Early Predictors of Separation Anxiety Disorder: Early Stranger Anxiety, Parental Pathology and Prenatal Factors

Abstract

Separation anxiety disorder (SAD) is defined as anxiety over being away from a loved one, usually a parent, and is one of the most common anxiety disorders in children under 18 years of age [1] , with median prevalence rates between 1.09 and 4.1% in English-speaking children aged 5-11 [2-4] and 0.75% in Swiss children aged 7-16 years [5] . Further, SAD is a well-established predictor of later psychopathology, including depression, panic dis order with and without agoraphobia [6][7][8] , generalized anxiety disorder, obsessive-compulsive disorder, bipolar disorder, pain disorder, alcohol dependence [9] , specific phobia, posttraumatic stress disorder and acute stress [10] . Despite its significance, a thorough etiological profile of the factors contributing to SAD is not yet complete.Current models of the development of anxiety in children tend to focus on anxiety disorders in general, and have not been specifically tested with children with specific disorders such as SAD. Further, existing models, while expansive, may not be completely comprehensive. Key WordsSeparation anxiety disorder ؒ Parental pathology ؒ Prenatal risk factors ؒ Pregnancy ؒ Stranger anxiety Abstract Objective: The present study seeks to extend research on the etiology of separation anxiety disorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. Method: The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical interviews to assess parental pathology, pregnancy variables and strong early stranger anxiety. Results: Children with SAD were more likely than healthy children to have had a phase of stronger stranger anxiety in infancy. Further, early stranger anxiety remained a significant predictor of SAD after controlling for maternal depression. Meaningful effects were not found for the influence of parental age at birth or other pregnancy factors. Conclusion: This study provides beginning evidence of the potential predictive value of strong stranger anxiety in distinguishing children with SAD from those with no disorder, above and beyond the influence of parental pathology.

The Separation Anxiety Hypothesis of Panic Disorder Revisited: A Meta-Analysis

“…These results support a developmental psychopathology conceptualization of anxiety disorders, a perspective that is expected to be strengthened in DSM-5 (47). Preliminary evidence suggests a developmental pathway that may start with exaggerated stranger anxiety in infancy (48). Understanding stranger anxiety as an age-dependent developmental task may provide new insight to our understanding of the etiology of separation anxiety disorder.…”

Separation anxiety in families with emerging adults.

“…Separation anxiety typically starts to manifest at about 8 months, with a peak around 13 months, and a decrease from 30 months onwards (see also Hock & Lutz, 1998). When separation anxiety is excessive and persists beyond infancy, this may signal deficiencies in the quality of the 4 parent-child relationship (e.g., preoccupied attachment) and it may forecast separation anxiety disorder and poor adjustment and ill-being later in life (e.g., Bernstein & Borchardt, 1991;Brumariu & Kerns, 2010;Dallaire & Weinraub, 2005;Lavallee et al, 2011). Increasingly, it is being argued that separation anxiety is relevant in later developmental periods as well.…”

“…parent-child relationship (e.g., preoccupied attachment) and it may forecast separation anxiety disorder and poor adjustment and ill-being later in life (e.g., Bernstein & Borchardt, 1991;Brumariu & Kerns, 2010;Dallaire & Weinraub, 2005;Lavallee et al, 2011). Increasingly, it is being argued that separation anxiety is relevant in later developmental periods as well.…”

Separation Anxiety Disorder

“…One study examined whether early stranger anxiety could differentiate youth with SAD from those without [ 40 ] . This study found that parents of children with SAD (ages 4-14) described their children as having greater stranger anxiety as toddlers than parents of youth without SAD.…”