|Separation Anxiety Disorder
Separation Anxiety Disorder is a condition in which children four years of age or older experience distress
when being separated from their parents or other individuals, to whom they are closely attached. In
addition to experiencing anxiety and distress at school or in other situations that separate them from their
parents, children with this disorder cling to their parents when they are at home, following them around the
house, trying to sleep in their bedroom, and resisting being left with baby sitters.
Being separated from a parent may be a traumatic time for a child, especially if he or she is not old
enough to understand the circumstances of the separation. It is usually overcome when the child's
attention is diverted or he or she adapt to the surroundings. For some children, the anxiety of being away
from a parent or loved one is too overwhelming to comprehend, and causes severe emotional stress.
These children have difficulty falling asleep by themselves at night. When separated, they may fear that
their parent will be involved in an accident or taken ill, or in some other way be gone to the child forever.
Their need to stay close to their parent or home may make it difficult for them to attend school or camp,
stay at friends’ houses, or be in a room by themselves. Separation anxiety disorder almost always occurs
Fear of separation in separation anxiety disorder can lead to symptoms of dizziness, nausea or
palpitations and is also associated with the symptoms of depression, sadness, withdrawal, apathy and
concentration challenges. Some children also develop physical symptoms, such as headaches or
stomachaches, at the thought of being separated. Young children even suffer from fear and experience
nightmares with separation anxiety disorder. Separation anxiety disorder may run in families and is likely to
affect shy, nervous children.
The cause of separation anxiety disorder is not clearly known although some risk factors have been
identified. Separation anxiety disorder is triggered by major changes in the child’s life such as death,
hospitalization, divorce, a move to a new school, significant family stress, or trauma especially physical or
sexual assault can trigger separation anxiety disorder. The symptoms of separation anxiety disorder are
displayed in a number of ways as diverse as temper tantrums, nightmares, fear of the dark, physical
symptoms, and lack of concentration.
Separation anxiety disorders in children are equally distributed between the sexes, although separation
anxiety disorder according to surveys is higher in girls. The remission rate is high with separation anxiety
disorder. Children affected with separation anxiety disorder tend to emerge from close-knit families and
although separation anxiety disorder tends to run in families, the exact role of environmental and genetic
factors is yet to be established.
Separation anxiety disorder in children or adolescents should not be confused with the normal separation
anxiety experienced in infants and toddlers. To reach the diagnostic threshold for this disorder, the anxiety
or fear must cause distress or affect social and academic functioning. If an older child continues to react to
potential separations with unreasonable fear, separation anxiety disorder may be diagnosed. Without
professional help this disorder can damage a child’s self image and ultimately lead to adult emotional
Most mild cases of separation anxiety disorder do not need medical treatment. In more severe cases or
when the child refuses to go to school, treatment may be needed. The goals of treatment include reducing
anxiety in the child, developing a sense of security in the child and the caregivers, and educating the child
and family/caregivers about the need for natural separations.
Psychotherapy (a type of counseling) is the main treatment approach for separation anxiety disorder. The
focus of therapy is to help the child tolerate being separated from the caregivers without the separation
causing distress or interfering with function. A type of therapy called cognitive-behavioral therapy works to
reshape the child's thinking (cognition) so that the child's behavior becomes more appropriate. In
cognitive-behavioral therapy, a related therapy, patients learn to react differently to the triggers of anxiety
attacks. They also learn to understand how their thinking patterns contribute to their symptoms and how to
change their thoughts to reduce or prevent the symptoms. Family therapy also may help teach the family
about the disorder and help in teaching better support for the child during periods of anxiety.
There is no known way to prevent separation anxiety disorder, but recognizing and acting on symptoms
when they appear can minimize distress and prevent problems associated with not going to school. In
addition, reinforcing a child's independence and self-esteem through support and approval may help
prevent future episodes of anxiety. Most children with separation anxiety disorder get better, although their
symptoms may recur for many years, particularly when stressful events or situations occur. When
treatment is started early and involves the family as well as the child, the child's chance of recovery
improves. Most patients respond well to treatment, and the success rates among those who receive
treatment are usually very high, allowing patients to return to productive, fulfilling lives.