Separation anxiety disorder

Date Updated: 04/05/2021

Overview

Separation anxiety is a normal stage of development for infants and toddlers. Young children often experience a period of separation anxiety, but most children outgrow separation anxiety by about 3 years of age.

In some children, separation anxiety is a sign of a more serious condition known as separation anxiety disorder, starting as early as preschool age.

If your child's separation anxiety seems intense or prolonged — especially if it interferes with school or other daily activities or includes panic attacks or other problems — he or she may have separation anxiety disorder. Most frequently this relates to the child's anxiety about his or her parents, but it could relate to another close caregiver.

Less often, separation anxiety disorder can also occur in teenagers and adults, causing significant problems leaving home or going to work. But treatment can help.

Symptoms

Separation anxiety disorder is diagnosed when symptoms are excessive for the developmental age and cause significant distress in daily functioning. Symptoms may include:

Recurrent and excessive distress about anticipating or being away from home or loved ones
Constant, excessive worry about losing a parent or other loved one to an illness or a disaster
Constant worry that something bad will happen, such as being lost or kidnapped, causing separation from parents or other loved ones
Refusing to be away from home because of fear of separation
Not wanting to be home alone and without a parent or other loved one in the house
Reluctance or refusing to sleep away from home without a parent or other loved one nearby
Repeated nightmares about separation
Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated

Separation anxiety disorder may be associated with panic disorder and panic attacks ― repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.

When to see a doctor

Separation anxiety disorder usually won't go away without treatment and can lead to panic disorder and other anxiety disorders into adulthood.

If you have concerns about your child's separation anxiety, talk to your child's pediatrician or other health care provider.

Causes

Sometimes, separation anxiety disorder can be triggered by life stress that results in separation from a loved one. Genetics may also play a role in developing the disorder.

Risk factors

Separation anxiety disorder most often begins in childhood, but may continue into the teenage years and sometimes into adulthood.

Risk factors may include:

Life stresses or loss that result in separation, such as the illness or death of a loved one, loss of a beloved pet, divorce of parents, or moving or going away to school
Certain temperaments, which are more prone to anxiety disorders than others are
Family history, including blood relatives who have problems with anxiety or an anxiety disorder, indicating that those traits could be inherited
Environmental issues, such as experiencing some type of disaster that involves separation

Complications

Separation anxiety disorder causes major distress and problems functioning in social situations or at work or school.

Disorders that can accompany separation anxiety disorder include:

Other anxiety disorders, such as generalized anxiety disorder, panic attacks, phobias, social anxiety disorder or agoraphobia
Obsessive-compulsive disorder
Depression

Prevention

There's no sure way to prevent separation anxiety disorder in your child, but these recommendations may help.

Seek professional advice as soon as possible if you're concerned that your child's anxiety is much worse than a normal developmental stage. Early diagnosis and treatment can help reduce symptoms and prevent the disorder from getting worse.
Stick with the treatment plan to help prevent relapses or worsening of symptoms.
Seek professional treatment if you have anxiety, depression or other mental health concerns, so that you can model healthy coping skills for your child.

Diagnosis

Diagnosis of separation anxiety disorder involves determining whether your child is going through a normal stage of development or the issue is actually a disorder. After ruling out any medical conditions, your child's pediatrician may refer you to a child psychologist or child psychiatrist with expertise in anxiety disorders.

To help diagnose separation anxiety disorder, your mental health professional will likely give your child a psychological evaluation, including a structured interview that involves discussing thoughts and feelings, as well as observing behavior. Separation anxiety disorder may occur along with other mental health problems.

Treatment

Separation anxiety disorder is usually treated with psychotherapy, sometimes along with medication. Psychotherapy, sometimes called talk therapy or psychological counseling, involves working with a therapist to reduce separation anxiety symptoms.

Cognitive behavioral therapy (CBT) is an effective form of psychotherapy for separation anxiety disorder. During therapy your child can learn how to face and manage fears about separation and uncertainty. In addition, parents can learn how to effectively provide emotional support and encourage age appropriate independence.

Sometimes, combining medication with CBT may be helpful if symptoms are severe. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be an option for older children and adults.

Lifestyle and home remedies

While separation anxiety disorder benefits from professional treatment, you can also take these steps to help ease your child's separation anxiety:

Learn about your child's separation anxiety disorder. Talk to your child's mental health professional to learn about the disorder and help your child understand it.
Stick to the treatment plan. Make sure to keep the therapy appointments for your child. Consistency makes a big difference.
Take action. Learn what triggers your child's anxiety. Practice the strategies developed with the mental health professional so you're ready to deal with your child's anxious feelings during separations.

Coping and support

Coping with a child who has separation anxiety disorder can be frustrating and cause conflict with family members or cause a great deal of worry and anxiety for parents.

Ask your child's therapist for advice on coping and support. For example, the therapist may advise you to:

Demonstrate calm support. Encourage your child or loved one to try new experiences, experience separation and develop independence with your support.
Practice goodbyes. Leave your child with a trusted caregiver for short periods of time to help your child learn that he or she can count on you to return.

It's also important to develop and maintain supportive relationships for yourself, so you can better help your child.

Preparing for an appointment

You may start by seeing your child's pediatrician. He or she may refer you to a mental health professional with expertise in anxiety disorders.

What you can do

Before your appointment, make a list of:

Your child's symptoms of anxiety. Note when they occur, whether anything seems to make them better or worse, and how much they affect day-to-day activities and interactions.
What causes your child to be stressed. Include any major life changes or stressful events your child dealt with recently, as well as any past traumatic experiences.
Any family history of mental health problems. Note if you, your spouse, your parents, grandparents, siblings or other children have struggled with any mental health problems.
Any other health problems your child has. Include both physical conditions and mental health issues.
All medications that your child takes. Include any medications, vitamins, herbs or other supplements, and the dosages.
Questions to ask to make the most of your appointment.

Questions to ask may include:

Are there other possible situations, psychological issues or physical health problems that could be causing or worsening the anxiety?
Does my child need any tests?
What type of therapy might help?
Would medication help? If so, is there a generic alternative?
In addition to treatment, are there any steps I can take at home that might help my child?
Do you have any educational materials that I can have? What websites do you recommend?

Don't hesitate to ask other questions during the appointment.

What to expect from your doctor

The mental health professional is likely to ask you a number of questions. For example:

What are your child's symptoms, and how severe are they? How do they impact your child's ability to function?
When did you first begin noticing your child's separation anxiety?
What, if anything, seems to reduce your child's anxiety?
Has your child had any traumatic experiences recently or in the past?
What, if any, physical or mental health conditions does your child have?
Does your child take any medications?
Do you or any of your blood relatives have persistent anxiety or other mental health conditions, such as depression?

Preparing and anticipating questions will help you make the most of your time with the mental health professional.