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.
Note: In young children, this may appear as
(a) fear or subjective anxious affect related to leaving home for day care or school,
(b) anticipatory fear or subjective anxious affect related to day care or school situation, or
(c) the child stays out of day care or school because of fear, anxiety, or emotional disturbance.
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. (Note: in preverbal or barely verbal children, there
may be frightening dreams without recognizable content.)
8. Repeated complaints or expression of physical symptoms (such as headaches, stomachaches, nausea, or
vomiting) when separation from major attachment figures occurs or is anticipated.
9. Persistent preoccupation or worrying about the whereabouts of attachment figures (e.g., looking out a window
or stopping play).
B. The duration of the disturbance is at least four 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. Note: In young children, the disturbance may cause parents to significantly
modify their behavior to modify the child’s behaviors.
E. The disturbance does not occur exclusively during the course of . . . (no change from DSM-IV).
Disorder of Inhibition/Avoidance
Table 18.3 Disorder of Inhibition/Avoidance
A. Excessive shrinking from contact with and persistent reluctance to approach unfamiliar people or novel
stimuli (e.g., new toys, new smells, new tastes, new sounds, new situations).
B. Exposure to unfamiliar people or to novel stimuli almost invariably provokes the behaviors in A which may
also be expressed in crying, tantrums, freezing, or shrinking from the situation.
C. Desire for social involvement with familiar people (family members and peers the person knows well) and
generally warm and satisfying relations with family members and other familiar figures.
D. The situations in A are avoided or else are endured with intense anxiety or distress.
E. The avoidance, anxious anticipation, or distress in the situation interfere significantly with the child’s normal
routine, functioning, play, or social activities or relationships, or there is marked distress concerning
F. Symptoms occur for a period of 3 months or longer.
G. The avoidance is not due to the direct physiological effects of a substance (e.g., a medication) or a general
medical condition and is not better accounted for by another mental disorder (e.g., separation anxiety disorder,
post-traumatic stress disorder, social phobia).
Generalized Anxiety Disorder
Excessive worry or anxiety occurring more days than not about many different topics or events. It is difficult to control the worry. It has been occurring for a least 6 months. For children they also need to be experiencing either restlessness, difficulty concentrating, irritability, or changes in their sleep patterns. (e.g. are they concerned about getting dirty, damage to their toys, refusal to do something benign (like take a bath) for fear of getting hurt.