Separation Anxiety

Nature

Separation Anxiety Disorder is characterized by a child’s extreme unwillingness to separate from a parent, other attachment figures, or the home.

The separation results in fear, which causes significant distress for the child and can negatively affect how the child functions at school, in social relationships and in other areas of life.

Most parents are familiar with and can recognize Separation Anxiety in younger children, but it can be harder to identify in adolescents because it manifests differently. Teens are less likely to throw a tantrum when dropped off for school or other activities. Besides fearing separation itself, individuals with the disorder may worry that something horrible will happen to them or their family members when they are apart. To be diagnosed with Separation Anxiety, the individual must experience these feelings for at least 4 weeks. Up to 4% of youth under the age of 12 will suffer from Separation Anxiety Disorder during the school year with rates decreasing into adolescence.  Onset tends to peak on entering kindergarten, between the ages of 7 and 9, and again with entry to middle and high school.

Experience

When children with Separation Anxiety are away from caregivers they can develop extreme fear.  

A child with Separation Anxiety might have difficulty concentrating in class because of their fear that a parent will have a car accident. Sufferers might be worried that her family will get hurt, or they will get hurt, or even abandoned. If a parent is five minutes late for a designated pick-up, the child might assume the family has left town without them.

Mobile phone technology can exacerbate anxiety due to the expectation of nearly instantaneous communication. Many parents of children with SAD receive a continuous stream of text messages and phone calls expressing distress, fears, and concerns. These children suffer panic if the parent is unable to immediately answer the texts or calls.

Overattachment also persists at home, where children can “shadow” a parent from room to room. Some children fear being left alone upstairs or sleeping alone in their beds. They may insist on sharing their parent’s bed at night or crawl into bed with them overnight.

Adolescents may have a spike in separation anxiety when entering middle or high school.  They usually come to realize that their peers will not accept acting-out behavior such as tantrums, so they begin to internalize their anxiety. While younger children generally become anxious at the moment of separation, older children can experience more anticipatory anxiety prior to or after the separation. This does not make it any less real or impactful, but it can make it harder to identify. Separation anxiety can often be intertwined with social phobia

Impact

Separation Anxiety Disorder is more than a few tears at school drop-off.

Children suffering from Separation Anxiety Disorder experience a wide array of symptoms and feel overwhelmed by their fears and worries. Some symptoms of Separation Anxiety in teens include:

Behavioral:

  • Nightmares about separation of loved one
  • School refusal or dislike of school
  • Refusing to go on school trips
  • Insomnia
  • Requesting to sleep with parents
  • Afraid to be alone
  • Difficulty sleeping away from the home
  • Lack of independence
  • Difficulty making and maintaining friends
  • Avoiding after school activities
  • Need to know where loved ones are at all times
  • Unwillingness to leave their parents or defiant behavior when they need to

Cognitive/Emotional:

  • Constant worry about the whereabouts of loved ones
  • Embarrassment or shame
  • Intense fearful thoughts regarding separation

Physical:

  • Headaches
  • Shortness of breath or racing heart
  • Stomachaches
  • Panic attacks
  • Muscle tension and pain
  • Dizziness
  • Prevalence of Separation Anxiety Disorder

    The lifetime prevalence of Separation Anxiety Disorder is about 4% for children and 6.6% for adults. The earliest age of onset of any anxiety disorder is between the ages of 7 and 8 years old. For adults with SAD, age of  onset is typically in the late teens and early 20s. About 2/3 of individuals with SAD  also suffer from another anxiety disorder and about half of individuals with SAD also have a depressive disorder. Separation Anxiety Disorder is somewhat more prevalent in females than males.

Treatment

Treatment for Separation Anxiety Disorder typically involves Cognitive Behavioral Therapy (CBT), which helps sufferers learn to manage their fears, recognize the thoughts perpetuating the anxiety, and change those thoughts to facilitate recovery.  

This might also include physical relaxation training, coping statements, and exposure therapy through which they gradually face, and conquer the fears that are preventing them from enjoying a normal life. Parents can inadvertently reinforce anxiety when they are comforting or reassuring their anxious children, so treatment frequently also involves parent psycho-education to coach parents on how to respond to anxiety in more productive ways.

Resources

Diagnostic Criteria for Separation Anxiety Disorder
BehaveNet Inc
Read Article

How to Help your Child with Separation Anxiety Disorder
Vertical Health
Read Article

Separation Anxiety in Children vs Teenagers
Informed Therapy Resources
Read Article