Welcome back to our exploration into all things emotional. In this edition our Emotional Health columnist Leigh Smith explores the struggles of living with Separation Anxiety Disorder, its powerful effect, how to identify it, and how to treat it.
T HE pain filled cry of “please don’t go” from a toddler clinging to a parent at the door is something that many of us will encounter at some point. Reassurance that they’ll be fine five minutes after being left persuades us to get on with our day. Generally speaking, clingy children who display distress at parents leaving is a normal childhood developmental phase, but for some children there is more to the tears, a sense of genuine terror at being separated which indicates a deeper rooted problem, Separation Anxiety Disorder (SAD). For children who suffer from SAD, the anxiety doesn’t pass in a few minutes and there is very little a teacher can do to distract the child and diminish the feelings of anguish and fear that can be both persistent and relentless. SAD is characterised by the fear of leaving home or parting from a particular individual, usually a parent or caregiver. The sufferer is plagued with excessive worry and dreads that something terrible will happen if they are apart from the significant person. They experience high levels of anxiety at even the idea of a separation for a few moments. Their distress is not purely developmental and requires some specialist attention. In those diagnosed with SAD the anxiety must exceed what is expected at the individual’s age and developmental level, and must persist for a period of over 4 weeks for children and longer for adults. Children suffering with SAD will consistently display excessive levels of fear and terror when separated, even when the significant person is only out of sight for a moment, perhaps in the bathroom or in the garden. It will seem to the sufferer that something horrific has happened and they will experience deep distress that is not appropriate for the situation. If your child is having nightmares about separation, experiencing excessive distress or physical symptoms (headache, nausea, dizziness) when separated from home or certain people, or worrying about bad things happening, and this has been going on for more than 4 weeks, then it is time to seek help. SAD is more common in younger children but can affect any age including adults and is not gender specific. It can be painful to witness children in so much distress, and not knowing what to do for the best is a parent’s nightmare. The pressure to ‘fix it’ can be overwhelming. Trying to figure out whether to leave for work even when your child is begging you to stay is an impossible task! If you stay are you reinforcing the fear? If you leave are you deepening the anxiety? SAD can occur as a result of a trauma, a significant loss, or a change in routine or environment, but the trigger may not always be easy to identify and the symptoms can be overwhelming and effect the whole family, putting huge demands on the parent or caregiver who can feel trapped, imprisoned, overwhelmed, and at a total loss. As with other anxiety disorders, tests show that SAD often produces a chemical imbalance in the brain, and the neurotransmitters that normally regulate mood may not be activated as they should, often leading to feelings of acute anxiety at anticipated dangers. The normal fear response is not regulated and becomes out of balance to the actual event. There are different approaches to supporting someone with SAD, depending upon the age and particular symptoms being displayed. For younger children you can support them by staying calm and level headed, explain that you are leaving but that you will be coming back, and remind them that they are safe. Treat their anxiety seriously but without drama, and show calm, patience and understanding. Avoid the temptation to sneak away without telling your child you are leaving. This can seem like the least distressing way to depart, but in the long run it can lead to developing mistrust and even more difficulty next time. Build a sense of security for your child by giving them lots of positive affirmations when they manage mini separations. These affirmations embed the fact that you can be parted and nothing bad happens. For older children and adults, exposure therapy is commonly used to treat SAD. The person is gradually exposed to the distressing situation in increments, built up until being separated becomes tolerable. This type of therapy can be very challenging and I urge you to seek medical advice from a doctor who may refer your child to the local child and adolescent mental health service (CAMHS), where the workers are trained to help young people with a wide range of problems. And in the case of adults with SAD I advise support from a trained counsellor or psychotherapist who has experience dealing with this disorder. In some cases your doctor will advise a combination of emotional support and medication in order to regain control and manage the disorder. The most important thing is to seek out support, which is invaluable for both the sufferer and the carer. Remember to trust your instinct and follow the guidance of the professionals. SAD can take over your life, take one step at a time and accept all the support you can.