Separation Anxiety Disorder

Separation Anxiety Disorder is persistent, excessive fear or anxiety about being apart from an attachment figure. The child may worry that a parent will be injured, become ill, or disappear; fear that an event will prevent reunion; refuse school or activities away from home; resist sleeping alone; have separation-related nightmares; or report headaches, nausea, or abdominal pain when separation is expected. Some separation distress is developmentally expected. The clinical pattern becomes clinically significant when the fear is out of proportion to the child’s developmental level, persists, and disrupts ordinary functioning. In children, diagnosis requires at least 3 specified symptoms for at least 4 weeks, clinically significant distress or impairment, and assessment that the presentation is not better explained by another disorder. Diagnosis is made by a qualified clinician; the RN gathers and documents the assessment data that inform that decision. The mechanism that matters most for nursing care is the avoidance cycle. Separation triggers a threat response; refusing school or calling the parent produces immediate relief. That relief reinforces avoidance, so the next separation can feel even more dangerous. Repeated...