309.21 Separation Anxiety Disorder

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309.21 Separation Anxiety Disorder
By June Hegarty Jason
Karampatsos Cecile Moran Nance
Robson Ed Shellito
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• Bob, 12 year old boy entering 7th Grade
• Only child of John Jane Doe
• John Madison Square Ad-Exec
• Jane Chemist for Pharmaceutical Co.
• Has lived in same town, attending the same school
  all through his elementary years.
• Enjoys having friends over to play video games
• Has played in towns soccer league (5 yrs.)

Our Client
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• Onset of symptoms began about 3 months (June)
  prior to 1st session
• Has always been clingy, but isnt growing out of
  it
• Frequent Nightmares
• Losing parents in a house fire
• Being left on an elevator
• Getting lost in a department store
• Needs Jane or John to stay with him in order to
  fall back asleep
• Often complains about feeling ill on school days,
  and asks mom to stay home with him
• More often than not, he isnt physically ill
• Refused to go to soccer camp
• Now hes ineligible to play this year for new
  school
• Recently he simply refuses to go to school, leave
  the house, or let John Jane go out together.

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Diagnostic Criteria for 309.21 Separation Anxiety
Disorder
A. Developmentally inappropriate and excessive
anxiety concerning separation from home or from
those to whom the individual is attached, as
evidenced by three (or more) of the
following (1) recurrent excessive distress when
separation from home or major attachment figures
occurs or is anticipated (2) persistent and
excessive worry about losing, or about possible
harm befalling, major attachment figures (3)
persistent and excessive worry that an untoward
event will lead to separation from a major
attachment figure (e.g., getting lost or being
kidnapped) (4) persistent reluctance or refusal
to go to school or elsewhere because of fear of
separation (5) persistently and excessively
fearful or reluctant to be alone or without major
attachment figures at home or without
significant adults in other settings (6)
persistent reluctance or refusal to go to sleep
without being near a major attachment figure or
to sleep away from home (7) repeated nightmares
involving the theme of separation (8) repeated
complaints of physical symptoms (such as
headaches, stomachaches, nausea, or vomiting)
when separation from major attachment figures
occurs or is anticipated B. The duration of the
disturbance is at least 4 weeks. C. The onset is
before age 18 years. D. The disturbance causes
clinically significant distress or impairment in
social, academic (occupational), or other
important areas of functioning.
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Attachment Theory(Bowlby/Ainsworth)

• Role parents play in development
• Profoundly influenced by way parents treat child
  as infant
• Mothers style of Mothering
• Influenced by emotional support receiving now
• Form of Mothering she received as a child

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Attachment Theory(Bowlby/Ainsworth)

• Secure Attachment Parent figure Available,
  Responsive, Helpful
• II. Anxious/Resistant Uncertain if Parent figure
  will be Available, Responsive, or Helpful when
  called upon
• Prone to Separation Anxiety
• Clinging Anxious when exploring world
• Conflict evident, Parent available on some
  Occasions
• Anxious/Avoidant No Confidence/when Seeks Care
  expects Rebuff
• Insecure disorganized/disoriented
• Dazed, Confused, and Fearful
• Strong patterns of Avoidance and Resistance

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Attachment Theory as applied to Separation
Anxiety Disorder (John Bowlby)

• Therapist role to provide a secure
  base/environment where the client can explore his
  relationship with his attachment figures.
• Explore Bobs unhappy/painful aspects of past and
  present
• Examine Bobs perceptions and expectations of
  attachment figures
• Encourage Bob to consider feelings/actions an
  outcome of Attachment relationship
• Empathize when Bob uncovers feelings that are
  frightening or unacceptable
• Enable Bob to recognize misleading messages from
  attachment figures

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Attachment Theory as applied to Separation
Anxiety Disorder (John Bowlby)

• Reappraising attachment figures relationship
  through new understanding acquired through
  therapeutic relationship.
• Comprehends unreasonable responses from past
  experiences.
• Cease being a slave to old images think and act
  in new ways

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Attachment TherapyThe Triangle of Conflict

• (Identify, Recognize) (Uncover,
  Express)
• Name-Empathize
  Empathize with Anxiety
• (Alteration of
  Image Self-Other Relationships)
• Elicit-Empathize with Impulse Feelings

Defense
Anxiety
Impulse/Feelings
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Attachment TheoryCrisis Intervention

• Have School Counselor visit home
• Carry memento of Mother to School
• Utilize special backpack
• Cell Phone, Scheduled Calls
• Mother volunteer as bus monitor

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Psychosocial Development(Erikson)
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Psychosocial Development(Erikson)

• Trust vs. Mistrust
• 1st Stage in Ericksons Developmental Theory
• 1st year of life
• Individual develops either a sense of trust or
  mistrust of environment
• Important to have physical comfort needs met
• They need to feel secure and minimal fear about
  the future
• Inconsistencies in parents and caretakers led
  Bob to learn to not trust his environment

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Psychosocial Development(Erikson)

• Autonomy vs. Shame Doubt
• 2nd Stage in Ericksons Developmental Theory
• Toddler Years (1-3 years old)
• A sense of independence and that their behavior
  is their own
• They need freedom to
• Explore their own abilities
• Practice emerging skills
• Without excessive restraint or harsh punishment
• Behavior in parents and caretakers contributed to
  developing self-doubt and lack of confidence

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Psychosocial Development(Erikson)

• Industry vs. Inferiority
• 4th Stage in Ericksons Developmental Theory
• 7-12 (Elementary Years)
• Individuals spends a great deal of energy gaining
  knowledge, thus developing a sense of competence
• Earlier issues (i.e. mistrust and self-doubt)
  hinder gaining a sense of Industry leading to a
  feeling of inferiority

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Psychosocial Intervention(Erikson)

• The intervention would be the process of therapy
  in and of itself
• Multiple weekly sessions, over an extended period
  of time
• Would explore the unconscious for psychosocial
  developmental issues
• Transference/counter transference, dreams
• Role of the Therapist is to interpret what the
  client brings to the session
• Interventions would focus on deficiencies in
  developmental stages
• (e.g. trust, autonomy, industry)
• Not seeking a resolution of the crisis, but a
  healthy balance favoring the more positive aspect

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Psychosocial Intervention(Erikson)

• Not as directive as other theorist, but still
  very intentional
• Psychoanalytic/Psychodynamic would not have used
  the DSM-IV
• Classical Erickson would be more long term than
  crisis intervention.

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A copy of this presentation is available
_at_www.june3rd.com/loyola