In the development of an anxiety disorder in a child, what role do the parents’ anxieties play?

Abstract

Children of anxious parents face a significantly higher risk—up to five times greater—of developing anxiety disorders themselves, due to a combination of genetic and environmental factors. We report the case of Lilia, a 7-year-old girl referred for school refusal. She was diagnosed with school refusal rooted in severe separation anxiety, manifested through co-sleeping, avoidant behaviors, and a sense of emotional insecurity in her mother's absence. A lack of improvement after eight weeks of well-conducted treatment—comprising parental guidance, psychotherapy, and medication—prompted an investigation into factors fueling the anxiety. This revealed a maternal history marked by severe psychological trauma, as well as a parenting style that was both permissive and overprotective. Initiating individual therapy for the mother facilitated the child's gradual return to school. This case illustrates the mechanisms of the transgenerational transmission of anxiety disorders and underscores the need for an integrated therapeutic approach—one that includes the parents—to ensure lasting remission.