Anxiety and Separation Disorders

Alexa L. Bagnell

doi:10.1542/pir.32-10-440

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Alexa L. Bagnell, MD, FRCPC*

^*IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.

Author Disclosure

Dr Bagnell has disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Describe the basic neurobiology of anxiety and fear.
Know the epidemiology of anxiety disorders in children and adolescents.
Differentiate separation anxiety disorder from other forms of school refusal and know how to approach it therapeutically.
Know the signs and symptoms of anxiety disorders in children and adolescents.
Understand the pharmacologic and nonpharmacologic management of anxiety disorders.

Definition

Anxiety is a physiologic response necessary for all human beings to survive. It helps protect individuals in dangerous situations and prepares them for challenges. Fears are the emotional response to a given stimuli or situation that is identified as threatening or scary. Fears are a normal part of development throughout childhood and adolescence, and they change throughout the life course (Table 1). Worries are the cognitive or thinking manifestations of fear and anxiety.

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Table 1.

Common Childhood Fears

Anxiety disorders are diagnosed when fears, worries, or anxiety occur outside the range of normal developmental responses or are extreme and cause significant distress or impairment in functioning (school, home, social settings). In anxiety disorders, the fear response is no longer adaptive and is either out of proportion to a stressor or occurs when there is no threat. Due to the physiologic mechanisms activated with the anxiety and stress response in the body, individuals who have chronic anxiety and stress have a greater risk of both physical and mental health problems. Individuals who have anxiety often present to their primary clinicians with frequent physical complaints, not necessarily reporting anxiety. Parents also may report significant changes in behavior, with increased opposition and tantrums in certain situations that are triggered by anxiety.