Separation Anxiety - Selective Mutism

The first anxiety disorder indicated in the DSM-5 diagnostic manual is Separation Anxiety Disorder. This is a typical problem of childhood and youth, connected to "attachment wounds." But what is attachment?

In short, attachment is the bond between a mother and her child. To be more technical, attachment is a deep and enduring emotional bond between a child and their primary caregiver. Two types of attachment have been classified. Secure attachment occurs when caregivers behave consistently and appropriately, and the child weakly protests in the absence of the caregiver and re-establishes a positive interaction upon their return.

The second type of attachment is insecure attachment, which can further be classified into:

• Avoidant: The child is not stressed by the separation and does not re-establish contact when the caregiver returns. In this case, the caregivers are rejecting and provide little physical contact.
• Resistant: The child is highly stressed by the separation (crying intensely) and pushes the caregiver away in protest upon their return. These caregivers provide inconsistent care with strong approaches and strong withdrawals.
• Disorganized: The child is generally confused and frightened both during separation and when close to the caregiver. These caregivers are neglectful or abusive.

Separation Anxiety Disorder is diagnosed when an individual experiences excessive fear or anxiety relative to their age and displays at least three of the following symptoms for four weeks in children and adolescents and six months in adults:

• Excessive and persistent distress in anticipation of or during separation from home or the caregiver.
• Excessive and persistent worry about losing the caregiver due to unforeseen circumstances.
• Excessive and persistent worry about experiencing an event that leads to separation from the caregiver.
• Reluctance or refusal to leave home for fear of separation.
• Reluctance or refusal to be alone.
• Reluctance or refusal to sleep away from home or the caregiver.
• Repeated complaints of physical symptoms.

The disorder causes significant distress in the individual's life and cannot be explained by another condition.

Another disorder typical of childhood or early youth is Selective Mutism. In this case, individuals are able to speak but do not do so in particular social situations (such as at school). Specifically, they not only do not initiate conversations but also do not respond when spoken to. The condition must persist for at least one month and interfere with the individual's school, work, or social life. There is no other explanation for the condition.

Sources:

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

I also recommend watching this video.

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