Separation Anxiety Disorder

Separation anxiety disorder is characterized by an exaggeration of worries and significant distress about being apart from someone an individual is emotionally attached to. Separation anxiety is the most common anxiety disorder in children. 

Separation anxiety disorder in children: A typical phase for many infants and toddlers

It’s expected for children to feel separation anxiety in early childhood—anxiety and fear are normal feelings in response to life stresses or separation from caregivers for most children. However, separation anxiety can escalate into a diagnosable anxiety disorder if it’s overly intense or if the age and context are inappropriate. 

Earlier editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) limited separation anxiety disorder to children and adolescents, but the fifth edition in 2013 expanded the separation anxiety diagnosis to include its potential manifestation in adults. 

There are various differences between separation anxiety in children and adults, but one of the most significant is who the attachment figures are. Children may feel anxious or experience anxiety symptoms when separated from their parents and primary caregivers; for adults, it’s usually separation from their children or romantic partners. In both cases, the individual may take steps to avoid separation and anxiety. 

Let’s take a closer look at how separation anxiety may manifest across various age groups, which might help to prevent separation anxiety disorder.

Feeling anxious when separated: When separation anxiety is normal

Separation anxiety is a normal part of development for children between nine and 18 months of age; most outgrow this separation anxiety by about age three. Signs of separation anxiety in babies and toddlers may include:

• Crying when the parent or caregiver leaves the room
• Waking and crying after previously being able to sleep through the night
• Refusing to go to sleep without a parent close by
• Clinging and crying, especially in an unfamiliar situation

Babies who haven’t developed object permanence yet–which generally begins to develop around 4-7 months of age–may react strongly to the absence of a caregiver, exhibiting separation anxiety and other anxiety symptoms. This is because they believe their parent or primary caregiver has gone away forever when they can’t see them. 

When separation anxiety may qualify as a mental health disorder

• Refusing to sleep alone
• Repeated nightmares about separation from parents or caregivers
• Frequent or excessive worry about being away from home or family members
• Panic when separated from parents or caregivers
• Clinginess 
• Physical symptoms of anxiety such as headaches and stomachaches

Separation anxiety disorder can also affect adolescents. Symptoms of intense separation anxiety at this age may include:

• Refusing to go to school
• Repeated nightmares about separation from parents or caregivers
• Insomnia, or being unable to sleep without a parent in the room
• Anxiety around being separated from home
• Physical symptoms of anxiety such as headaches and stomachaches
• Panic attacks

In adults, symptoms of separation anxiety are more likely to apply in reference to an attachment to one’s romantic partner or children. Signs of separation anxiety in adults may include:

• Excessive distress related to the separation that interferes with school, work, or daily functioning
• Frequent checking in with attachment figure(s) via call or text
• An excessive, persistent fear of being alone
• Repeated nightmares about separation from the attachment figure(s)
• Anxiety around sleeping away from the attachment figure(s)
• Physical symptoms of anxiety such as headaches and stomachaches
• Panic attacks

For an individual to be diagnosed with separation anxiety disorder at any age, they must typically experience three or more anxiety symptoms for four or more weeks. In most cases, separation anxiety symptoms must also significantly impact daily functioning. Clinical separation anxiety disorder is estimated to affect about 4% of children.

Risk factors for developing separation anxiety disorders

According to an article published by the National Libraries of Medicine, there are various hypotheses about why separation anxiety may develop in children, adolescents, or adults. One commonly cited risk factor for separation anxiety is life events that result in separation—especially early in life—such as the loss of a loved one, a parent leaving, or a natural disaster or political turmoil that results in separation. “Early childhood experiences promoting an external locus of control” may contribute as well, making an individual feel especially vulnerable to outside forces of separation. 

Parenting styles may also play a role, with “low parental warmth and parenting behaviors that discourage autonomy” having been linked to the development of separation anxiety or other anxiety disorders in children. Overprotective or over-involved parenting behaviors may also increase a child’s dependence on their parents and may reduce the perception of their own control over their environment. Finally, “temperamental and biological vulnerabilities” may contribute to separation anxiety or other anxiety disorders, too.

Treatment for separation anxiety disorder (Cognitive Behavioral Therapy)

Treating separation anxiety disorder in children and adolescents can improve their quality of life and may even reduce their risk of developing additional anxiety disorders as adults. Treating separation anxiety disorder in adults can improve the quality of life and daily functioning. 

Cognitive Behavioral Therapy (CBT)

The recommended treatment for separation anxiety at any age is often psychotherapy, especially cognitive behavioral therapy (CBT). A CBT therapist specializing in separation anxiety can help the individual learn to recognize thoughts that are contributing to anxious feelings and behaviors and shift them in a more realistic, healthy direction. A separation anxiety therapist may also teach individual relaxation techniques to reduce separation anxiety symptoms and strategies to help them learn to handle separation in a healthy, calm way. If you or your child is experiencing symptoms of separation anxiety disorder, it’s typically best to meet with a mental health professional for anxiety evaluation and treatment advice.

How parents can help with anxiety disorders and alleviate fear

There are also strategies that parents of children with separation anxiety issues might try in conjunction with professional treatment to support their child in overcoming anxiety symptoms. 

How parents can support their children’s mental health

• Preparing them for changes in routine. Children tend to thrive on routines, especially those who experience symptoms of anxiety. If there will be changes to your child’s routine, such as someone else picking them up from school, preparing them for these ahead of time may help ease their anxiety.
• Following through. If you tell your child you will be home at a specific time, it’s generally helpful to make sure you’re home at that time. You might also avoid sneaking away without saying goodbye. The reason is that it can help your child know that they can trust you to tell them when you’re leaving and when you’ll return.
• Not lingering on transitions. Long, drawn-out goodbyes may intensify separation anxiety. Instead, it may help to create a succinct, replicable goodbye ritual that involves letting your child know when you’ll be back for them.
• Acknowledging and validating their feelings. One study found that “a judgmental attitude toward one’s thoughts and feelings is the strongest predictor of both depression and anxiety” in adults. Teaching your child that it’s okay to have difficult emotions like separation anxiety and then supporting them in managing these feelings can help them feel cared for and may set them up for better mental health in the future.

Parents can recognize risk factors and take steps to help prevent separation anxiety disorder. Look for signs of separation anxiety disorder and other anxiety disorders, such as excessive clinginess or fear of anticipated separation. From there, they can teach their child coping skills for anxiety and promote healthy independence through gradual exposure to separations and fostering secure attachments. 

This can be helpful even if the child’s separation anxiety or generalized anxiety disorder is diagnosed by a mental health professional. Social anxiety disorder, separation anxiety, panic disorder, and other mental health concerns can all be addressed with early diagnosis and a solid treatment plan. 

Seeking treatment and therapy as an adult or as parents

If you’re experiencing symptoms of separation anxiety disorder, you may benefit from speaking with a mental health professional. They can help you identify mental health concerns and learn to manage separation anxiety symptoms so you can experience less anxiety and develop a healthier relationship with your romantic partner, children, or other people in your life you may be attached to. 

Therapy may also help if you’re working to assist your child with overcoming separation anxiety and you feel guilty about the process. This is a normal response from parents and guardians who have children with separation anxiety or other anxiety disorders, and talking to an anxiety therapist can help. 

Online therapy

Those with a busy schedule—especially those who experience separation anxiety when away from loved ones—may benefit from seeking care for anxiety online. With a virtual therapy platform like BetterHelp, you can get matched with a licensed anxiety therapist whom you can meet via phone, video call, and/or in-app messaging from the comfort of home or anywhere you have an internet connection. Research suggests that online therapy and traditional, face-to-face therapy can be “equally effective,” so this format may be worth considering for those who find it to be more reachable or convenient.