. If you do think that there is a significant anxiety, oftentimes we want to look very closely at, did something happen to that child? So, if they are now 10 years old, have never had separation anxiety before, and now there's pretty significant separation anxiety, something might have happened to that child. Nothing horribly bad, but we do want to try to investigate. And it is also very important when talking to children, remembering that they're very impressionable. You don't want to say statements like: did so and so hit you? You don't want to put in their mind what it could be, right? And a lot of professionals will use play therapy to allow the child to naturally reveal where the anxiety is coming from. Again, this could be anywhere from normal separation anxiety to something significant has happened or could be evidence that there's an underlying generalized anxiety disorder. But very specifically, to meet the criteria for separation anxiety disorder, there has to be a recurrent excessive distress, it's persistent. And there is persistence in its experiences in several locations. There’s a reluctance or refusal to go out of their way and separate in more than one location, so it's not just starting school. It would also be when trying to take them to daycare or toa house where they should feel comfortable. Any kind of separation there. And there is avoidance for that, and it lasts more than four weeks in children and typically more than six months in adults. If you are that adult and you are experiencing a separation anxiety to someone that you are close to, I challenge you. Often, there's something underneath. What is the real anxiety associated with? Because separation anxiety is often a symptom of something else. So again, it could be simple and normal, or it could be there's something seriously going on and this is a symptom of something deeper. And this is often a symptom of post-traumatic stress. There's been some sort of trauma, and now you are experiencing not wanting to separate, not wanting to be alone. Just having insight into that. A lot of these I don't like to even call a disorder, right? They’re a symptom of something that we can work through that we can use cognitive behavioral techniques to find what we call post traumatic growth and post traumatic growth is for any kind of stressor, not necessarily you know, severe trauma. But we all experience micro traumas and we all experience stress, right? How can we take that and grow from it? Think of separation anxiety as a symptom and that we can work through and be stronger because of it.