Separation Anxiety
When I was fourteen, I was sent to study abroad; suddenly, leaving my close-knit family and the familiar environment felt like a cataclysmic event. Of course, with time, I have become more adept at dealing with changes and new situations. We are born defenseless and unable to survive on our own. Fortunately, our mother’s love, hormonal changes, and cute baby smiles elicit bonding and the survival benefit until we can fend for ourselves and pursue our interests.
Around the age of 6-8 months, we start developing a form of “Stranger anxiety” that sensitizes our antennae making us more adept at identifying potential risks and threats. Our secure attachments with our parents allow us to explore as we crawl or walk away, turning back occasionally to “refuel” as we glance at our parents, who encourage us to proceed.
Our innate temperament can affect this process, especially in those infants and children with “Behavioral Inhibition,” who are more cautious and guarded when confronting new situations and have more difficulty with change.
Another factor that affects how we deal with change and new situations is the type of bonding that we develop with our primary caregivers, usually our mothers. Most parent-child attachments are “secure,” allowing the infant or child to explore and develop adequate skills to deal with new situations or environments. However, other forms of bonding, such as “anxious or disorganized” attachments, can impact this new phase of exploration and lead to significant developmental concerns.
Early in elementary school, this anxiety can be experienced as physical symptoms like stomach aches, headaches, or “not feeling well.” These experiences can reappear later when starting middle school, high school, college, or adulthood with new jobs or relationships. Frequently they are transient and do not cause much dysfunction.
Our species has consistently formed family ties, tribes, and communities to protect us from potential predators or threatening situations. These groups protect the most vulnerable. On the other hand, humans also tend to explore and seek new opportunities to enhance resources. These two opposing tendencies are ingrained and typically balanced out. As a practicing child and adolescent psychiatrist, I frequently see children in my practice with more intense forms of anxiety, especially as school starts in the fall and after the Christmas Holidays.
Recently, I saw a twelve-year-old male who was starting middle school. According to his parents, Carlos was always more anxious than his siblings. He was described as a shy kid; he usually experienced some anxiety in the first week of school during elementary, complaining of stomach aches, headaches, and “just not feeling well.” He also reported “transient tearfulness” that responded well to reassurance and support from parents and teachers.
As Carlos started middle school this year, his symptoms became more intense and protracted. He complained that some kids were teasing him, and his parents decided to move him to a new school, hoping that this would help, but this did not improve the situation. The parents obtained a note from the pediatrician to allow Carlos to stay home for a few days. But now, he refuses to take the bus or car and attend school. Parents are seeking homebound schooling to avoid academic deterioration. There is a family history of anxiety in the mother and Grandmother.
Carlos has recently been sleeping with his grandmother when previously he slept in his bed. His mother reports that when she tries to drop him off at school, she feels overwhelmed and has mixed feelings about leaving him at school as if one of her hands is prompting him forward. The other is clenching his shirt, holding him back. (Note, this is a composite case).
Fortunately, most of these situations resolve quickly with some cognitive behavioral interventions and modifications at school. The most important recommendation is to ensure that the child does not miss any school and that they also sleep in their bed. These two activities are the most prolonged separations that children and their parents experience daily. This approach will ensure that the child does not develop phobic symptoms (inability to do these activities). These phobic symptoms can become very protracted if not attended to promptly but can resolve if dealt with on time.
During the pandemic, most people initially stopped going to school and work. Most of us were relieved once these recommendations were lifted and were ready to resume our normal activities after being aware of safety precautions and vaccines. The pandemic also magnified some children and adults these anxiety tendencies. This event tipped the balance between our need for exploration and our fear of change. Furthermore, it keeps leading many to develop this dread of change.
I am confident that most will be able to resume their exploration and adventurous tendencies and become more confident and comfortable with change. We must be supportive to those affected by overwhelming anxiety, feeling significantly cautious and afraid to participate in more activities. We also need to encourage those that become incapacitated by this anxiety and develop phobic symptoms to seek professional help.
As students prepare to leave home and move away to attend college or study abroad, many will experience some angst or initial dread of change, with a mixture of excitement as they venture out to a new experience. We need to support their efforts and provide reassurance while they adapt to their new environment.
In general, most of us are flexible and resilient (able to bounce back) after traumatic or overwhelming experiences. Many adults, after the pandemic, have had to make drastic changes and adjustments with carrier changes, new jobs, and relocations that offer better opportunities. These can lead to a reasonable level of anxiety. As noted, we are equipped with an antenna-like capacity that guides us to approach or retreat from new situations and guides our decision-making.
The unexpected pandemic will likely bring some challenges as we move forward and re-examine our previous roles and required changes. Some will experience this as a reboot. Hopefully, being attuned to these effects in us and supportive of others while they adapt to the new changes will lead to new opportunities and growth.
