Feriante Joshua, Torrico Tyler J., Bernstein Bettina
University of Utah
Consilient Interventional Healthcare
Anxiety describes an uncomfortable emotional state characterized by inner turmoil and dread over anticipated future events. Anxiety is closely related and overlaps with fear, a response to perceived and actual threats. Anxiety often results in nervousness, rumination, pacing, and somatization. Every human experiences anxiety because it is an evolved behavioral response to prepare an individual to detect and deal with threats. Anxiety becomes pathological when it is so overwhelming that there is persistent distress, a decrease in quality of life, and impairment in regular major life activities. Anxiety disorders are the most common psychiatric disorders in children and are often underrecognized. Untreated anxiety disorders in children can significantly impair quality of life, lead to comorbid psychiatric conditions, and interfere with social, emotional, and academic development. Adults with anxiety similarly experience a poorer quality of life than those without anxiety disorders, and the severity of anxiety can impact daily functioning. Separation anxiety disorder (SAD) is 1 of the most common childhood anxiety disorders. SAD involves significant distress when the child is unexpectedly separated from home or a close attachment figure. SAD is an exaggeration of otherwise developmentally normal anxiety and manifests as excessive concerns, worry, and even dread of the actual or anticipated separation from an attachment figure or home. Although separation anxiety is a developmentally appropriate phenomenon, the disorder manifests with improper intensity at an inappropriate age or in an inappropriate context. The edition 4 (DSM-4) limited the diagnosis of SAD to children and adolescents. However, in the DSM-5, the diagnosis was extended to include adults first diagnosed with SAD in adulthood. One difference in children diagnosed with separation anxiety compared to adults is the type of attachment figures involved. In the case of children, the attachment figures are usually adults, such as parents, whereas adults experience anxiety due to actual or anticipated separation from children, spouses, or romantic partners. Developmentally appropriate separation anxiety manifests between 6 to 12 months of age. This normative or physiological separation anxiety remains steadily observable until approximately age 3 and, under normal circumstances, diminishes afterward. Developmentally appropriate separation anxiety eventually extinguishes as a child develops a greater sense of autonomy, cognitive ability, and an understanding that a separated attachment figure return. More significant than expected duration or intensity of separation anxiety symptoms in children or the development of this disorder in older children, adolescents, or adults constitutes SAD. This disorder severely affects the quality of life and functioning across several areas, including school, work, social interactions, and close relationships. SAD is a gateway anxiety disorder that can lead to poor mental and physical health outcomes, including excessive worry, sleep disturbances, undue distress in social settings, poor academic performance, and somatic complaints.
焦虑是一种令人不适的情绪状态，其特征为内心的混乱以及对预期未来事件的恐惧。焦虑与恐惧密切相关且相互重叠，恐惧是对感知到的和实际存在的威胁的一种反应。焦虑常常导致紧张、反复思考、踱步以及躯体化症状。每个人都会经历焦虑，因为它是一种进化而来的行为反应，能让个体察觉并应对威胁。当焦虑过于强烈，导致持续的痛苦、生活质量下降以及日常主要生活活动受损时，它就会变成病理性的。焦虑症是儿童中最常见的精神障碍，且常常未被充分认识。儿童未经治疗的焦虑症会显著损害生活质量，导致共病的精神状况，并干扰社交、情感和学业发展。患有焦虑症的成年人同样比没有焦虑症障碍的人生活质量更差，焦虑的严重程度会影响日常功能。分离焦虑症（SAD）是最常见的儿童焦虑症之一。当孩子意外与家或亲密的依恋对象分离时，SAD会引发严重的痛苦。SAD是对原本在发育上正常的焦虑的一种过度反应，表现为过度担忧、担心，甚至对与依恋对象或家的实际或预期分离感到恐惧。尽管分离焦虑是一种在发育上正常的现象，但该障碍在不适当的年龄或不适当的情境下会以不适当的强度表现出来。第四版《精神疾病诊断与统计手册》（DSM - 4）将SAD的诊断局限于儿童和青少年。然而，在《精神疾病诊断与统计手册》第五版（DSM - 5）中，诊断范围扩大到包括成年后首次被诊断为SAD的成年人。与成年人相比，被诊断患有分离焦虑症的儿童涉及的依恋对象类型有所不同。就儿童而言，依恋对象通常是成年人，比如父母，而成年人则因与孩子、配偶或恋爱伴侣的实际或预期分离而感到焦虑。发育上正常的分离焦虑在6至12个月大时出现。这种正常的或生理性的分离焦虑在大约3岁之前一直可以稳定观察到，在正常情况下，之后会逐渐减轻。随着孩子发展出更强的自主感、认知能力以及理解到分离的依恋对象会回来，发育上正常的分离焦虑最终会消失。儿童分离焦虑症状的持续时间或强度超过预期，或者在年龄较大的儿童、青少年或成年人中出现这种障碍，就构成了SAD。这种障碍会严重影响多个领域（包括学校、工作、社交互动和亲密关系）的生活质量和功能。SAD是一种引发其他焦虑症的焦虑症，会导致不良的身心健康后果，包括过度担忧、睡眠障碍、在社交场合过度痛苦、学业成绩不佳以及躯体不适。
