Separation Anxiety

Separation anxiety refers to excessive fear or worry about separation from home or an attachment figure.

Separation anxiety is a normal stage in an infant's development, as it helps children understand relationships and master their environment. It usually ends around 2 years old, when toddlers begin to understand that a parent may be out of sight right now but will return later. The key feature of separation anxiety disorder, however, is when the anxiety exceeds what might be expected given a person's developmental level.

Children with separation anxiety disorder may cling to their parents excessively, refuse to go to sleep without being near a major attachment figure, be reluctant to attend camp or sleep at friends' homes, or require someone to be with them when they go to another room in their house. Children also commonly experience physical symptoms when they anticipate separation, such as headaches, nausea, and vomiting. Adults with the disorder may be uncomfortable traveling independently, experience nightmares about separating from attachment figures, or be overly concerned about their children or spouse and continuously check on their whereabouts. 

When separation does happen, children may seem withdrawn, sad, or have difficulty concentrating on work or play. Depending on the age of the person, they may have a fear of animals, monsters, the dark, burglars, kidnappers, plane travel, or other situations that are perceived as dangerous. Some people become severely homesick when separated from attachment figures, regardless of their age. The experience of separation anxiety disorder is often frustrating for family members and can lead to resentment and conflict in the family.

Separation anxiety disorder is the most prevalent anxiety disorder in children under the age of 12. In a given 12-month period in the U.S., the prevalence of separation anxiety disorder is estimated to be 4 percent among children, 1.6 percent among adolescents, and 0.9 to 1.9 percent among adults, according to the DSM-5. This condition occurs equally in men and women.

Symptoms

Symptoms of separation anxiety disorder include:

  • Excessive distress when separated from the home or attachment figures
  • Worry about losing or harm coming to major attachment figures
  • Excessive worry about experiencing an unexpected negative event (getting lost, becoming ill) that leads to separation from attachment figures
  • Refusal to leave home, school, work, or another place because of fear of separation
  • Persistent fear about being alone or without major attachment figures at home or other places. In children, this may look like "clinging" behavior, or staying close to the parent around the house. 
  • Refusal or reluctance to sleep away from home or to go to sleep without attachment figures nearby
  • Nightmares involving themes of separation from home or major attachment figures
  • Repeated physical complaints such as headaches and nausea when separation has occurred or is anticipated

For separation anxiety disorder to be considered, these symptoms must be present for at least four weeks in children and adolescents and six months or more in adults. Additionally, these symptoms must cause impairment of school, social, occupational or personal functioning as a result of the anxiety.

Causes

Separation anxiety from attachment figures is a normal part of early development, particularly in the first few years of life. The anxiety becomes problematic when it is excessive given the person's developmental stage, and when it disrupts the person's life.

Though the cause of separation anxiety disorder is unknown, some risk factors have been identified. Separation anxiety disorder commonly develops after a person experiences a major stressor or loss, such as the death of a loved one or pet, a change of schools, divorce, or some disaster that separates an individual from their loved ones. Additionally, having parents who are overprotective or intrusive might lead to separation anxiety disorder. 

While the precise role of the genetic factors involved in separation anxiety disorder has not been established, research has shown that the condition might be heritable.

Treatment

To resolve the feelings of separation anxiety, a child must develop an adequate sense of safety, trust in their parent's return, and trust in people other than their parents. It is helpful for a parent to accompany the child during medical examinations or treatments whenever possible. When a parent is not available, prior exposure to the situation, such as visiting the doctor's office before an appointment, can be helpful for the child. Some hospitals provide Child Life specialists who explain procedures and medical conditions to children of all ages. If a child is particularly anxious and needs significant medical care, parents may consider asking their health care provider about such services.

For older children and adults, effective treatments may include psychotherapy, changes in parenting techniques for adolescents (and for anxious adults with children), and anti-anxiety medications. Treatment for certain cases may involve family education and family therapy.

For younger children, a parent or caregiver can take the following actions:

  • Try to schedule departures after naps and mealtimes since the child will be more susceptible to separation anxiety when tired, hungry, or sick.
  • Prepare the child before the separation occurs by reassuring them that their parent will return. Treat the anxiety seriously and react with understanding, patience, and confidence: "I know you don't want me to go away right now, but I will be back after school." Do not tease: "You're so silly to cry about it." Do not sound annoyed: "You make me feel so mad when you cry like that!"
  • Stay calm, matter-of-fact and, sympathetic: "I know you are upset that I have to go into the kitchen, but I need to cook dinner." 
  • Create feelings of security for the toddler by providing lots of love and attention. Young children learn faster when they receive necessary attention and affection than by the parent's taking a "learn the hard way" attitude.
  • Practice short-term separations around the house. When a parent goes into another room, they can talk to the child: "Where did mommy go?" When the parent returns, let the child know: "Here I am!" These repeated separations might help the child learn that a parent's disappearance is only temporary.
  • Do not sneak away from the child. It might be tempting, but this approach will only lead to more difficulty during the next departure.
  • Parents also need to maintain control over their own anxieties. If the child senses or sees parents' distress when they leave, it will signal to the child that something is wrong.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised  
  • DSM-IV Made Easy: The Clinician's Guide to Diagnosis
  • American Academy of Pediatrics
  • National Institutes of Health - National Library of Medicine
  • Zeanah, P. D. (1995). Touchpoints: Your child's emotional and behavioral development, by T. Berry Brazelton, Wesley Publishing Co., Reading, MA, 1992, 479 pp.

Last reviewed 02/07/2019