A 5-year-old girl cries inconsolably and clings to her mother whenever she is dropped at kindergarten. She persistently worries that something bad will happen to her mother, refuses to sleep unless her mother lies beside her, and has recurrent nightmares about being separated. Symptoms have been present for 6 months and impair daily functioning. Which is the most likely diagnosis?

• A Generalized anxiety disorder
• B Separation anxiety disorder ✓
• C Specific phobia
• D Reactive attachment disorder

Explanation

Separation anxiety disorder is defined by excessive, developmentally inappropriate fear of separation lasting at least 4 weeks, with worries about harm befalling attachment figures, refusal to sleep away, nightmares about separation, and functional impairment. Generalized anxiety is ruled out because her fears center specifically on separation rather than spanning multiple domains, which is the discriminating fact. Specific phobia targets a discrete object, and reactive attachment disorder stems from grossly deficient early caregiving with social neglect.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.