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Separation Anxiety

Separation Anxiety


Separation anxiety is defined as feelings of negative emotions such as loss, loneliness, and sadness that are experienced by individuals when they are separated from an important person in their life. Separation anxiety is typically used to describe the reaction of an infant who is separated from a major caregiver such as the mother or father. Separation anxiety, however, has also been noted to occur at other times during an individual's life. For example, the term is used to describe parents' reactions to leaving their young infant (Hock, McBride, and Gnezda 1989). Separation anxiety may also be experienced, at any age, when a significant person in one's life is lost due to death.

Theoretically, separation anxiety in a young infant is considered to be a normal process of development which helps ensure the infant's survival (Bowlby 1969). According to the ethological theory, an infant experiencing a separation from a caregiver will produce behaviors such as crying, following, and calling, which have the goal of ending the separation from the caregiver and allowing the infant to stay in close proximity to the caregiver. By staying close to the caregiver the infant increases the likelihood that he or she will be nurtured and protected and therefore will survive.

The infant's cognitive development is important in the development of the infant's separation anxiety. The development of the infant's memory and the ability to recognize when someone is familiar—or unfamiliar—is a key component in the development of the infant's separation anxiety and protest. Infants show a strong preference for people with whom they are familiar. Once the infant can recognize a familiar caregiver the infant will protest the separation from that caregiver and show a wariness of people who are strangers.

Separation anxiety develops over the infant's first year of life. Initially, a young infant does not differentiate between those persons who are familiar and those who are unfamiliar and therefore shows no sign of anxiety during separations from their major caregivers. At this early age infants readily accept the interaction of strangers and do not protest separation from caregivers. At approximately seven months of age the infant begins to recognize caregivers and it is at this time that the infant will begin to express separation anxiety and direct proximity seeking behavior (e.g., cries, smiles, and coos) toward familiar caregivers (Shaffer and Emerson 1964).

When the infant becomes mobile he or she becomes more active in contact-seeking and separation protest behavior. With the development of creeping and crawling the young infant, instead of just calling and crying, will follow a major caregiver when he or she leaves the room. Ethological theory assumes that the development of separation anxiety serves a functional purpose of causing the now mobile child to stay in contact with the caregiver.

The overt manifestations of separation anxiety (e.g., crying, calling, and following) typically peak between twelve and eighteen months of age. As the toddler matures, usually after the child's second birthday, he or she begins to develop cognitive and behavioral means to cope with separations and separation anxiety decreases. Examples of methods used by older children to cope with these separations are maintaining a mental picture of their caregiver and keeping themselves busy during separations. Older children also are beginning to understand that separations are temporary and that their caregiver will return shortly.

The development of the infant's caregiverdirected separation protest and contact-seeking behavior coincides with the development of the infant's attachment to his or her major caregivers. It is over the course of the infant's first year that the quality of the infant's attachments to major caregivers develops. The quality of the infant's attachment to major caregivers does not influence the development of separation anxiety, but it may influence the infant's overt separation protest behaviors and the child's ability to cope during separations. Insecurely attached infants may have heightened or decreased levels of separation protest and their separation anxiety may not be reduced when their caregiver is present. Though infants who are securely attached to their caregivers also protest separation, their separation anxiety decreases with the presence of their caregiver (Ainsworth et al. 1978).

The infant's security of attachment originates within the interactions of the infant-caregiver dyad during the infant's first year of life. For example, when the caregiver is sensitive to the infant and responds appropriately to the infant, the infant will develop a secure attachment. A securely attached infant is confident that their caregiver will be available when they need the caregiver and separation anxiety is decreased. However, if the infant has experienced rejection from a caregiver or is unsure of the caregiver's responsiveness the infant may develop an insecure attachment. The insecurely attached infant's separation anxiety will be enhanced due to the infant's lack of confidence in the caregiver's availability.

The degree to which the infant experiences separation anxiety is influenced by many factors besides quality of attachment. For example, the caregiver's behavior immediately proceeding the separation will influence how long the infant protests the separation (Field et al. 1984). Preparing a child for the separation by letting the child know that the separation is going to occur and that the caregiver will return, instructing the child on what to do during the separation (e.g., play with the toys), and making the leave-taking short has been found to decrease overt signs of separation anxiety.

Infants also display greater separation anxiety when they have less experience with separation from their caregiver ( Jacobson and Wille 1984). When an infant has multiple caregivers (e.g., mother, father, grandparents, and baby-sitters) less separation protest is observed. It is assumed that children with multiple caregivers are familiar with what occurs during separations, understand that these separations are temporary, and have learned how to cope with these separations. These children may also have developed attachments to multiple caregivers and/or may have learned to gain comfort from other adults.

The level of separation anxiety expressed by infants is also influenced by cultural practices. Typically, Japanese infants have little or no experience with maternal separation. Japanese mothers also give their infants their total attention and positive regard. Japanese infants have an immediate and negative response to separation from their mothers. These infants appear to have a high level of separation anxiety (Van Ijzendoorn and Sagi 1999).


Separation Anxiety Disorder

Though separation anxiety is considered to be part of normal development, when a young child's separation anxiety is severe and prolonged he or she may by diagnosed with Separation Anxiety Disorder (American Psychiatric Association 1994). Separation Anxiety Disorder is diagnosed when a child, under the age of eighteen years, shows excessive anxiety about separation from a primary attachment figure or home which lasts for at least four weeks. Some of the symptoms associated with this disorder are unrealistic worry that either the child or the caregiver will be harmed during separation, refusal to go to school, and becoming physically ill or complaining of illness before or during the separation. This disorder is estimated to occur in approximately 4 percent of children (Anderson et al. 1987). It is assumed that Separation Anxiety Disorder may manifest itself in other psychological disorders when the child becomes an adult; however, little research has been completed to support this hypothesis (Majcher and Pollack 1996).

The symptoms associated with Separation Anxiety Disorder may decrease the number of positive interactions that the child has with his or her parents. For example, a child's school refusal may lead to daily prolonged negative interactions, with the parent attempting to get the child up and ready for school and the child refusing to cooperate and complaining of physical illness as a means to avoid school. Parents may respond to school refusal with increased harshness and develop feelings of guilt because of their child's behavior and their inability to manage this behavior.

The possible causes of Separation Anxiety Disorder are diverse and it is often difficult for the therapist to determine the exact cause. Cases of Separation Anxiety Disorder have been noted due to prolonged parental separation (e.g., if parent or child is hospitalized) and death of a significant figure in the child's life (e.g., grandparent). In some cases, the parents have also been found to have experienced a high level of anxiety as a child. Though theory and research show a connection between separation anxiety and protest and the child's quality of attachment, research is still needed to determine if the quality of the child's attachment relationships has an impact on the development of Separation Anxiety Disorder (Greenberg 1999).

There are several treatment options available for children with Separation Anxiety Disorder. Research is still needed to determine the most effective method to treat this childhood disorder. Therapies used to treat Separation Anxiety Disorder include behavioral therapy and cognitive-behavioral therapy, which have been found to be effective in decreasing the level of anxiety and overt separation protest behaviors produced by children (Mash and Barkley 1998). Examples of behavioral and cognitive-behavioral therapy include rewards for appropriate behaviors, modeling of appropriate behavior, and systematic desensitization.

With systematic desensitization the child is exposed to a series of events with each event in this series eliciting more separation anxiety than the preceding event. The first event usually causes the child to experience very little separation anxiety, the next event would cause the child to experience a little more separation anxiety, and so forth. These events may be imagined by child, if they are old enough and have the cognitive ability to imagine events, or the environment is manipulated so that the child actually experiences the events. Starting with the least anxiety producing event (e.g., the child imagines his/her mother explaining that she will need to go to the store to get an item of food for dinner or the mother actually explains to the child that she will need to go to the store to get an item of food for dinner), the child is taken through relaxation steps or counter conditioning (child receives a positive reward) that leads to a decrease in the anxiety. Once the child is experiencing little or no anxiety to this stimulus the next separation anxiety producing event is presented.

Family therapy and pharmacological interventions have also been used to treat Separation Anxiety Disorder. Family therapy may include child management training and parent education. The parents are given information about the disorder, how to manage their child's reactions to separations and school refusal, and how to support their child's emotional needs. In most cases family therapy is provided together with individual therapy for the child. Pharmacological interventions for Separation Anxiety Disorder are relatively recent and are usually integrated with the other forms of therapy described above. More research is needed to determine the effectiveness of pharmacological interventions on Separation Anxiety Disorder (Allen, Leonard, and Swedo 1995).

Treatment for school refusal, one of the possible symptoms of separation anxiety, varies depending upon how quickly the child develops this symptom. For children who develop this symptom quickly, a method developed by Wallace Kennedy (1965) appears to be effective. Kennedy's approach is to get the child into school, keep them at school, and provide them with positive reinforcement for attending school as well as modeling appropriate behavior. For other children, the development of school refusal occurs over an extended period of time and many different factors may play a role in the development of this symptom. In these cases treatment usually consists of individual therapy for the child as well as family therapy.


See also:Anxiety Disorders; Attachment: Parent-Child Relationships; Development: Cognitive; Developmental Psychopathology; Loneliness; School Phobia and School Refusal; Separation-Individuation; Shyness: Therapy: Family Relationships; Therapy: Parent-Child Relationships


Bibliography

ainsworth, m.; blehar, m.; waters, e.; and wall, s. (1978). patterns of attachment: a psychological study of the strange situation. hillsdale, nj: erlbaum.

allen, a.; leonard, h.; and swedo, s. (1995). "current knowledge of medications for the treatment of childhood anxiety disorders." journal of the american academy of child and adolescent psychiatry 34:976–986.

american psychiatric association (1994). diagnostic andstatistical manual of mental disorders, 4th edition. washington, dc: author.

anderson, j.; williams, s.; mcgee, r.; and silva, p. (1987). "dsm-iii disorders in preadolescent children: prevalence in a large sample from the general population." archives of general psychiatry 44:69–76.

bowlby, j. (1969). attachment and loss: attachment. new york: basic books.

field, t.; gewirtz, j.; cohen, d.; garcia, r.; greenberg, r.; and collins, k. (1984). "leave-takings and reunions of infants, toddlers, preschoolers, and their parents." child development 55:628–635.


greenberg, m. (1999). "attachment and psychopathology in childhood." in handbook of attachment: theory, research, and clinical applications, ed. j. cassidy and p. shaver. new york: guilford press.

hock, e.; mcbride, s.; and gnezda, m. t. (1989). "maternal separation anxiety: mother-infant separation from the maternal perspective." child development 60:793–802.

jacobson, j., and wille, d. (1984). "influence of attachment and separation experience on separation distress at 18 months." developmental psychology 20: 477–484.

kennedy, w. (1965). "school phobia: rapid treatment of 50 cases." journal of abnormal psychology 70:285–289.

majcher, d., and pollack, m. (1996). do they grow out of it? long-term outcomes of childhood disorders. washington, dc: american psychiatric press.

mash, e., and barkley, r. (1998). treatment of childhooddisorders. new york: guilford press.


schaffer, h. r., and emerson, p. e. (1964). "the development of social attachments in infancy." monographs of the society for research in child development 29(3):1–77.

van ijzendoorn, m., and sagi, a. (1999). "cross-cultural patterns of attachment: universal and context dimensions." in handbook of attachment: theory, research, and clinical applications, ed. j. cassidy and p. shaver. new york: guilford press.

diane e. wille

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Separation Anxiety

Separation anxiety

Definition

Separation anxiety is distress or agitation resulting from separation or fear of separation from a parent or caregiver to whom a child is attached.

Description

Separation anxiety is a normal part of development. It emerges during the second half year in infants. Separation anxiety reflects a stage of brain development rather than the onset of problem behaviors. On the other hand, prolonged separation anxiety that develops in school age children is considered an anxiety disorder by the American Psychiatric Association.

Normal separation anxiety

Developmentally normal separation anxiety usually begins somewhere around eight to 10 months and peaks by 18 months, after which it gradually diminishes until by age three. Only occasional bouts of separation anxiety then occur when the child is faced with new situations, such as starting preschool or the addition of a new baby to the family .

Before about six months of age, infants show little special attachment to a particular caregiver and no distress at being left alone. At about eight months, babies begin to react by crying and fussing whenever their primary caregiver leaves the room. Bedtimes may become a struggle, with the child refusing care from all but the primary caregiver and crying, fussing, and calling the caregiver when it is time to go to sleep . This unwillingness to be left alone can continue for many months.

When left with a babysitter, even a familiar individual that the infant formerly accepted, the child may scream and cry to exhaustion. This is likely to be due to a combination of separation anxiety and stranger anxiety , which arise at about the same time and has similar origins.

Separation anxiety is thought to develop because as babies mature mentally, they begin to recognize their caregivers as unique individuals. However, infants lack the mental capacity to understand that the caregiver still exists when out of sight. To the infant, once the caregiver cannot be seen, she is gone forever (lack of object permanence). This inability to project beyond what is immediately visible, coupled with the newly formed attachment to the caregiver, causes distress that is usually expressed by crying. Although this is a difficult stage for parents, the fact that a child fusses when the preferred caregiver leaves is a sign of healthy bonding and normal development. With experience and increased mental maturity, the child will eventually understand that he is not being abandoned permanently and that the caregiver will return.

Although separation anxiety is normal in infants and toddlers, cultural practices have an impact on the timing of its emergence and its extent. Babies who remain in constant contact with their mothers may develop separation anxiety earlier and possibly for more intense and prolonged periods than infants frequently cared for by a variety of different caregivers.

Separation anxiety disorder

Separation anxiety disorder occurs when older children refuse to leave a parent or other caregiver to whom they have become attached. Often separation anxiety disorder begins around age six or seven at a time when it can interfere with school attendance. School phobia can be a type of separation anxiety disorder.

Children with separation anxiety disorder repeatedly show at least three of the following behaviors at a developmentally inappropriate age:

  • excessive distress at leaving home or leaving the primary caregiver, or even distress in anticipation of leaving
  • excessive worry that something catastrophic will happen at home or to the caregiver while the child is away
  • extreme fear that something will happen to them, such as getting lost or kidnapped, that will prevent their return to the caregiver
  • unwillingness to be alone, even in familiar settings
  • nightmares about separation from home and loved ones
  • inability to stay at a friend's house overnight or go away to camp due to worry about what is happening at home
  • physical complaints such as stomach pains, dizziness , headaches, or vomiting when faced with separation from home or caregiver
  • refusal to attend school not related to events at school such as bullying or academic failure
  • attachment to home or caregiver that interferes with social life and school attendance

Unlike developmentally normal separation anxiety, children do not outgrow separation anxiety disorder. This disorder is usually treated with a combination of behavioral and cognitive therapy. Behavioral therapy involves teaching parents and children strategies for overcoming stressful separation and may involve desensitization by gradual exposure to longer and longer periods apart. Cognitive therapy teaches children to redirect their thoughts and actions into a more flexible and assertive pattern. Family therapy may also be used to help resolve family issues that may be negatively affecting the child.

Separation anxiety disorder sometimes occurs in conjunction with other psychiatric disorders, such as pervasive developmental disorder, schizophrenia , other anxiety or panic disorders, and major depression. Depending on the diagnosis, children may also be treated with drugs to help alleviate these disorders. However, the use of antidepressants in minors is currently under review. In October 2003, the United States Food and Drug Administration issued an advisory indicating that children being treated with selective serotonin re-uptake inhibitor antidepressants (SSRIs) for major depressive illness may be at higher risk for committing suicide . A similar warning was issued in the United Kingdom. Parents and physicians must weigh the benefits and risks of prescribing these medications for children on an individual basis.

Common problems

Parents are frequently frustrated by the intensity of their child's separation anxiety while an infant and toddler and believe that something is wrong with their child rather than accepting this natural stage of development. In school-age children, refusal to attend school due to separation anxiety disorder is common. This can lead to academic failure and difficulty in making friends and developing relationships outside the home.

Parental concerns

Parents are distressed and concerned when their child is distressed. However, since anxiety disorders have an inherited component, in some families a parent will also have an anxiety disorder. The parent's anxieties can add to the child's concerns about separating, worsening the separation anxiety. In this case, family therapy as well as individual therapy for the parent and child may be appropriate.

When to call the doctor

Parents should call the doctor when a child in kindergarten or older shows extreme reluctance to separate from the parent to the point where it interferes with the child's normal life and social development. After a physical examination, a psychological evaluation that includes several assessments for anxiety and a behavioral checklist that evaluates the child's behavior at home and school should be done by a psychologist or psychiatrist with experience in separation anxiety.

KEY TERMS

Selective serotonin reuptake inhibitors (SSRIs) A class of antidepressants that work by blocking the reabsorption of serotonin in the brain, thus raising the levels of serotonin. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

See also Stranger anxiety; School phobia/school refusal.

Resources

BOOKS

Greenberg, Mark T., Dante Cicchetti, and E. Mark Cummings. Attachment in the Preschool Years: Theory, Research, and Intervention. Chicago: University of Chicago Press, 1990.

Moore, David and James Jefferson. "Separation Anxiety Disorder." Handbook of Medical Psychiatry, 2nd ed. St Louis: Mosby, 2004 pp 52-54.

"Separation Anxiety." The Gale Encyclopedia of Childhood and Adolescence Detroit, MI: Gale Research, 1998.

ORGANIZATIONS

American Academy of Pediatrics T 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098 Telephone: 847/434-4000 Fax: 847/434-8000 Web site: <http://www.aap.org>

WEB SITES

"Other Mental Disorders in Children and Adolescents: Separation Anxiety Disorder." Mental Health: A Report Card from the Surgeon General [accessed 6 September 2003] <http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html>.

Tish Davidson, A.M.

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Separation Anxiety

Separation anxiety

Distress reaction to the absence of the parent or caregiver.

Separation anxiety emerges according to a developmental timetable during the second half year in human infants. This development reflects advancing cognitive maturation, rather than the onset of problem behaviors.

As illustrated in the accompanying figure, infants from cultures as diverse as Kalahari bushmen, Israeli kibbutzim, and Guatemalan Indians display quite similar patterns in their response to maternal separation, which peaks at the end of the first year and gradually becomes less frequent and less intense throughout later infancy and the preschool years. This fact has been interpreted to mean that the one-year-old is alerted by the absence of the parent and tries to understand that discrete event. If it fails, fear is created and the child cries.

Cultural practices have an impact on separation anxiety. Infants who remain in constant contact with their mothers may show an earlier onset of separation anxiety, and possibly more intense and longer periods of reactivity. For example, Japanese infants who are tested in Mary Ainsworth 's Strange Situation show more intense reactions to the separation, presumably as a result of cultural norms prescribing constant contact between mother and infant for the first several years of life.

Like separation anxiety, researchers who observe infant emotions and behavior in the first month or two of life generally agree that no specific fear reaction is present at this early stage. Rather, infants become distressed due to unpleasant stimulation involving pain , discomfort, or hunger.

Typically researchers have found that by five to six months, if a stranger stares in silence at an infant, the infant will often return the look and after about 30 seconds begin to cry. Bronson has termed this distress reaction to a stranger's sober face "wariness." Because of the gradual building up of tension in the infant, Bronson interprets the emotional distress as a reaction to the failure to assimilate the unfamiliar face to a more familar schema. In another words, the older infant can distinguish between familiar and unfamiliar faces, tries to understand the distinction, and becomes upset if the new face does not match the now familiar pattern.

A few months later, infants may react immediately to strangers, especially if approached suddenly or picked up by the stranger. This fear reaction, which can be readily elicited in most infants between seven and twelve months, has been called stranger distress or stranger anxiety .

The context and qualitative aspects of the stranger's approach are critical in determining how an infant might respond. If the stranger approaches slowly when the caregiver is nearby, smiling and speaking softly, offering a toy, the infant will often show interest or joy, and distress is unlikely. Also, the degree of distress shown by an infant to the silent intrusion of the stranger varies greatly from baby to baby, a finding that many believe to be rooted in the temperament of the infant. Finally, if the infant finds the stranger's approach to be ambiguous, the caregiver's reaction will often influence the infant's response. Should the parent smile and warmly greet the new person, the older infant will often use these emotional reactions as cues for how to respond.

Stranger distress was originally described by Rene Spitz as an emotion that suddenly appears in all infants at about 8 months. While we now understand how important a role context and cognition play in determining this response, there is nevertheless evidence suggesting a precise timetable for its emergence across different cultures, including Uganda, Hopi Indian, and the United States. A genetic basis has also been shown by twin research, with identical twins showing more similar onset of stranger distress than fraternal twins. Rather than indicating emotional difficulties, the emergence of a fear of strangers in the second half of the first year is an indicator of cognitive development . For example, EEG and heart rate patterns in human infants both show a major developmental shift at this time in response to the presentation of threatening stimuli.

As infants acquire more experience in dealing with unfamiliar persons at family outings, visits to the home, or in day care, they no longer become distressed at the sight of a stranger. Young children show a wide variety of responses depending on the situation, their past experiences, and their level of sociability. Parents will want to encourage their child's natural curiosity and friendliness, while at the same time teaching them that they should always rely on parental guidance and approval in dealing with strangers.

The study of these two common fears of infancy underscores the important links between emotion and cognition. Discrepancy theories originating in the work of Hebb and Jean Piaget provide an account of the steps in the development of this basic emotional system in infancy and demonstrate its dependence on perceptual and cognitive development. In addition, the importance of context and meaning have been clearly shown in the work of Jerome Kagan , Alan Sroufe, and others to be the hallmark of the mature fear response, as distinct from the general distress of early infancy.

While stranger distress and separation anxiety are normal for one-year-old infants, should a parent become concerned if they persist into the toddler or preschool years? The key to answering this question depends upon the nature of the child's response, its intensity, and persistence over time. For example, it is commonplace for young preschoolers to show some distress at separation from their parents during the first week or two of daycare in a new setting. Typically this settling in period does not last too long. If a preschooler persists in showing excessive separation anxiety even after several weeks at a new preschool and this interferes with the child's participation with peers and teachers, parents should consult with the teacher and other child care professionals. Childhood anxieties of this sort are generally quite responsive to treatment, and this may be a better option than waiting for the problem to resolve itself.

See also Strange situation; Stranger anxiety

Peter LaFreniere

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Separation Anxiety

Separation Anxiety

BIBLIOGRAPHY

Separation anxiety is characterized by infants and toddlers intense emotional reactions to the departure of a person with whom they have established an emotional attachment. Having its roots in psychodynamic theory, according to which infants attachment to their mothers is a learned response to being fed, the ethological theory of attachment (Bowlby 1980) frames the development of emotional attachment as an innate behavioral need that not only satisfies infants hunger, but also keeps them safe from danger and allows for a secure base from which they can explore their surroundings. According to attachment theory, separation anxiety is a normal developmental stage in which infants have formed a representation of their caretakers as reliable providers of comfort and security.

The strange situation procedure (Ainsworth et al. 1978), in which infants and toddlers are observed during brief separations from and reunions with the parent, is often used by researchers to determine if infants have reached the stage of separation anxiety and if their attachments with caregivers are healthy and secure. Using such procedures, researchers have found that separation anxiety is a fairly universal phenomenon that emerges around six to eight months, with signs of distress peaking around fourteen to twenty months, at which age toddlers may follow or cling to caregivers to prevent their departure.

Typically, separation anxiety lasts only a few minutes; however, many factors, such as tiredness, illness, changes in the household routine, family changes such as birth of a sibling, divorce, death, or a change in caregiver or routine at a day-care center, can contribute to more intense episodes. The intensity of distress also varies depending on: (1) the availability of another person with whom the child has a close bond; (2) the familiarity of the situation; (3) previous experience with the caretaker leaving; and (4) the childs sense of control over the situation. Separation anxiety diminishes as children develop a sense of safety and trust in people other than parents, become familiar with the environment, and trust in the parents return.

Although separation anxiety is part of normal development for infants and toddlers, for older children, adolescents, or adults such anxieties and behaviors may represent symptoms of a serious disorder known as separation anxiety disorder, or what are also referred to as disorders of attachment. In addition to excessive distress when separated from the primary caregiver, symptoms of disorders of attachment include sleep disturbances such as difficulty falling asleep, nightmares, or fears at bedtime; depressed or withdrawn behavior; apathy; difficulty concentrating; and somatic complaints (e.g., dizziness, nausea, or palpitations). Children may also fear losing the parent or worry about the parent being harmed. Their need to stay close to the parent or home makes it difficult to form healthy relationships with others, such as peers or teachers. Older individuals with separation anxiety disorder may have difficulty moving or getting married and may, in turn, worry about separation from their own children and partner. To reach the diagnostic threshold for this disorder, the anxiety or fear must cause distress or affect social, academic, or job functioning.

SEE ALSO Anxiety; Attachment Theory; Child Development; Children; Neuroticism; Psychology

BIBLIOGRAPHY

Ainsworth, Mary D. S., M. C. Blehar, E. Waters, and S. Wall. 1978. Patterns of Attachment : A Psychological Study of the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: Author.

Bowlby, John. 1980. Loss: Sadness and Depression. Vol. 3 of Attachment and Loss. New York: Basic Books.

Becky Kochenderfer-Ladd

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