Wednesday, January 28, 2015

. What is separation anxiety, part 1?

In some ways, there is something worse than our own depression; it is our children having it. I have spoken in the past of one of our sons and his severe panic and depression. Having to watch him go through all the pain that is involved in this disease has proven to be a severe trial for Robyn and me. He was not the first of our children to have a depression/panic disorder. 
Our daughter, Lindsay, who has been in heaven for about fourteen years now, was diagnosed with separation anxiety and depression when she was in the fourth grade. I was a pastor in Kansas and the severity of her symptoms scared us. Fortunately I had training and experience because I  had worked as a Children's therapist and had seen this in others.  I used behavior management and also had her see a psychiatrist in Topeka, Kansas. The psychiatrist put her on Imipramine (an old tricyclic antidepressant) and after about ten days we noticed a lessening of her symptoms).  In God's providence, I was a pastor and my office was next to our parsonage and our parsonage was across the street from the school.  Lindsay was gradually urged to go to school for short periods of time.  At one point I was allowed to sit in her fourth grade class. The kids did not mind and they said that they had wondered what the pastor did all week anyway since he only worked on Sundays.
The times I spent with her in class began to be shorter.  After I felt she was well enough for me to leave her in school alone, we began the second segment of our strategy. Robyn was a homemaker and Lindsay was permitted (after some heavy persuasion with the principal) to come home every hour-just to check in and see Robyn. It didn't take long for Lindsay to be reassured that she was home and safe and everything was fine. She would run back to her classroom and repeat the process several times each day. After a while, she stayed longer and longer and her medication did its work, too.  Eventually she was able to return to school without behavioral intervention.  She remained on her medication mostly for the rest of her life. She was killed at nineteen and was always timid and slightly panicky. Now, we know she is at perfect rest with the Lord. For those of you who are facing this or have an interest in separation anxiety, I list the criteria from the DSM V. This is a very real illness.

What are the Diagnostic Criteria for Separation Anxiety?
A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from
       home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about 
       possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g.
        getting lost, being kidnapped, having an accident, becoming ill) that causes 
       separation from a major attachment figure.
4. Persistent  reluctance or refusal to go out, away from home to school,  to work
        or elsewhere because  of fear of separation .
5. Persistent  and excessive fear of or reluctance about being alone or without 
       major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep 
       without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated  complaints of physical symptoms (e.g., headaches, stomach aches, 
      nausea, vomiting) when  separating from major attachment figures occurs 
      or is anticipated.
B.The fear, anxiety, or avoidance is persistent, lasting at least four weeks in 
     children and adolescents and  typically six months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, 
     academic, occupational, or other important areas of functioning.
D. The disturbance is not better explained by another mental disorder, such as
     refusing to leave home because of excessive resistance to change as in autism 
     spectrum disorder; delusions or hallucinations concerning separation in
     psychotic disorders; refusal to go outside without a trusted companion as 
     in agoraphobia; worries about ill health or other harm befalling significant others
     as in generalized anxiety disorder.