Separation Anxiety Disorder

One of several anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders, separation anxiety disorder can cause excessive nervousness and worry. As a result of separation anxiety disorder, people may experience a range of emotional, physical, and behavioral symptoms. These symptoms often appear when the individual is separated from the person or place to which they are attached or when separation is anticipated. The intensity of the symptoms can vary depending on factors like age, personality, and other psychological conditions. According to the Diagnostic and Statistical Manual of Mental Disorders, three symptoms must be present for a diagnosis to be provided.

Emotional symptoms

Below are some of the potential emotional symptoms that can accompany separation anxiety disorder: 

• Excessive worry or fear: Individuals with SAD often exhibit extreme worry about potential harm coming to themselves or their loved ones when separated. These worries might appear as a fear of getting lost, getting injured, or someone experiencing sudden illness or death.
• Difficulty calming down: Even after being reassured, people with SAD may have a hard time calming down after getting upset about a separation.
• Clinginess: Children with SAD may become excessively clingy, constantly wanting to be near their parents or caregivers. Adults with SAD may exhibit similar behavior with their partners, pets, or friends.
• Reluctance or refusal to be alone: Individuals with SAD may find it difficult or impossible to be alone and may believe they require constant companionship.

Behavioral symptoms

Below are several behavioral symptoms that people with separation anxiety disorder may partake in: 

• Avoidant behaviors: People with SAD might avoid activities that require separation, such as going to school, work, or social events.
• Tantrums: In the case of children with SAD, they might throw tantrums when faced with the prospect of separation from their caregivers.
• Physical complaints: Children with SAD might complain of physical symptoms like headaches or stomachaches when faced with separation.
• Refusing to sleep alone: Children may insist on sleeping with their parents or caregivers and may have difficulty falling asleep if not in the same room as them.

Physical symptoms

Physical symptoms of separation anxiety disorder could include the following: 

• Nausea or vomiting: Some children with SAD may experience nausea or even vomit when faced with separation.
• Trembling or shaking: In intense cases, the anxiety caused by SAD may manifest physically as trembling or shaking.
• Headaches: The stress and anxiety associated with SAD can lead to headaches.
• Stomachaches: Many children with SAD experience stomachaches when confronted with separation.

According to the Diagnostic and Statistical Manual of Mental Disorders, children and adolescents must experience symptoms for a minimum of four weeks to be diagnosed with separation anxiety disorder. Symptoms must persist for six months for an adult to be diagnosed with the disorder.

The symptoms of SAD can significantly impact a person's daily life, making it challenging to participate in everyday activities and social interactions. Untreated SAD can lead to further complications, such as depression or social phobia². Therefore, it can be crucial to identify and address the symptoms of SAD to reduce its impact on one's life.

Separation anxiety disorder is primarily seen in children, but it can also occur in adults. The causes of SAD are multifaceted and can include a mix of genetics, environment, and psychological factors.

Genetic factors

Certain genetic traits can contribute to the development of SAD, making some people more susceptible to the disorder than others. For example, people with a family history of anxiety or other mental health conditions may be at higher risk for SAD.

Environmental factors

Several environmental factors may lead to the development of SAD, including but not limited to the following: 

• Life changes: Significant life changes, such as starting school, moving to a new place, or the birth of a sibling, may cause SAD in children.
• Traumatic³ events: Experiencing traumatic events like accidents, natural disasters, or the loss of a loved one can make children more vulnerable to SAD.
• Overprotective parenting: Children with overprotective or excessively anxious parents may be more prone to SAD, as they might not have the opportunity to develop coping skills for managing separation.

Psychological factors

A few psychological factors may be at play in the development of this disorder, including but not limited to the following: 

• Temperament: Children with an "inhibited" temperament, characterized by shyness and wariness of new situations, are at a higher risk of developing SAD.
• Attachment styles: Children who have not formed a secure attachment with their parents or caregivers may be more susceptible to SAD.

Experiencing separation anxiety is often a normal part of development in young children. However, if anxiety persists beyond the age of six, is intense, or hinders everyday activities, it may indicate SAD. Understanding the factors contributing to separation anxiety disorder can be vital in developing an appropriate treatment plan and helping individuals manage their symptoms effectively.

Treatment for separation anxiety disorder aims to help children or adults learn to manage their anxiety and function independently, even when separated from their primary attachment figure. The treatment approach depends on the severity of the symptoms and the individual's age, among other factors.

Medication

Below are a few medications that may help treat separation anxiety disorder: 

• Antidepressants: SSRIs (selective serotonin reuptake inhibitors) are commonly prescribed to treat SAD in children and adults. These medications may reduce anxiety by increasing serotonin levels in the brain.
• Anti-anxiety medications: Some anti-anxiety medications may be prescribed for short-term use in severe cases of SAD. However, they are often not recommended for long-term use due to the risk of dependence.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

For children with SAD, working closely with teachers and school staff to develop strategies for easing separation anxiety may be beneficial. These interventions may include gradual separation, accommodation in the classroom, or a safe space for the child to go to when anxious.

Self-care

Below are a few self-care strategies that can be implemented at home alongside treatment to reduce anxiety and stress: 

• Relaxation techniques: Practicing relaxation techniques, such as deep breathing or progressive muscle relaxation, may reduce physical symptoms of anxiety.
• Healthy lifestyle: A balanced diet, regular exercise, and adequate sleep can be essential for overall mental health and may help individuals better manage anxiety.
• Supportive environment: Creating a supportive and understanding environment for a person with SAD is crucial. Reassurance, patience, and encouragement may help them overcome fears. Reduce judgment and labeling, as these behaviors may increase anxiety for the individual. 
• Positive reinforcement: Rewarding a child for their efforts in facing separation may boost their confidence and motivation to continue working through their anxiety. Adults can motivate themselves with rewards, as well. 

Consult a healthcare professional before starting treatment for SAD, as they may determine the most appropriate approach based on the individual's specific circumstances. Treatment may involve a combination of therapies, medications, and self-care strategies. 

Therapy can provide support and guidance to help clients navigate through the challenges and complexities associated with separation anxiety. Online therapy through a platform like BetterHelp can offer a convenient way to receive professional help from the comfort of one's own home, which can be especially beneficial for those who may feel too anxious to attend in-person sessions. 

In addition to online therapy, there are other valuable resources available to support individuals with SAD and their families, such as the following: 

• National Institute of Mental Health (NIMH): The NIMH website provides comprehensive information on various mental health conditions, including SAD, and resources for finding treatment.
• Anxiety and Depression Association of America (ADAA): ADAA offers a wide range of resources, including educational materials, webinars, and a directory of therapists specializing in anxiety disorders.
• Child Mind Institute: This organization focuses on children's mental health and offers resources for parents, educators, and healthcare professionals to support children with SAD. Along with their caregivers, individuals with SAD can find a doctor, attend group sessions, and participate in workshops through Child Mind Institute.
• National Library of Medicine: The NLM publishes a fact sheet on separation anxiety disorder with detailed information on the symptoms, causes, and treatment of the condition, along with the Diagnostic and Statistical Manual of Mental Disorders’ criteria.

Connecting with others who are going through similar experiences can provide invaluable support. Local or online support groups for anxiety disorders, such as those offered by the ADAA, may be a way to share experiences, learn coping strategies, and find a sense of community.

Seeking help for SAD can be a crucial step toward managing anxiety and allowing your child or yourself to lead a full and meaningful life. With the right treatment, individuals with separation anxiety disorder may learn to cope with their fears and live independently despite them. 

Please see our Get Help Now page for more immediate resources.

New research on separation anxiety disorder is uncovering valuable insights into the possible underlying factors and practical treatment approaches for this anxiety disorder.

A recent study explored the impact of maternal employment shortly after childbirth on the emergence of separation anxiety symptoms in children. This research examined the connection between a mother's return to work (versus taking maternity leave), the family's economic situation when the child reached five months of age, and how these factors might be related to later separation anxiety symptoms. The study found that mothers who returned to work earlier and experienced financial difficulties were more likely to have children exhibiting separation anxiety symptoms.

Another study assessed the effectiveness of child-centered group play therapy (CCGPT) as a treatment for separation anxiety disorder. The outcomes revealed that children who participated in CCGPT, as well as those who underwent combined group interventions, experienced a marked decrease in separation anxiety symptoms post-intervention. These results can be promising, suggesting that CCGPT and combined group therapies could serve as valuable therapeutic options for mitigating SAD in early childhood.

Both studies emphasize the importance of early intervention and highlight the need for continued research to unravel the multifaceted factors contributing to SAD and to identify the most efficacious treatment modalities.

The following statistics on separation anxiety disorder may be helpful when learning about this disorder: 

• Separation anxiety disorder stands out as the predominant anxiety disorder in children, contributing to 50% of the cases referred for mental health treatment for anxiety concerns.
• Adult separation anxiety disorder has a high lifetime prevalence, with rates varying between 7% and 23%.
• A comorbidity rate of 65.3% has been observed between separation anxiety disorder and other psychiatric disorders.
• Approximately 60% of pediatric anxiety patients respond to cognitive-behavioral therapy (CBT), which has been recognized as an effective and evidence-based method of treatment.