Separation Anxiety Disorder - Diagnosis

Diagnosis

It is crucial to differentiate separation anxiety disorder from other disorders, especially anxiety disorders, as the two can be confused. To achieve this, children are asked what they fear will happen upon separation. Their answer to this question is a way to determine if they are suffering from separation anxiety disorder. Children who fear something terrible may happen to their parents or primary caregiver, or that they will be permanently separated from their parents or primary caregiver, serves as an indication that the child is suffering from separation anxiety disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (2000) lists criteria that must be fulfilled for a patient to be diagnosed with separation anxiety disorder. These diagnostic criteria include:

A. Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

(1) recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated (2) persistent and excessive worry about losing, or about possible harm befalling, major attachment figures (3) persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped) (4) persistent reluctance or refusal to go to school or elsewhere because of fear of separation (5) persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings (6) persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home (7) repeated nightmares involving the theme of separation (8) repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The duration of the disturbance is at least 4 weeks.

C. The onset is before age 18 years.

D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder with Agoraphobia.

Specify if: Early Onset: if onset occurs before age 6 years

Proposed changes for SAD in the DSM-V (to be published in May 2013) include changing the examples of untoward events happening to the child, the examples in DSM-IV are restricted to untoward events happening to the child, but fail to capture untoward events to attachment figures that may lead to loss. Among those, worries about death and dying are common. Terms are added/deleted to increase the relevance to adults with Separation Anxiety Disorder (e.g., A 4 – “work”, A 5 – removal of “adults” since attachment figures may not be always adults (e.g. for adults, attachment figures can be partners or children). The duration will increase from four weeks to typically lasting at least six months to minimize overdiagnosis of transient fears. The text will clarify that this cut off should not be applied too rigidly. However, a caveat permits shorter durations in cases of acute onset or exacerbation of severe symptoms. The Specifier for SAD (Early onset before age 6 years) in the DSM-IV will be deleted in the fifth edition as there is no evidence for such a specifier and because in all anxiety disorders age of onset could be specified as a continuous variable.