Separation anxiety disorder: symptoms, causes, and treatments

By

Walter Alejos

|

May 9, 2021

happy dad reunited with daughters who have separation anxiety disorder (1)
If you have separation anxiety, even the thought of being apart from loved ones can cause extreme distress.

People with this disorder experience extreme anxiety at the idea of being separated from caregivers or loved ones. Someone with separation anxiety disorder may feel panic at the idea of leaving home to attend school or go to work.

For people with anxiety and depression, purposefully engaging in pleasurable activities can improve mental health.
If you have separation anxiety, even the thought of being apart from loved ones can cause extreme distress.

People with this disorder experience extreme anxiety at the idea of being separated from caregivers or loved ones. Someone with separation anxiety disorder may feel panic at the idea of leaving home to attend school or go to work.

What is separation anxiety?

Separation anxiety affects both children and adults. People with this disorder can experience the onset of symptoms at any time during childhood or adulthood.

Almost all children under the age of three experience some form of normal separation anxiety. Whether they cry when a parent leaves the room or cling to a caregiver for comfort, separation anxiety is a normal part of development for babies and small toddlers.

Separation anxiety disorder is the name for fear of separation that persists beyond early childhood. This anxiety disorder affects children older than three years of age, as well as adolescents and adults.

Anxiety worsens when a person with this mental health disorder experiences actual separation. Excessive fear may provoke tantrums in young children and panic attacks in adolescents and adults.

Statistics

  • Research indicates that 4.1% of children will exhibit a clinical level of separation anxiety.
  • An estimated 36.1% of childhood cases persist into adulthood if left untreated.
  • Of children with separation anxiety disorder, about 75% aren’t willing to go to school.
  • 77.5% of adults with this condition experience the onset in adulthood.
  • Both adult separation anxiety disorder and persistent childhood separation anxiety disorder (lasting beyond childhood) are more common in women than men.
  • 50 – 75% of children with this condition come from homes with low socioeconomic status.

Symptoms

Some of the most common symptoms of separation anxiety disorder in children are:

  • Refusing to sleep alone
  • Refusing to sleep away from home
  • Ongoing nightmares about separation
  • Distress when separated from attachment figures
  • Anxiety about the safety of attachment figures
  • Excessive worry about getting lost
  • Not being willing to go to school
  • Physical symptoms like stomach aches and headaches
  • Clinginess, even in the home
  • Temper tantrums or panic when separated from attachment figures

When this disorder presents in adults, the symptoms include:

  • Being overly fearful about being alone
  • Excessive distress at the thought of being separated from loved ones
  • Fearing that someone you love will get hurt if you leave them alone
  • Experiencing physical symptoms of distress when separated from a loved one
  • An obsessive need to keep tabs on where loved ones are at all times

Causes

Separation anxiety disorder may be triggered by an incident, such as a traumatic event or the loss of a loved one. In other cases, a person with separation anxiety disorder may have a genetic predisposition to mental illness or anxiety.

Risk factors that make someone more likely to develop separation anxiety disorder include:

Stressful events

Any significant changes, such as the illness of a family member or switching schools, can result in feelings of separation. A fear may develop, making a patient believe that future separation will trigger another traumatic event.

Personality type

Some people are more prone to anxiety. An imbalance of norepinephrine and serotonin likely contributes to this disorder.

Genetics

Anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder, can run in families. Having a family history of anxiety disorders makes you more likely to develop this disorder.

Environment

If a caretaker or parent is anxious, a child may adopt a similar fear. Environmental factors, such as parental intrusiveness, are thought to be more influential in developing separation anxiety disorder.

Diagnosis

Separation anxiety disorder symptoms are usually evaluated by mental health professionals. Your healthcare provider will make the diagnosis based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The DSM-5 lists several different symptoms for the disorder that are relevant to both adults and children.

To be diagnosed with separation anxiety disorder, you must display at least 3 of the following criteria:

  • Too much distress on a regular basis when separated from home or certain individuals.
  • Excessive worry on a regular basis when you think about losing these people or them being harmed.
  • Regular worry that an unfortunate event, like getting lost or becoming ill, will lead to your separation from an attachment figure.
  • Ongoing reluctance to go anywhere or do anything out of fear of being separated.
  • Being unwilling to spend the night away from home or your attachment figures.
  • Persistent nightmares about separation.
  • Regularly complaining about physical symptoms, such as headaches or nausea, when you’re separated from your attachment figures or anticipating separation from them.

In addition to the diagnostic criteria listed above, a person with this disorder must experience anxiety symptoms that persist for at least 4 weeks in children or 6 months in adults.

More criteria for diagnosis

The anxiety must cause distress or impairment that interferes with daily life. When diagnosing separation anxiety disorder in children, a clinician will need to determine whether a child’s anxiety exceeds that appropriate to their developmental level. Both children and adults must have 3 or more of the symptoms listed above.

If you exhibit three or more of the symptoms identified by the DSM-5, further evaluation is necessary to make a diagnosis. When diagnosing separation anxiety in adults, your clinician will likely ask about your physical health, family history, and any medications you take.

To learn more about your symptoms, a mental health professional will typically complete an evaluation consisting of a questionnaire and structured interview. This may include questions designed to identify other mental health conditions, such as depression or addiction issues, that could affect your diagnosis.

Your clinician will also be checking that the separation anxiety symptoms are not primarily due to different conditions such as prolonged grief disorder or PTSD.

The way you answer these questions will help eliminate any underlying medical conditions that may be contributing to your anxiety. Your healthcare professional will also want to rule out the medications you take as a potential cause.

Prevention

There are no guaranteed ways to prevent separation anxiety disorder in children or adults; however, the following precautions may help parents care for anxious children.

Seek treatment.

By addressing symptoms early, you may be able to keep your child’s development on track. A professional can aid you in building coping and resilience skills to reduce symptoms, which can help not only your child but also you as the parent.

Follow a treatment plan.

Work closely with a pediatric psychiatrist or mental health professional, keeping them informed of your child’s progress. Learn and use self-help and skills work to make life more manageable for you or your child.

Model good behavior.

If you experience anxiety, seek treatment from a professional. Be sure to model practical social skills, learn grounding skills, and practice a constructive mindset.

Pay attention to physical complaints.

Stomach aches, headaches, and other physical symptoms often result from feelings of anxiety, both in younger children and adults.

Practice goodbyes.

Separating for short periods of time may help your child build the skills they need for longer separations. Some parents or couples come up with little “rituals” for parting, like reading a book together before a goodbye or having the child wave out the window as part of the goodbye.

Treatments

If you’ve been diagnosed with this disorder, your mental health professional will likely recommend psychotherapy. Cognitive behavioral therapy (CBT) is one of the first-line separation anxiety treatments.

By getting to the root of your fears around separation, CBT can teach you to be more independent and manage your symptoms. As part of the CBT protocol, your therapist may recommend exposure therapy, in which you are gradually exposed to longer periods of separation.

In some cases, when symptoms are severe, your doctor may also recommend anti-anxiety medications or antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medication for patients with separation anxiety disorder. Some brand-name SSRI medications include Prozac, Lexapro, Zoloft, Paxil, and Celexa.

Outlook

Early treatment of separation anxiety disorder in children may reduce symptoms and keep them on track with developmental milestones. For both adults and older children, treatment can help reduce or arrest anxiety symptoms.

Without treatment, anxiety may continue to worsen, leading to conditions like agoraphobia and social phobia. Separation anxiety disorder often presents alongside other mental health conditions, such as depressive disorders and other anxiety disorders.

Starting treatment for separation anxiety disorder at the first sign of symptoms gives you a better chance of disrupting negative thought patterns and finding freedom from your fears.

If you or someone you love experiences this condition, we want you to know that you’re not alone. With the proper support and treatment plan, you can find healthier ways to cope with anxiety and fear.

Visit Lemonaid to talk with a healthcare professional about the best anxiety treatment options for you.

Takeaway

  • Separation anxiety is normal in very small children under the age of three.
  • Adults and children who experience a fear of being away from loved ones that causes distress or impairment may have separation anxiety disorder.
  • If left untreated, separation anxiety can persist from childhood into adulthood.
  • Separation anxiety disorder treatments include cognitive behavioral and other therapies, as well as prescription medications.
  1. Ehrenreich et al. (2008). Separation anxiety disorder in youth: phenomenology, assessment, and treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788956/
  2. Mayo Clinic. (2018). Separation anxiety disorder. https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455
  3. Masi et al. (2001). Separation anxiety disorder in children and adolescents: epidemiology, diagnosis and management. https://doi.org/10.2165/00023210-200115020-00002
  4. Stanford Children’s Health. (N.D.) Separation Anxiety Disorder in Children. https://www.stanfordchildrens.org/en/topic/default?id=separation-anxiety-disorder-90-P02582
  5. Shear et al. (2006). Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. https://doi.org/10.1176/ajp.2006.163.6.1074

By

Walter Alejos

|

May 9, 2021