Schizoaffective disorder

Separation Anxiety Disorder

1) Disease Description (Causes and Symptoms)

• Definition: An anxiety disorder in which excessive anxiety occurs, disproportionate to the person’s age, when separated from an attachment figure (usually a parent or caregiver) or from home, causing impairment in daily life. The prevalence among children and adolescents is approximately 4%. It commonly begins around 7–8 years of age but occurs most often before puberty. In some cases, it may persist into adulthood.
• Main causes and pathophysiology:
  • It is associated with temperamental factors (anxiety-prone disposition), a family history of anxiety disorders, and an overprotective or excessively close parenting environment.
  • Stressors (such as the death of a close relative, a parent’s illness, moving, or changing schools) or the child’s own physical illness may act as triggers.
  • From a neurobiological perspective, increased sensitivity of anxiety circuits (such as the amygdala) and increased stress reactivity are involved.
• Main symptoms:
  • Extreme reluctance to separate from the attachment figure, wanting to be together at all times, or frequently checking whether the person is present
  • Avoidance of separation situations, such as refusing to attend school or participate in school trips or camps
  • Excessive worry about unfortunate events, such as the death or serious injury of the attachment figure
  • Sleep disturbances (such as wanting to sleep with a parent), nightmares, and physical symptoms such as headache, abdominal pain, dizziness, and palpitations
  • Peer relationships are often relatively adequate

2) Treatment Methods and Precautions

• Psychotherapy
  • Cognitive behavioral therapy (CBT): The key components are gradual exposure with family participation (gradually increasing separation situations to reduce anxiety) and cognitive restructuring.
  • Family therapy/parent training: Adjusting parents’ overprotective responses, establishing consistent rules, and teaching appropriate reward and reinforcement techniques.
  • Play therapy/supportive counseling: Effective in younger children and helps them express anxiety.
• Medication
  • If symptoms do not improve with behavioral therapy or are severe enough to cause functional impairment (such as refusal to attend school), medications with anti-anxiety effects, including selective serotonin reuptake inhibitors (SSRIs), may be considered. The choice, dosage, and duration of medication should be discussed with a psychiatrist.
• Lifestyle and self-management
  • Gradual exposure to separation (setting small, specific goals), regular sleep and meals, and maintaining a regular routine
  • Excessive reassurance (such as allowing repeated phone calls) may provide temporary relief but can reinforce avoidance behaviors in the long term, so it should be used strategically
  • Anxiety-relief techniques (breathing and relaxation training) and a positive reward system
• Precautions and complications
  • Refusal to attend school can worsen rapidly and lead to declines in academic and social functioning, so early intervention is recommended
  • Comorbid conditions such as depression, panic disorder, and behavioral disorders should be assessed and treated
  • If left untreated over the long term, it may lead to separation anxiety in adulthood (refusal to move away from home and difficulties with interpersonal relationships and forming a family)

3) Outpatient Visit Checkpoints (Preparation and Example Questions)

• Items/materials to prepare or bring
  • A list of current medications (including prescription drugs, nonprescription drugs, and supplements)
  • Previous medical records and psychological test results (if available)
  • Notes on when symptoms began and how they have progressed (when, in what situations, how often, and for how long the anxiety occurs)
  • The number and duration of school refusal episodes (e.g., the number of days absent during the past month) and a sleep diary (bedtime, wake-up time, and nighttime awakenings)
  • School counseling records and teachers’ observation notes (if available)
• Key items to confirm during the outpatient visit (providing this information in advance can facilitate the consultation)
  • Situations in which anxiety worsens (specific places, times, or people)
  • Presence of physical symptoms (such as headache or abdominal pain) and test results (whether there are any medical abnormalities)
  • Family composition and family history (parents’ anxiety or psychiatric history)
  • Recent stressors (moving, starting school, changes at home, etc.)
  • Any thoughts of self-harm or suicide or extreme behaviors

4) Examples of General Questions to Ask the Doctor

• "What is the expected course (prognosis) of this condition?"
• "What treatment methods do you recommend, and how long is treatment expected to take?"
• "If medication is needed, what medication would be used and what are its side effects?"
• "What specific actions can parents take at home (words, rules, and rewards)?"
• "How should we cooperate with the school when refusal to attend school is severe?"
• "What objective indicators (such as attendance days or anxiety scores) can be used to assess treatment effectiveness?"

5) Examples of Condition-Specific Questions

• "When my child is afraid to sleep alone at night, how can we create a specific step-by-step plan to help them become independent?"
• "If my child continues to refuse to attend school, what should we request first when consulting with the school (such as matters to discuss with the homeroom teacher or school counselor)?"

(If needed, we can additionally provide a customized consultation plan that includes diagnostic criteria, treatment options, and information about local mental health resources.)