Separation Anxiety Disorder (SAD) and Depression

SAD and depression actually share many symptoms.

separation anxiety
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Separation Anxiety Disorder and depression share many symptoms. As a parent, you are probably familiar with separation anxiety -- the feeling an infant experiences when separated from her caregivers, for example. You may be less familiar with separation anxiety disorder (SAD) and its relation to depression. This is not to be confused with seasonal affective disorder (SAD).

Separation Anxiety Differs from Separation Anxiety Disorder

Your infant will likely experience some separation anxiety when you or other caregivers are out of sight.

This is a normal developmental process and usually begins around eight months and lasts through the child's second year. For an infant, when you are out of sight, you are gone forever. As your infant matures, she will learn through experience that you will return and she will begin to be more comfortable with separations.

For some children, however, the thought of you or another caregiver leaving them is so overwhelming that they will do what they can to avoid separation. This is separation anxiety disorder. In order for it to be diagnosed, symptoms must be severe enough to interfere with a child's daily functioning for at least four weeks. When a child starts to miss out on important things such as school and social activities to avoid a separation, it is considered to be SAD. SAD affects approximately 4 to 5 percent of children.

Research has indicated that a high rate of children who develop SAD later develop a depressive disorder.

With such a strong correlation between SAD and depression, it is important to be aware of the signs and symptoms of both disorders and to seek out early treatment for your child.

Symptoms of Separation Anxiety Disorder

According to Dr. Peter M. Lewinsohn, Ph.D., who published a study of SAD in The Journal of The American Academy of Child and Adolescent Psychiatry in 2008, the underlying fear of a child with SAD is that he or his parent will be harmed, lost or gone forever as a result of the separation.

Additional symptoms of SAD may be:

  • Persistent worry about being separated from parent
  • Refusal to attend school or social events for fear of being separated from parent
  • Worry about something bad happening to a parent even when they are near
  • Refusal or hesitation to go to sleep alone
  • Nightmares involving a theme of separation
  • Excessive worry about being kidnapped, lost or kept from parent
  • Complaints of physical ailments, especially when separated from parent (headache, bellyache, generalized pain)

How SAD Relates to Depression

In Lewinsohn's long-term study of children with SAD, he estimated that 75 percent of children with SAD developed depression by the age of 30. Though research hasn't proven that SAD is the cause of depression in these children, the association between the two is a substantial one.

SAD and depression actually share many symptoms. Clinging to a parent, refusing to go to school and avoiding social activities, worrying that harm may come to self or a parent, and vague physical complaints such has headache, bellyache and general pain are common symptoms of both disorders.

Again, the research findings do not suggest that all children with SAD will experience depression. Nor does it confirm why such a large number of children with SAD go on to develop depression. But given the findings, it is important for parents and clinicians to keep a close eye out for any depressive symptoms in children with SAD.

What Can Parents Do?

Keep an eye out for additional signs of depression in children, including unexplained crying, feeling misunderstood, withdrawing from family or peers, losing interest in things of former interest, sleeping difficulties, appetite and weight changes, difficulty concentrating and making decisions, and thoughts or actions of self-harm.

When dealing with your child:

Talk to your child on an age appropriate level. Find out what he is scared of and why he doesn't want to leave you. What you hear may surprise you. Your child may have a simple complaint, which you can easily remedy. If it is something more serious (he is worried that you will do if he doesn't see you, for example), you should consult with your child's physician.

A recent tragic event, such as an earthquake or the death of a loved one, may temporarily disrupt your child's sense of security. In this case, providing your child with some extra attention may ease his anxiety.

Prepare your child for an upcoming event or separation. Explaining what will be happening, who will be there, how long he will be away from you and how he can reach you may help him feel more comfortable with a separation.

If your efforts, support and compassion do not seem to be helping your child adjust to even short separations, you should consult with your child's physician.

If you notice any symptoms of depression in your child, it is important to seek help. Depression is associated with serious short- and long-term consequences such as poor self-esteem, poor academic performance, substance abuse and suicidal thoughts and behavior.

Remember, your child may go through phases when he is more in need of your attention and love, especially during times of significant stress or tragedy. However, given the high rate of depression in children with SAD, it is best to check with a physician if you have any concerns about your child's behavior.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.

Martin T. Stein, Janet Crow, Myles Abbott and J. Lane Tanner. "Organic or Psychosomatic? Facilitating Inquiry With Children and Parents." Pediatrics , 2004 114:1496-1500.

Parenting Q&A: Separation Anxiety. American Academy of Pediatrics. Accessed 07/25/2010. http://www2.aap.org/publiced/BK0_SeparationAnxiety.htm

Peter M. Lewinsohn, Ph.D., Jill M. Holm-Denoma, Ph.D., Jason W. Small, B.A., et al. "Separation Anxiety Disorder in Childhood as a Risk Factor for Future Mental Illness." Journal of American Academy of Child and Adolescent Psychiatry, 2008 47(5): 548-555.

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