Big & Little Book Feature: Separation Anxiety

Written By Lauren Rivers, MS : Resident in Counseling

Introducing Big & Little Book Feature - A regular blog post that will discuss one type of disorder or issue, and the books I recommend for the big (parent, teacher) and the little (any child) in your life! I've personally read (or own) the books I will recommend here. I will note why I recommend these and include a photo of each. I will touch a little on the disorder or issue at hand and provide references at the bottom for you to learn more. Enjoy!

Big: Separation Anxiety in Children and Adolescents: An Individualized Approach to Assessment and Treatment by Andrew R. Eisen and Charles E. Schaefer 

Although this book is written clinically, it is done so assuming many parents, teachers, or others will be reading and implementing some of the strategies outside a clinical setting. It touches on cognitive-behavioral approaches and what a typical counseling session (intake assessment and follow up sessions) might look like. It includes case studies with real-life examples for relatability, allowing the parent or clinician to better visualize the issue. While it also includes case conceptualization and treatment planning for the use of a clinician, it doesn’t mean that these tools aren’t helpful at home. If you’re not in the position to access therapy at the moment, many of these tools and resources are reproducible in a safe home environment. Much of what scares young children is simply due to it being unknown or novel to them. Flipping through this book and gaining a better understanding of what separation anxiety is, and how best to label and describe it to your child, is a big step toward empowering your kiddo to learn about and stand up to this form of anxiety! 

 Little: The Invisible String by Patrice Karst

 This book is adorable! It is a bestseller and has been recommended to therapists, teachers, and other professionals for such a long time, for a good reason. It compares the unshakeable bond of love between a child and caregiver to that of an invisible string that will always be there. It touches on the feelings of loneliness and even subtly describes the specific type of loneliness that comes with grief and loss. I recommend reading this to a child with separation anxiety every morning before school, and eventually going down to once a week and so on as the child gains confidence and understands the concept. Pairing this book with a tangible art activity that involves a string, or allowing the child to take their very own string to school in their pocket, is a fun way to begin equipping them for a new school year, a parent leaving for a work trip, the death of a loved one, or any type of separation.

Understanding Separation Anxiety

Understand the symptoms. One main symptom of separation anxiety disorder in children include a constant (and often irrational) fear that the worst will happen to the parent while they’re away. This is the beginning of a child thinking that if they are in the parent’s presence, nothing bad will happen. This is problematic because it can lead to the type of “magical thinking” that can cause OCD, a tendency or need to be in control of things, and a falsified categorization of when bad things will or won’t happen. It is important to remind the child that bad things can happen at any time, and there is often nothing we can do to control this except learning to cope and calm ourselves down in healthy ways. A few other symptoms are clinging to the parent or not allowing the parent to give attention or spend time with another child (such as a classmate, friend, or even sibling), a belief that a separation will last forever, refusing to go to school, or the child repeatedly reporting somatic symptoms before bedtime or school drop-off such as a tummy ache.

Practice empathy and observe your tone. When coping with a child with separation anxiety, it is important to be cautious with your tone. Making sure your tone is non-judgmental and empathetic is important because this validates the child’s very real fears. While you may know that nothing will permanently separate you from your child, their developing minds cannot grasp this as easily, especially when the emotion of fear is involved. If the child has felt separated from a caregiver before, they’ve likely experienced a very real fear that has caused their fight or flight system to respond. When the fight or flight system is enacted, the brain responds to the fear of separation with a survival mechanism of its choosing (ex: school refusal, clinging, crying, etc.). Their bodies are doing exactly what they’re designed to do: survive. 

Understand that this is a real fear for them and do your best to be patient with their unique way of coping with this fear. Remind them that no type of separation is a permanent one even in the case of death, (customize this conversation to your unique religious or spiritual beliefs, of course) because love, or an invisible string, will always keep you together.

*all books I share can be found on Amazon unless stated otherwise. 

REFERENCE

https://www.helpguide.org/articles/anxiety/separation-anxiety-and-separation-anxiety-disorder.htm

The Impact of Trauma on Adolescent Girls

Written By Lauren Rivers, MS : Resident in Counseling

As empirical research on trauma becomes more widespread and readily available, we learn just how impactful a traumatic experience can be. These impacts are far-reaching and influence almost all aspects of an individual. But what happens when trauma meets adolescence, puberty, and the fast-paced social and emotional changes that come with this developmental stage? I’m going to share some of the different ways trauma affects adolescents, from an increased rate of self-harm and dissociation to unnecessary, insensitive labels, and the biology of the brain. 

“40% of sexual abuse survivors participate in self-injurious behavior, of one form or another” (Lev-Wiesel & Zohar, 2014; as cited in Suyemoto, 1998). Often, this self-injurious behavior involves a level of dissociation (Lev-Wiesel & Zohar, 2014). Peritraumatic and persistent dissociation are two types of dissociation associated with self-harm and trauma. Peritraumatic dissociation is the type of dissociation we typically see present itself as a sort of “protective barrier” during the traumatic or stressful event. The best way I've heard this described, by Dr. Frank Ochberg, is that it essentially you "giving your body up to protect your soul", "a form of natural anesthesia." Whereas, persistent dissociation is longer lasting and can generally make it more difficult for the individual to access (and therefore, resolve) the memories (Lev-Wiesel & Zohar, 2014).

This is concerning because this persistence often paves the way for continuous psychopathology and distress due to an inability to process it. Dissociation and self-injurious behaviors are just two symptoms, or behaviors, that can surface after trauma. We see the effects of trauma on a much deeper level, as well.

For adolescent females, in particular, the occurrence of mood-related disorders appears to increase after trauma (Malhi et al., 2019). During the “pre-teen” years, many adolescent females receive labels such as, “moody,” “difficult,” or even “bratty.” However, we know that this critical development period is when the brain is in one of its most malleable, or “plastic” states (Malhi et al., 2019). High plasticity in the brain means more susceptibility to change, growth, and formulation of new connections. While this is crucial for development, the brain is left rather vulnerable to harmful experiences - especially those involving stress and trauma (Malhi et al., 2019).

This harmful exposure often leads to symptoms associated with depression, anxiety, PTSD, and mood disorders. Our limbic system, the brain’s HQ for all things emotional (and memory and motivation) plays the VIP role concerning the development of mental health disorders after trauma (Malhi et al., 2019). Why? Because the limbic system houses our hippocampus, and our hippocampus is especially sensitive to trauma and distress (Malhi et al., 2019).

Interestingly enough, the type of trauma (emotional, physical or sexual abuse), the age of the individual when the trauma occurred, and the individual’s sex at birth all play a unique role in how the traumatic experience impacts the hippocampus (Malhi et al., 2019). Research by Infurna et al., 2016 & Mandelli et al., 2015 found that emotional abuse typically produces more harmful outcomes,than does sexual or physical abuse (Malhi et al., 2019; as cited in Infura et al., 2016; Mandelli et al., 2015).

Whenever I share some of this information with a client, they appear as shocked as I was when I first learned this stuff! Never, under any circumstances, underestimate or compare your abuse or trauma to others, even if you think it is smaller because "it was just emotional abuse", for example. 

Your trauma has impacted you and that is all that matters. It is valid. 

I hope this helps you understand a little bit more about how trauma impacts others, not just adolescents. Please keep in mind that a traumatic experience can strongly shape a persons development and growth, and unnecessary labels or added difficulties only continue to hinder their growth.

REFERENCES

Malhi, G.S., Das, P., Outhred, T., Irwin, L., Gessler, D., Bwabi, Z., Bryant, R., & Mannie, Z. (2019). The effects of childhood trauma on adolescent hippocampal subfields. Australian & New Zealand Journal of Psychiatry, Vol. 53 (5). Retrieved from: https://journals-sagepub-com.proxy1.library.jhu.edu/doi/full/10.1177/0004867418824021

Lev-Wiesel, R., & Zohar, G. (2014). The Role of Dissociation in Self-Injurious Behavior among Female Adolescents Who Were Sexually Abused. Journal of Child Sexual Abuse, Vol (23). Retrieved from: http://web.b.ebscohost.com.proxy1.library.jhu.edu/ehost/detail/detail?vid=0&sid=814d0090-db27-4190-8c68-d13776431b6c%40sessionmgr103&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl

Suyemoto, K. L. (1998). The functions of self mutilation. Clinical Psychology Review, 18(5), 531–554.