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Separation Anxiety Disorder

Suggested Diagnostic Criteria For Separation Anxiety Disorder In Children

The two most common documents used for the diagnosis of Separation Anxiety Disorder are the DSM IV and ICD 10. The DSM IV is used mostly in the United States though it has been used elsewhere, including the U.K., whereas the ICD 10 is more commonly used in Europe. We have included the descriptions of both, as below.

DSM IV
ICD 10 (European Description)

Note: Consider a criterion met only if the behaviour is considerably more frequent than that of most people of the same mental age.



DSM IV (Diagnostic & Statistical Manual) Separation Anxiety Disorder Diagnostic Criteria:

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:

A. recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
B. persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
C. persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
D. persistent reluctance or refusal to go to school or elsewhere because of fear of separation
E. persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
F. persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
G. repeated nightmares involving the theme of separation
H. 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

Differential Diagnosis

Pervasive Developmental Disorders; Schizophrenia, or other Psychotic Disorders; Generalized Anxiety Disorder; Panic Disorder with Agoraphobia; Agoraphobia Without History of Panic Disorder; Conduct Disorder; developmentally appropriate levels of separation anxiety.



Separation Anxiety Disorder - European Description:

The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992

F93.0 Separation Anxiety Disorder Of Childhood

It is normal for toddlers and preschool children to show a degree of anxiety over real or threatened separation from people to whom they are attached. Separation anxiety disorder should be diagnosed only when fear over separation constitutes the focus of the anxiety and when such anxiety arises during the early years. It is differentiated from normal separation anxiety when it is of such severity that is statistically unusual (including an abnormal persistence beyond the usual age period) and when it is associated with significant problems in social functioning. In addition, the diagnosis requires that there should be no generalized disturbance of personality development of functioning; if such a disturbance is present, a code from F40-F49 should be considered. Separation anxiety that arises at a developmentally inappropriate age (such as during adolescence) should not be coded here unless it constitutes an abnormal continuation of developmentally appropriate separation anxiety.

Diagnostic Guidelines

The key diagnostic feature is a focused excessive anxiety concerning separation from those individuals to whom the child is attached (usually parents or other family members), that is not merely part of a generalized anxiety about multiple situations. The anxiety may take the form of:

(a) an unrealistic, preoccupying worry about possible harm befalling major attachment figures or a fear that they will leave and not return;
(b) an unrealistic, preoccupying worry that some untoward event, such as the child being lost, kidnapped, admitted to hospital, or killed, will separate him or her from a major attachment figure;
(c) persistent reluctance or refusal to go to school because of fear about separation (rather than for other reasons such as fear about events at school);
(d) persistent reluctance or refusal to go to sleep without being near or next to a major attachment figure;
(e) persistent inappropriate fear of being alone, or otherwise without the major attachment figure, at home during the day;
(f) repeated nightmares about separation;
(g) repeated occurrence of physical symptoms (nausea, stomachache, headache, vomiting, etc.) on occasions that involve separation from a major attachment figure, such as leaving home to go to school;
(h) excessive, recurrent distress (as shown by anxiety, crying, tantrums, misery, apathy, or social withdrawal) in anticipation of, during, or immediately following separation from a major attachment figure.

Many situations that involve separation also involve other potential stressors or sources of anxiety. The diagnosis rests on the demonstration that the common element giving rise to anxiety in the various situations is the circumstance of separation from a major attachment figure. This arises most commonly, perhaps, in relation to school refusal (or "phobia"). Often, this does represent separation anxiety but sometimes (especially in adolescence) it does not. School refusal arising for the first time in adolescence should not be coded here unless it is primarily a function of separation anxiety, and that anxiety was first evident to an abnormal degree during the preschool years. Unless those criteria are met, the syndrome should be coded in one of the other categories in F93 or under F40-F48.

Excludes:

* mood [affective] disorders (F30-F39)
* neurotic disorders (F40-F48)
* phobic anxiety disorder of childhood (F93.1)
* social anxiety disorder of childhood (F93.2)

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ICD-10 copyright © 1992 by World Health Organization. Internet Mental Health (www.mentalhealth.com) copyright © 1995-1997 by Phillip W. Long, M.D.

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