Depressive and bipolar disorders. These disorders may be associated with reluctance to leave home, but the main concern is not worry or fear of untoward events befalling at- tachment figures, but rather low motivation for engaging with the outside world. How- ever, individuals with separation anxiety disorder may become depressed while being separated or in anticipation of separation.
Oppositional defiant disorder. Children and adolescents with separation anxiety disor- der may be oppositional in the context of being forced to separate from attachment figures.
Oppositional defiant disorder should be considered only when there is persistent opposi- tional behavior unrelated to the anticipation or occurrence of separation from attachment figures.
Psychotic disorders. Unlike the hallucinations in psychotic disorders, the unusual per- ceptual experiences that may occur in separation anxiety disorder are usually based on a misperception of an actual stimulus, occur only in certain situations (e.g., nighttime), and are reversed by the presence of an attachment figure.
Personality disorders. Dependent personality disorder is characterized by an indis- criminate tendency to rely on others, whereas separation anxiety disorder involves con- cern about the firoximity and safety of main attachment figures. Borderline personality disorder is characterized by fear of abandonment by loved ones, but problems in identity, self—direction, interpersonal functioning, and impulsivity are additionally central to that disorder, whereas they are not central to separation anxiety disorder.
In children, separation anxiety disorder is highly comorbid with generalized anxiety dis- order and specific phobia. In adults, common comorbidities include specific phobia,
PTSD, panic disorder, generalized anxiety disorder, social anxiety disorder, agoraphobia, obsessive-compulsive disorder, and personality disorders. Depressive and bipolar disor- ders are also comorbid with separation anxiety disorder in adults.
Diagnostic Criteria 312.23 (F94.0)
A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
B. The disturbance interferes with educational or occupational achievement or with social communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of school).
D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g., childhood- onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.
When encountering other individuals in social interactions, children with selective mut- ism do not initiate speech or reciprocally respond when spoken to by others. Lack of speech occurs in social interactions with Children or adults. Children with selective mut- ism will speak in their home in the presence of immediate family members but often not even in front of close friends or second-degree relatives, such as grandparents or cousins.
The disturbance is often marked by high social anxiety. Children with selective mutism of- ten refuse to speak at school, leading to academic or educational impairment, as teachers often find it difficult to assess skills such as reading. The lack of speech may interfere with social communication, although children with this disorder sometimes use nonspoken or nonverbal means (e.g., grunting, pointing, writing) to communicate and may be willing or eager to perform or engage in social encounters when speech is not required (e.g., nonver- bal parts in school plays).