separation anxiety disorder

separation anxiety disorder, condition characterized by intense and prolonged concern, dread, worry, or apprehension about being separated from a loved one. Separation anxiety disorder is associated with significant distress, to the degree that it interferes with the affected individual’s ability to function, and can negatively impact mental health, academic and professional performance, and relationships with family and peers.

Separation anxiety disorder affects males and females equally, and it occurs in individuals of all ages, though it is one of the most common anxiety disorders diagnosed among children. Affected children tend to fear separation from parents or other close caregivers. Adults with the condition may fear separation from their children or from their spouses or significant others.

Characteristics and risk factors

Separation anxiety is a natural part of early development and is attributed to a lack of understanding of time and object permanence—the reality that objects, including people, exist even when not within sight. Separation anxiety first appears at age 6–12 months and is most intense around 18 months, wherein features of “clinginess” (excessive attachment) and fear of strangers become apparent. By age three, however, most children have come to understand that when loved ones leave, they will return, at which point separation anxiety generally diminishes. Fear of separation may reappear when a child begins school, though typically it soon disappears again. In some children, however, separation anxiety escalates into a serious, recurring issue. It emerges as a disorder when the anxiety becomes extreme, being inappropriate for the stage of development and interfering with daily activities and quality of life.

Risk of separation anxiety disorder is often associated with a stressful event that leads to separation from a loved one. Examples include the death or other absence of a parent or parental divorce. A change in environment, such as moving or switching schools, can also trigger the condition. A family history of anxiety further raises an individual’s risk, especially for children who have a parent who is affected by anxiety and who models anxious behaviors.

Symptoms

There is considerable variation in the symptoms of separation anxiety disorder. Children, for example, may refuse to leave home. This often manifests as a refusal to attend school or as crying, screaming, or clinging to their loved one when being dropped off at school. Children with separation anxiety disorder also tend to worry about being lost or kidnapped or experiencing other events that would separate them from their parents or caregivers, and they often fear that their parents or caregivers might die from an accident or illness in their absence. As a result, affected children may follow their parent or caregiver closely, refuse to stay at home without their loved one, or refuse to sleep without the person nearby. Children may also experience physical symptoms, including headaches, stomachaches, muscle aches, dizziness, chest pain, trouble breathing, nausea, vomiting, and diarrhea. Nightmares, nocturnal enuresis (bed-wetting), panic attacks, and temper tantrums may also occur when a child is faced with a separation. Adults with separation anxiety disorder may experience similar symptoms and often have similar fears about being separated from a loved one.

Symptoms typically become apparent when the affected individual is about to be separated—or begins thinking about being separated—from a loved one. The intense anxiety often interferes with not only the individual’s daily activities but also their loved one’s ability to work and carry out daily responsibilities. Separation anxiety disorder may be accompanied by or lead to other mental health conditions—many of which share overlapping symptoms with separation anxiety disorder—including agoraphobia (fear and avoidance of certain places or situations), depression, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and social anxiety disorder. Affected adults are more likely to also have personality disorders, such as borderline personality disorder; fear of abandonment is a symptom of both borderline personality disorder and separation anxiety disorder.

Diagnosis and treatment

Early diagnosis and treatment of separation anxiety disorder can ease symptoms and prevent the disorder from progressing. In children, separation anxiety is assessed to determine whether the degree to which it is experienced constitutes a disorder. In general, the condition is diagnosed in children when symptoms of separation anxiety are present for at least four weeks and interfere with daily life. In adults, diagnosis is based on the presence of symptoms for at least six months, with other causes ruled out.

Treatment varies depending on age, health, and symptom severity. In most instances, separation anxiety disorder does not resolve on its own and requires treatment. The primary form of treatment is cognitive behavior therapy (CBT), through which patients develop a better understanding of their condition and acquire coping strategies. Children further benefit when parents with anxiety seek treatment and become more effective in managing their own distress. Antianxiety and antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) such as sertraline, are sometimes used to reduce symptoms. Some patients may benefit from a combination of CBT and SSRI treatment.