Separation Anxiety Disorder

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Separation Anxiety Disorder

THC Editorial Team December 11, 2020
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Contents

What Is Separation Anxiety Disorder?

Separation anxiety disorder involves distressing levels of worry or fear when you are separated—or faced with the possibility of separation—from a particular person. While feeling concern over the well-being of loved ones is natural, separation anxiety can cause debilitating fear that disrupts daily life. Although you may realize these feelings are irrational, you may feel powerless to overcome them.

Separation anxiety is a normal part of infant and toddler development. During this stage of life, children are still learning that caregivers will return after leaving. It is common for children of this age to physically and emotionally cling to caregivers or cry inconsolably when a caregiver leaves the room.

Health care providers consider such behavior to be typical until children are about 3 years old. If the behavior persists past this age or begins at a later stage in life, a mental health care provider may diagnose separation anxiety disorder.

What Are the Symptoms of Separation Anxiety Disorder?

Mental health professionals have traditionally believed separation anxiety exclusively affects children. However, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) recognizes that separation anxiety disorder can begin or recur at later stages of life.1 Additionally, and perhaps contrary to popular assumption, a multicountry study conducted by the World Health Organization found that 43.1% of lifetime separation anxiety cases occurred in people older than the age of 18.2

Symptoms of separation anxiety may affect people emotionally, cognitively, or physically and may include the following:

  • frequent nightmares in which a loved one disappears or is otherwise separated from you
  • physical discomfort, such as an upset stomach, a headache, or a racing heartbeat when you anticipate separation
  • difficulty sleeping, or an inability to sleep, away from home or without a loved one nearby
  • a pressing need to know the exact location of a loved one
  • excessive fear of being alone
  • a belief that harm will come to loved ones when they are separated from you

Causes and Risk Factors for Separation Anxiety Disorder

You or your child may experience separation anxiety as a result of various life experiences. Additionally, people with certain personality traits or those with other anxiety-related disorders may be more likely to develop separation anxiety disorder.

Traumatic or Life-Changing Events

Trauma, or events that cause major upheaval in everyday life may trigger separation anxiety.3 These can include the following:

  • the death of a loved one
  • moving out of the family home
  • parental divorce
  • family history of anxiety and related disorders
  • surviving a harrowing experience, due to assault or natural disaster, in which you were separated from a loved one

Early Home Life

Growing up with an overprotective parent increases the chance of separation anxiety during childhood or later in life. Specifically, research suggests that mothers who experience separation anxiety themselves may be more likely to pass this behavior on to their children.4

Personality

Separation anxiety disorder tends to be more common in individuals who have a natural tendency to be timid or withdrawn. Since these traits are part of their personality, people who experienced separation anxiety as a child are at an increased risk of having recurrent symptoms as an adolescent or adult.5

Other Anxiety-Related Disorders

People who have been diagnosed with another anxiety-related disorder may be at a higher risk for developing symptoms of separation anxiety.6 These co-occurring conditions include the following:

How Is Separation Anxiety Disorder Diagnosed?

If you think you or your child is experiencing the symptoms of separation anxiety, you can meet with a mental health professional for an interview and a behavioral evaluation. Your mental health provider may diagnose you with separation anxiety disorder if several of the following symptoms are present:

  • You experience recurring, intense fear or anxiety that a loved one will suffer harm or death during a period of separation.
  • Symptoms have been consistently present for a minimum of 4 weeks in children or adolescents or 6 months in adults.
  • There is no medical or other mental health condition responsible for your symptoms.
  • The fear of separation from a loved one significantly interferes with normal life activities, such as attending school, work, or other events.

Treatments for Separation Anxiety Disorder

Acknowledging your separation anxiety symptoms and seeking appropriate treatment are important. Neglecting separation anxiety symptoms can decrease the effectiveness of treatment for another anxiety disorder such as agoraphobia or panic disorder.7 As noted above, people of any age can develop separation anxiety due to a variety of causes.

Treatment often successfully reduces the severity of separation anxiety symptoms and helps individuals engage in everyday life. Based on your specific needs, your mental health professional will recommend a care plan that may include the treatments below.

Psychotherapy

Cognitive-behavioral therapy (CBT) is often effective for treating separation anxiety in all age groups.8 Your mental health professional will use a combination of talk therapy and exercises to address both the thought patterns and behaviors associated with separation anxiety. CBT may involve teaching coping strategies, developing plans to cope with separation, relaxation techniques, and sometimes systematic desensitization.

Medication

If your separation anxiety is moderate to severe and doesn’t respond fully to talk therapy, medication may help manage your symptoms. There are no medications specifically approved by the US Food and Drug Administration to treat separation anxiety. Physicians—most often psychiatrists—typically prescribe the same types of medications commonly used for other anxiety disorders.

Benzodiazepines.

These drugs are antianxiety medications that can provide some relief from classic anxiety symptoms such as panic and worry. However, they can be habit forming and can cause dependencies in people who use them. Thus, doctors usually prescribe benzodiazepines on an as-needed and/or a short-term basis.9

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).

Although these medications have an antidepressant effect and are therefore commonly referred to as antidepressants, they are highly effective at decreasing symptoms of anxiety. They work by increasing the level of certain neurotransmitters in the brain.10

Beta-blockers.

These drugs influence the effects of adrenaline on the heart. Beta-blockers can help lower your blood pressure and dull the physical symptoms of separation anxiety. Since they can have serious side effects, your physician may prescribe them with caution or for only a short time.11

Complementary Therapies

You may find that complementary treatment methods can help you manage your separation anxiety symptoms and give you a sense of ownership over your condition. However, these techniques should be only one part of your overall treatment plan; they will not replace a mental health professional’s care.

Physical Exercise.

Regular aerobic exercise can help you direct your anxiety in a productive direction and may provide a healthy distraction. Physical activity could include walking, running, yoga, swimming, cycling, and more.12

A Support Group.

A formal or informal support group can provide a safe environment to share stories and encouragement with individuals who also experience separation anxiety.

References

  1. Substance Abuse and Mental Health Services Administration. DSM-IV to DSM-5 Separation Anxiety Disorder Comparison
  2. Silove, D., Alonso, J., Bromet, E., Gruber, M., Sampson, N., Scott, K., . . . Kessler, R. C. (2015). Pediatric-onset and adult-onset separation anxiety disorder across countries in the world mental health survey. American Journal of Psychiatry, 172(7), 647–656.
    https://doi.org/doi:10.1176/appi.ajp.2015.14091185
  3. Staff, Mayo Clinic. “Separation Anxiety Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 May 2018.
    https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455
  4. Stone, L. L., Otten, R., Soenens, B., Engels, R. C., & Janssens, J. M. (2015). Relations bBetween parental and child separation anxiety: the role of dependency-oriented psychological control. Journal of Child and Family Studies, 24(11), 3192–3199.
    https://doi.org/doi:10.1007/s10826-015-0122-x
  5. . Manicavasagar, V., Marnane, C., Pini, S., Abelli, M., Rees, S., Eapen, V., & Silove, D. (2010). Adult separation anxiety disorder: a disorder comes of age. Current psychiatry reports, 12(4), 290–297.
    https://doi.org/10.1007/s11920-010-0131-9
  6. Mroczkowski, M. M., Goes, F. S., Riddle, M. A., Grados, M. A., Bienvenu, O. J., Greenberg, B.D., . . . Samuels, J. (2015). Dependent personality, separation anxiety disorder and other anxiety disorders in OCD. Personality and Mental Health, 10(1), 22–28.
    https://doi.org/doi:10.1002/pmh.1321
  7. Silove, D. M., Marnane, C. L., Wagner, R., Manicavasagar, V. L., & Rees, S. (2010). The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC Psychiatry, 10(1).
    https://doi.org/doi:10.1186/1471-244x-10-21
  8. James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2018). Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane Database of Systematic Reviews, 2018(10), CD013162.
    https://doi.org/10.1002/14651858.CD013162
  9. National Institute of Mental Health. (2018). Anxiety Disorders .
    https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
  10. Silverstone P. H. (2004). Qualitative review of SNRIs in anxiety. The Journal of clinical psychiatry, 65 Suppl 17, 19–28.
  11. Tucker, W. D., Sanka, P., & Kariyanna, P. T. (2020, May 03). Selective beta-1-blockers. StatPearls Publishing LLC. Retrieved August 26, 2020, from
    https://www.ncbi.nlm.nih.gov/books/NBK499982/
  12. Anderson, E., & Shivakumar, G. (2013). Effects of exercise and physical activity on anxiety. Frontiers in psychiatry, 4, 27.
    https://doi.org/10.3389/fpsyt.2013.00027

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