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Problem 4 (SAD diagnosis & symptoms (Adult SAD (only diagnosed if…
Problem 4
SAD diagnosis & symptoms
characterized by unrealistic/excessive fear of separation from attachment person (i.e.mother)
dysfunctional if --> age-inappropriate behavior, interference with social or academic functioning
psychiatric disorder
symptoms must be present min 4 weeks (6 months for adults)
not explained by another disorder
symptoms
minimum three symptoms must be present
nightmares, fear of sleeping alone, clinging to attachment figures, academic refusal, anxiety about separation from attachment persons, worries (i.e. being kidnapped, being abandoned, etc.), somatic complaints
prevalence
3-4% in children (little less in adolescents)
slightly more common in girls
15% of school children show some symptoms of SAD
1/3 of children referred to a professional, actually have SAD
may vary across cultures (collectivistic societies are more interdependent)
diagnosing methods
clinical interviews
clinician rating scales
child & parent self-report diagnostic tools
observational measures (i.e. separation anxiety test)
ideally: clinical interview + observation + self-report
Comorbidity
high comorbidity with panic disorders
comorbid with other anxiety disorders (73%)
most commonly with GAD + OCD
22% comorbidity with ADHD, 21% with conduct disorder
Adult SAD
lifetime prevalence rate ~ 7%
only diagnosed if onset was before age 18
DSM-IV, this was removed in DSM-V
symptoms may be present in childhood, but develop into full syndrome later
memory & reporting bias for recall about possible childhood SAD
gender differences in prevalence rates disappear
comorbid with mood disorders
Etiology
more hereditary for girls than boys
neuroticism/behavioral inhibition is a risk factor
parents have a panic disorder / depression--> higher likelihood for child to develop SAD
anxious ambivalent + insecure attachment
higher risk for SAD
excessive parental absence
very little autonomy as a child (parents discourage risk-taking)
higher risk
family problems (violence, illness, little social support)
higher risk
Treatment
CBT
individual + group sessions are effective
CBT to parents of children with SAD
teaches parents to become 'therapists' to child
exposure, relaxation therapy, cognitive therapy
3 phases: education phase, application phase, relapse prevention phase
Family-based treatment
education, support, attention therapy
attachment-based family therapy
altering parental factors to promote inviduation
pharamcological treatments
SSRIs
nothing approved by FDA
works best in combination with CBT