Separation Anxiety Disorder

Question 1

Prognosis for separation anxiety disorder as a child

Answer 1

This condition is quite difficult to treat

Without treatment, the patient is likely to develop depression and/or an anxiety disorder as an adult

Question 2

Somatic symptoms

Answer 2

Vague or diffuse feelings of pain or discomfort for which it is difficult to pinpoint an etiology

Question 3

Separation anxiety disorder is often precipitated by . . .

Answer 3

. . . life-threatening disease of a parent, typically the primary caretaker

Question 4

Children with separation anxiety disorder have a substantial risk of developing which disorders later in life?

Answer 4

• Panic disorder
• Panic disorder with agoraphobia
• Generalized anxiety disorder
• Major depressive disorder

Question 5

Diagnostic criteria for separation anxiety disorder

Answer 5

• Developmentally inappropriate anxiety about separation from home or from the care taker to which an individual is attached
• Duration at least 4 weeks
• Onset should be prior to 18 years of age
• Disturbance should cause clinically significant impairment in imporant areas of functioning

Question 6

Separation anxiety disorder tends to appear around age ___

Answer 6

Separation anxiety disorder tends to appear around age 8-11

Question 7

Good prognostic factors in separation anxiety disorder

Answer 7

• Timely diagnosis
• Rapid initiation of treatment (usually psychotherapeutic modalities)
• Treatment plans involving the individual, family, and school

Question 8

Treatment of separation anxiety disorder

Answer 8

• Should always include psychotherapy, usually exposure-based CBT
• Gradual plan to incrementally separate the patient from the parent with generous positive reinforcement for longer separations
• Family therapy is often beneficial
• SSRIs may be utilized to supplement CBT and decrease immediate anxiety while in therapy. Venlafaxine, TCAs, and buspirone may be used as second-line pharmacologic supplements.
• Benzodiazepines have been demonstrated not to be efficacious in treating separation anxiety disorder

Question 9

Benzodiazepines in child psychiatry

Answer 9

Benzodiazepines have not had any demonstrable efficacy in controlled trials for the treatment of childhood anxiety disorders

This is in stark contrast to their wide usage in adult anxiety disorders

Question 10

Separation anxiety disorder vs dependent personality disorder

Answer 10

In SAD, the focus of separation anxiety is on one individual caretaker

In DPD, the patient tends to be indiscriminate about attachments to others, not just one main attachment figure

Additionally, SAD is a diagnosis of childhood while personality disorders cannot be diagnosed before age 18.