Your Guide to Separation Anxiety Disorder

Medically Reviewed By Lori Lawrenz, PsyD
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Separation anxiety disorder is a condition that affects young children when they are away from familiar people or places. They can experience intense feelings of fear and distress that is greater than usual. These emotions are usually a result of biological, family, or environmental factors. It is usual for young children to feel anxious when they are away from a parent or a place that they are familiar with. However, around 4% of children experience separation anxiety disorder.

Separation anxiety typically occurs from 18 months to 3 years of age. This is a period during which some degree of separation anxiety is typical. However, children with separation anxiety disorder will continue to experience symptoms or develop the condition as they get older.

Read on to learn more about separation anxiety disorder, including how to recognize symptoms and what treatment options are available.

What is separation anxiety disorder?

A child looks upset and tearful
Maria Manco/Stocksy

Separation anxiety disorder is a mental health condition where the individual experiences extreme feelings of fear and worry. Separation anxiety typically begins between the ages of 18 months and 3 years, but separation anxiety disorder persists or further develops as the child grows up.

Children will experience symptoms most when they are away from a parent or loved one.

Experiencing anxiety is a part of growing up. However, symptoms of separation anxiety disorder are more serious and can cause distressing feelings of fear and worry in the child.

As most children experience anxiety now and again, it may be difficult to recognize separation anxiety disorder. If the child frequently displays symptoms of anxiety and finds it challenging or impossible to take part in routine activities typical of their age group, they may require treatment.

View our article about anxiety disorders in children for information about similar conditions.

3 stages of separation anxiety

Attachment theory suggests that a child’s separation anxiety manifests in 3 stages: protest, despair, and detachment.

This begins with the child protesting and trying to prevent their loved one from leaving them. A period of sadness and lethargy follows once the loved one has left. When the loved one returns, the child may show signs of detachment, withdrawing from the parent or caregiver to help them to recover from the pain of the separation.

This theory is not as popular today as it was when it was first theorized in the 1950s. However, some children may still display this pattern of behavior, which can help to identify separation anxiety.

If the pattern persists or begins to prevent the child from experiencing age-appropriate activities, they may be displaying symptoms of separation anxiety disorder.

Vs. stranger anxiety

Separation anxiety disorder is different from stranger anxiety. It is typical for young children to feel anxious when around people they do not know, for example, when they are going into a new classroom or attending a new school.

However, with separation anxiety, the anxiety is not typically due to the prospect of being around strange people. Instead, it is a fear of being away from a parent or other loved one.

Learn more about different types of anxiety disorders in our article on anxiety.

What are the symptoms of separation anxiety disorder?

When a child experiences separation anxiety, they may display signs of worry or fear that is greater than usual for their age. Examples of separation anxiety symptoms can include:

  • worrying that something will happen to parents or loved ones while they are away
  • having difficulties saying goodbye to parents
  • having tantrums when they have to leave a parent or caregiver
  • constantly needing to know where their parents or loved ones are
  • frequently getting in touch with parents or loved ones, for example, by texting or calling them
  • having nightmares about negative things happening to loved ones
  • always following a parent around the house
  • refusing to go into day care, school, or anywhere else where a parent is dropping them off
  • experiencing physical symptoms such as stomachaches and headaches

Younger children tend to be anxious during the time of separation, such as when a parent takes a child to the school gates. Older children can become anxious when they know that there is an upcoming separation.

Who can get separation anxiety disorder?

Separation anxiety typically begins among children ages 18 months to 3 years. This is a typical age during which young children display signs of worry when their parent or loved one is out of the room or away for any length of time.

If separation anxiety continues past this age, or if it manifests in an older child, this can be a sign of separation anxiety disorder. The average age for the onset of the disorder is 6–7 years.

Older children and teenagers may experience symptoms, particularly during times of stress.

Both males and females can experience separation anxiety. A child is more likely to develop the condition if they have a parent with an anxiety disorder.

Adult separation anxiety disorder

While separation anxiety disorder, sometimes known as childhood separation anxiety disorder (CSAD), typically manifests in childhood, the condition can also affect adults. This is known as adult separation anxiety disorder (ASAD).

Around 6.6% of the general population of the United States develops ASAD, with 77.5% of those cases beginning in adulthood. Around 3 in 4 patients with ASAD seek treatment for the condition.

How long does separation anxiety last?

How long separation anxiety disorder lasts will depend on each child and their own symptoms. For some, it may persist as they grow up and enter their teenage years. Symptoms can also recur if new situations emerge.

However, with the right treatment, the child can recover from separation anxiety disorder. This is more likely if treatment involves the parent or loved one.

What causes separation anxiety disorder?

Separation anxiety disorder typically occurs as a result of biological, family, or environmental factors.

Biological factors

Chemicals in the brain may play a part in causing separation anxiety. If two neurotransmitters known as serotonin and dopamine do not function or communicate as expected, they can cause feelings of anxiety.

Family factors

Family history of mental health issues may be a contributing factor for children with separation anxiety. A child may also develop symptoms of anxiety if a parent or loved one displays anxious behavior around them.

Environmental factors

Environmental factors can play a role in the development of separation anxiety disorder in a child. Examples of environmental contributors may include the following:

  • losing a parent or loved one, either through separation or death
  • having extended periods of a parent or carer being absent, such as due to work, deployment, or incarceration
  • feeling a lack of warmth from a parent or caregiver
  • being away from parents, such as if a child spends time in foster care
  • frequent relocation due to the occupation of a parent or caregiver
  • having a parent with alcohol use disorder, which affects around 14% of children with a separation anxiety disorder diagnosis

When to contact a doctor

Contact a doctor or healthcare professional if separation anxiety causes the child a lot of distress, particularly if they remain upset for a long time after you have left them.

It is important to contact your doctor if the separation anxiety persists for more than a few weeks without improvement, or if the distress is preventing the child from getting the most out of new experiences, such as attending day care or socializing with other children.

Diagnosing separation anxiety disorder

If the child displays symptoms of separation anxiety, a doctor will refer them to a child psychologist or other licensed mental health professional. In order to reach a diagnosis of separation anxiety disorder, they must typically experience fear or worry about being away from loved ones for at least 4 weeks.

In order to reach a separation anxiety diagnosis, the child must meet at least 3 of the 8 symptoms that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines. The symptoms include:

  • displaying significant distress with either real or anticipated separation
  • having persistent concern about losing loved ones or that something bad will happen to them
  • having persistent concern that they will experience an unfortunate event that will separate them from a loved one
  • ongoing reluctance or inability to leave home or go to school due to separation fears
  • feeling reluctance to sleep away from home or away from the loved one
  • experiencing nightmares about being separated from a loved one
  • experiencing physical symptoms when anticipating or experiencing separation from a loved one

What treatments can help with separation anxiety disorder?

With the right treatment, a child can overcome separation anxiety disorder. Around 96% of children who undergo treatment for separation anxiety no longer experience the disorder following an evaluation around 3–4 years later.

Treatment options may differ depending on the child’s age, overall health, and extent of their symptoms. Treatments offered may include:

  • cognitive behavioral therapy (CBT), which can help the child to manage their anxiety in situations that trigger symptoms
  • family therapy to help parents or caregivers be more involved in the child’s treatment
  • involvement from the child’s school
  • antidepressants or antianxiety medication, which can help alleviate symptoms when prescribed alongside therapy

View our article on CBT for more information about what to expect during sessions.

How to help a child with separation anxiety

Alongside therapy or other treatment options, parents, caregivers, and other loved ones can help a child with separation anxiety disorder. Tips for helping to ease symptoms of the condition include:

  • showing the child reassurance that the separation will be okay
  • encouraging the child to take part in age-appropriate activities
  • recognizing situations that may cause the child distress and planning ahead
  • informing other adults of the child’s separation anxiety so that they may provide additional support
  • making sure the child attends all healthcare appointments

Summary

Most young children experience separation anxiety. When feelings of fear and worry are greater than expected, or when they prevent the individual from experiencing age-appropriate activities and milestones, they may be experiencing separation anxiety disorder.

Separation anxiety disorder can occur due to environmental, family, or biological factors. The individual may experience distress when away from a parent or caregiver, and they may also experience fear or worry when anticipating separation.

The condition can continue into adolescence, and for some, it may persist into their teenage years.

With the right treatment, most children overcome separation anxiety. CBT and family therapy can help the individual to manage their symptoms and address their anxieties surrounding being away from loved ones and familiar places.

Contact a doctor if you feel that your child is experiencing extreme or persistent distress when separated from a loved one or familiar place. The doctor may recommend a child psychologist to help to assess the child and offer the best treatment option for them.

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Medical Reviewer: Lori Lawrenz, PsyD
Last Review Date: 2022 Mar 20
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