The essential feature of separation anxiety disorder is excessive fear concerning separation from home or from the separation of an attachment figure. The anxiety one can expect with this condition will exceed that which is expected given the person’s developmental level.

When a child with separation anxiety disorder is separated from major attachment figures, they may exhibit social withdrawal, apathy, sadness, or difficulty concentrating on work or play. Depending on their age, individuals may have fears of animals, monsters, the dark, muggers, burglars, kidnappers, car accidents, plan travel, and other situations that are perceived as presenting danger to the family or themselves.

Some individuals with separation anxiety disorder ultimately become homesick and uncomfortable to the point of misery when they are away from home. Separation anxiety disorder in children may lead to school refusal, which in turn may lead to academic difficulties and social isolation.

Children with separation anxiety disorder may be described as demanding, intrusive, and in need of constant attention, and, as adults, may appear dependent and overprotective. The individual’s excessive demands often become a source of frustration for family members, leading to resentment and conflict in the family (American Psychiatric Association, 2013, pp. 191–192).




Common Symptoms of Separation Anxiety Disorder

  • Repeated nightmares about separation
  • Refusing to sleep away from home without a parent or other loved one nearby
  • Lots of worry when away from home or family
  • Overly worried about getting lost from family
  • Refusing to go to school
  • Not wanting to be home alone and without a parent or other loved one in the house
  • Fearful and reluctant to be alone
  • Frequent stomachaches, headaches, or other physical complaints
  • Overly concerned about safety of self
  • Being very clingy, even when at home
  • Panic or temper tantrums at times of separation from parents or caregivers
  • Overly worried about the safety of a family member
  • Constant, excessive worry about losing a parent or other loved one to an illness or a disaster
  • Refusing to be away from home

Causes of Separation Anxiety Disorder

Environmental. Separation anxiety disorder often develops after life stress, especially a loss (e.g., the death of a relative or pet; an illness of the individual or a relative; a change of schools; parental divorce; a move to a new neighborhood; immigration; a disaster that involved periods of separation from attachment figures). In young adults, other examples of life stress include leaving the parental home, entering into a romantic relationship, and becoming a parent. Parental overprotection and intrusiveness may be associated with separation anxiety disorder.

Genetic and physiological. Separation anxiety disorder in children may be heritable. Heritability was estimated at 73% in a community sample of 6-year-old twins, with higher rates in girls. Children with this disorder display particularly enhanced sensitivity to respiratory stimulation using CO2-enriched air.

Periods of heightened separation anxiety from attachment figures are part of normal early development and may indicate the development of secure attachment relationships (e.g., around 1 year of age, when infants may suffer from stranger anxiety). Onset of separation anxiety disorder may be as early as preschool age and may occur at any time during childhood and more rarely in adolescence.

Typically there are periods of exacerbation and remission. In some cases, both the anxiety about possible separation and the avoidance of situations involving separation from the home or nuclear family (e.g., going away to college, moving away from attachment figures) may persist through adulthood.

However, the majority of children with this mental illness are free of impairing anxiety disorders over their lifetimes. Many adults with separation anxiety disorder do not recall a childhood onset of separation anxiety disorder, although they may recall symptoms.

The manifestations of separation anxiety disorder vary with age. Younger children are more reluctant to go to school or may avoid school altogether. Younger children may not express worries or specific fears of definite threats to parents, home, or themselves, and the anxiety is manifested only when separation is experienced.

As children age, worries emerge; these are often worries about specific dangers (e.g., accidents, kidnapping, mugging, death) or vague concerns about not being reunited with attachment figures. In adults, this disorder may limit their ability to cope with changes in circumstances (e.g., moving, getting married, etc.)

Adults suffering from this condition are typically overconcerned about their offspring and spouses and experience marked discomfort when separated from them. If this wasn’t distressing enough, they may also experience significant disruption in work or social experiences because of needing to continuously check on the whereabouts of a significant other (American Psychiatric Association, 2013, pp. 192–193).

Diagnostic Criteria

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

  1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
  2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
  3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
  4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
  5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  7. Repeated nightmares involving the theme of separation.
  8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder (American Psychiatric Association, 2013, pp. 190–191).




Prevalence

The 12-month prevalence of this disorder among adults in the United States is 0.9%-1.9%. In children, 6- to 12-month prevalence is estimated to be approximately 4%. In adolescents in the United States, the 12-month prevalence is 1.6%.

Separation anxiety disorder decreases in prevalence from childhood through adolescence and adulthood and is the most prevalent anxiety disorder in children younger than 12 years. In clinical samples of children, separation anxiety disorder is equally common in males and females. In the community, this disorder is more frequent in females (American Psychiatric Association, 2013, p. 192)

Comorbidity

In children, separation anxiety disorder is highly comorbid with generalized anxiety disorder 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 disorders are also comorbid with separation anxiety disorder in adults (American Psychiatric Association, 2013, p. 195).

Suicide Risk

Separation anxiety disorder in children may be associated with an increased risk for suicide. In a community sample, the presence of mood disorders, anxiety disorders, or substance use has been associated with suicidal ideation and attempts. However, this association is not specified to this disorder and is found in several other anxiety disorders (American Psychiatric Association, 2013, p. 193).

Gender-Related Diagnostic Issues

Girls manifest greater reluctance to attend or avoidance of school than boys. Indirect expression of fear of separation may be more common in males than in females, for example, by limited independent activity, reluctance to be away from home alone, or distress when spouse or offspring do things independently or when contact with spouse or offspring is not possible (American Psychiatric Association, 2013, p. 193)

Separation Anxiety Disorder Treatments

For someone suffering with this condition, there are several different types of treatments available for them. For instance, individual psychotherapy (talk therapy), family therapy, as well as some medications may be able to help reduce the intensity of the symptoms associated with this disorder.

Talk therapy such as cognitive behavioral therapy (CBT) may be very effective at helping a child with their condition to better understand the causes of their anxiety, as well as learning much more effective ways to cope with their fears, among other things. CBT is a very common form of therapy for people suffering from anxiety disorders and is often used to treat generalized anxiety disorder (GAD) and obsessive compulsive disorder (OCD), among other conditions.

Depending on the age of the individual, as well as the severity of their symptoms, they may be able to greatly benefit from taking an anti-anxiety medication or an antidepressant. These medications are commonly prescribed for individuals suffering from anxiety disorders and mood disorders, and they may also be able to help relieve some of the symptoms associated with separation anxiety as well. Although, this is something you should first discuss with your doctor.

If you suspect that you or your child is suffering from separation anxiety disorder, then you should talk to your doctor as soon as you can so that you or your child can be properly diagnosed and treated.


References:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.
  • Busman, R. (n.d.). Separation Anxiety – What Parents Should Know. Anxiety and Depression Association of America. Retrieved November 2, 2020, from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/separation-anxiety-what-parents-should-know
  • Pietro, S. (2020, September 10). Separation Anxiety Disorder Basics. Child Mind Institute. https://childmind.org/guide/separation-anxiety-disorder/
  • Separation anxiety disorder – Symptoms and causes. (2018, May 8). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455
  • Separation Anxiety Disorder Symptoms & Causes. (n.d.). Boston Children’s Hospital. Retrieved November 2, 2020, from https://www.childrenshospital.org/conditions-and-treatments/conditions/s/separation-anxiety-disorder/symptoms-and-causes
  • Stanford Children’s Health. (n.d.). Stanford Children’s Health. Retrieved November 2, 2020, from https://www.stanfordchildrens.org/en/topic/default?id=separation-anxiety-disorder-90-P02582