What Is Separation Anxiety Disorder?

Separation anxiety disorder (SAD) is a developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Simply put, it is an intense fear of separation from loved ones, including people and pets.

Separation anxiety is a normal part of childhood development and commonly occurs in infants and toddlers. Three to four percent of children are diagnosed with the disorder. SAD symptoms typically disappear around age 3; however, some children may exhibit symptoms of separation anxiety well into their grade school and teenage years. 

Although separation anxiety is more common in children, it can also occur in adults. Additionally, SAD can be indicative of general or mood-related mental health issues, and about one-third of children with SAD will have a mental health diagnosis as an adult.

Left untreated, separation anxiety may result in ongoing mental health-related issues. Baptist Health medical providers and mental health professionals can help with diagnosis and treatment options.

What Are the Symptoms of Separation Anxiety Disorder?

Separation anxiety disorder is diagnosed when symptoms are excessive for a child’s developmental age and cause significant distress in daily functioning. Additionally, the fear, anxiety, or avoidance is persistent and can last at least four weeks in children and adolescents, and six months or more in adults. Symptoms may include the following:

• Recurrent and excessive distress about anticipating or being away from home or loved ones
• Constant, excessive worry about losing a parent or other loved one to an illness or a disaster
• Constant worry that something bad will happen, such as being lost or kidnapped, or causing separation from parents or other loved ones
• Refusing to be away from home because of fear of separation
• Not wanting to be home alone or without a parent or other loved one in the house
• Reluctance or refusal to sleep away from home without a parent or other loved one close by
• Repeated nightmares about separation
• Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated

SAD may be associated with panic disorder and panic attacks, which are repeated episodes of sudden feelings of severe anxiety and fear or terror that reach a climax within minutes.

What Causes Separation Anxiety Disorder? 

Separation anxiety disorder can develop from various issues. Stress triggered by separation from a loved one may be a cause of SAD. Genetics may also play a part in developing the disorder. Additionally, underlying mental health conditions may contribute to the causes of SAD. These may include delusions from psychotic disorders or fear of change related to an autism spectrum disorder.

What Are the Risk Factors?

Separation anxiety disorder most often occurs in childhood, but may also occur in teenage years, and sometimes in adulthood.

SAD is more likely to occur in children with: 

• a family history of anxiety or depression
• shy, timid personalities or temperaments 
• low socioeconomic status
• overprotective parents
• a lack of appropriate interaction from parent or caregiver, insecure attachments
• problems dealing with kids their own age

SAD can also occur after a stressful life event such as:

• moving to a new home
• changing schools
• divorce
• the death of a close family member, friend or caregiver

How Is Separation Anxiety Diagnosed?

Diagnosis for separation anxiety disorder is contingent upon determining whether the child is simply in a normal stage of development, or if the child meets criteria for a clinical diagnosis. Additionally, it is important to rule out any medical conditions that may be correlated to the child’s symptoms, before referring to a mental health professional for further diagnostic assessment. Separation anxiety may occur with other mental health problems.

Once referred to a mental health professional, the child and parent(s) may be taken through a psychological evaluation, assessing for symptoms that meet criteria for clinical diagnosis. In addition, there may be assessments given to measure levels of distress experienced by the child. 

The American Psychiatric Association’s Diagnostic Manual for Mental Disorders (DSM-5), describes separation anxiety disorder as a developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. This is evidenced by at least 3 of the following:

• Recurrent excessive distress surrounding separation or anticipated separation from a major attachment figure (i.e., parent, caregiver, close friend or family member).
• Persistent and excessive worry about losing major attachment figures, or about possible harm to them (i.e., illness, injuries, natural disasters or death).
• Persistent and excessive worry about experiencing an unwanted event that would cause separation from a major attachment figure (i.e., getting lost, being kidnapped, an accident or illness).
• Persistent reluctance or refusal to go out or being away from home out of fear of separation (i.e., going to work, school or elsewhere).
• Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
• Repeated nightmares involving the theme of separation.
• Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated.

Additionally, to meet criteria for diagnosis, the fear, anxiety, or avoidance must be persistent and last at least four weeks in children and adolescence, and typically six months or more in adults. The disturbance must also cause clinically significant distress or impairment in social, academic, or occupational settings. Finally, the disturbance must not be better explained by another mental disorder or medical condition.

How Is Separation Anxiety Treated?

Treatment

There are multiple treatment approaches for separation anxiety disorder. The treatments discussed below are evidenced-based treatments, but are not the only effective treatments or therapeutic modalities a mental health professional may offer.

A commonly effective therapy in the treatment of SAD is cognitive behavioral therapy (CBT). With CBT, children and adults are taught coping skills to help reduce anxiety. Common techniques are thought stopping, challenging distorted thinking, and relaxation skills.

Another effective treatment approach for SAD is parent-child interaction therapy. It is a combination of play therapy and behavioral therapy for children and their parents or caregivers. The three main treatment phases include:

• Child-directed interaction (CDI) focuses on improving the quality of the parent-child relationship. It involves using warmth, attention, and praise. The specific interactions help to strengthen a child’s felt sense of safety.
• Bravery-directed interaction (BDI) educates parents about their child’s anxiety. A mental health professional will help the child build a bravery ladder, which explores situations that can trigger anxious feelings. A reward system is used to reinforce positive reactions.
• Parent-directed interaction (PDI) teaches parents to communicate clearly with their child, which can help to manage and reduce anxiety. 

A child’s school experience, including interactions with students and teachers, can have a significant effect regarding symptom onset and severity. If there are concerns about the child’s school environment or experience, reaching out to the child’s teacher, guidance counselor, or principal may provide helpful supports and resources. A community or integrated approach to treatment and management of SAD is most effective. 

Medications

There is not a specific medication for the treatment of SAD. However, antidepressants are sometimes used in older children with this condition, if other treatment approaches have proven ineffective. It is important to talk to a medical and mental health professional in the decision-making process, if a medication option is desired.