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Separation Anxiety Disorder — MRCPsych Paper B MCQ

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EasyChild & Adolescent PsychiatrySeparation Anxiety DisorderMRCPsych Paper B

A 12-year-old girl has repeatedly refused to attend school for 6 months. On school mornings she develops headaches and abdominal pain and becomes intensely distressed because she fears that her mother may be harmed while they are apart. Her symptoms settle if she remains at home with her mother. She has no fear of social scrutiny, no circumscribed feared object or situation, and no unexpected panic attacks. Which anxiety disorder most likely accounts for this presentation?

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Correct answer: B — Separation anxiety disorder

The correct answer is separation anxiety disorder. The discriminating feature is persistent, developmentally inappropriate distress about separation from her mother, expressed through school refusal, fear that harm will befall the attachment figure and physical symptoms arising when separation is anticipated. Social anxiety disorder centres on fear of scrutiny or embarrassment, which is absent. Generalised anxiety disorder involves excessive anxiety across several areas rather than anxiety predominantly focused on separation. Specific phobia concerns a particular object or situation but does not characteristically involve attachment-related fears. Panic disorder requires recurrent unexpected panic attacks and concern or behavioural change related to further attacks; neither is described.

Reference: Cooper-Vince CE et al. The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis. Journal of Abnormal Child Psychology. 2014;42(3):417–428. https://pubmed.ncbi.nlm.nih.gov/23963543/