We all experience anxiety at some point in our lives, especially when missing the ones who bring us comfort. However, for some people, this fear of separation is constant and overwhelming.
This article explores separation anxiety disorder in children and adults. We’ll cover the causes, symptoms, and treatment of this impactful condition.
This information is not intended to replace professional medical advice. If you or a loved one is worried about the impact of separation anxiety, speak to your healthcare provider.
- Separation anxiety is the experience of fear and distress when faced with the possibility of being even temporarily parted from a loved one.
- Separation anxiety disorder can occur in both children and adults. Adult separation anxiety is often under-recognized and undertreated.
- There are several risk factors for the development of separation anxiety disorder, including past trauma, neonatal influences, structural brain changes, and social factors.
What is separation anxiety?
Separation anxiety is an upsetting emotional state involving fear and dread brought on by being separated from a close attachment figure. It is common for children to experience some degree of separation anxiety, particularly between the ages of 18 months and 3 years. [1][2]
In contrast, separation anxiety disorder (SAD) is a mental health condition characterized by severe and overwhelming feelings of separation anxiety that impact a person’s day-to-day experiences. [2]
Does separation anxiety occur in adults?
Often thought of as a mental health condition of childhood, separation anxiety in adults is an increasingly recognized condition. It is estimated that between 7% and 23% of adults experience significant separation anxiety at some point in their lifetime. [3]
Separation anxiety disorder in adults can be separated into adult-onset separation anxiety disorder and separation anxiety that continues from a childhood diagnosis. In both cases, negative childhood experiences (clinically known as adverse childhood experiences, or ACEs) are often a key driver of separation anxiety symptoms. [4]
Symptoms of separation anxiety
Before diving into the symptoms, it’s worth considering the question: When does separation anxiety start?
In children, symptoms of separation anxiety disorder most commonly appear around the ages of 8 and 10 (the third or fourth grade). Returning from an absence from school (either after holidays or following periods of sickness) is often the trigger for separation anxiety symptoms. [2] Some common symptoms of separation anxiety in childhood include: [2]
- School avoidance
- Reluctance to spend time alone
- Excessive anxiety when away from family members or carers (and fear of losing a close relative)
- Distrubed sleep (including repeated nightmares and refusal to sleep alone)
- Being very clingy
- Worries about personal or family safety
- Physical symptoms such as abdominal pain, headaches, and muscle aches
- Panic attacks or tantrums occur when separated from caregivers
Symptoms of separation anxiety in adults
Resources often focus on the symptoms of separation anxiety disorder in children. These symptoms tend to be less applicable to adults with the condition. Some common symptoms of separation anxiety in adults include: [4]
- Excessive fear at the prospect of being separated from a loved one (usually a partner or a family member)
- Fear of harm or loss affecting a loved one
- Refusal to go to work or other commitments
- Avoiding occasions that require any amount of separation
- Excessive distress when separation occurs
What causes separation anxiety?
Much like every other mental health condition, there is no single cause of separation anxiety disorder. However, several recognized factors contribute to the risk of developing separation anxiety.
Exposure to traumatic events
The most widely recognized risk factor for the development of any anxiety disorder (including separation anxiety) is experiencing trauma during childhood. Exposure to trauma (such as abuse or an unexpected death) can disrupt the normal child-caregiver bonding process. [5]
Unexpected traumatic separation can have lifelong consequences, even serving as a primary trigger for separation anxiety years later in adulthood. [5]
Brain development
Although the exact mechanisms are unknown, several neurological changes have been seen in individuals with separation anxiety disorder. Infants who go on to develop separation anxiety have been shown to have: [5]
- Altered oxytocin receptor functioning (commonly referred to as the ‘love hormone’)
- Changes in overall brain shape and structure
- Altered connectivity of major brain regions responsible for information processing and behavioral output.
Neonatal risk factors
Research has demonstrated that maternal hormonal influences, such as exposure to hormone-altering medications (like corticosteroids), have a direct impact on the development of separation anxiety later in life. Early separation of a baby from their primary caregiver has a similar effect on the development of a future anxiety disorder. [5]
Social factors
One of the greatest lasting impacts of the COVID-19 pandemic is the effect that it has had on childhood mental health. The extended periods of social isolation brought on by stay-at-home orders have resulted in a significant increase in anxiety symptoms associated with returning to school. [5]
Family history
Children of parents with an anxiety disorder are much more likely to develop an anxiety disorder (including separation anxiety) themselves later in life. Research has demonstrated numerous genetic and social factors that explain this phenomenon. [5]
Living with separation anxiety
Living with separation anxiety can be a highly distressing experience. What others see as simple, unavoidable periods of absence from a loved one can seem unmanageable to someone with separation anxiety.
Managing separation anxiety as a parent of a child with the condition can be equally distressing. Schools can work with parents to develop self-management strategies that aim to improve educational attendance whilst lessening anxiety symptoms over time. These include: [6]
- Supporting transitions: The time and location of school entrance can be adjusted to reduce feelings of anxiety caused by the rush of other students.
- Routine and parental exit: An appropriate routine, such as spending 5 minutes together before leaving, should be established and followed.
- Tokens and distraction: The child may benefit from keeping a reminder of home with them throughout the day as a source of comfort when needed.
- School staff support: Building a relationship with a trusted key adult at school can help the child feel safe. Establishing safe spaces to manage panic symptoms and having trained staff understand the child’s needs can be a great comfort during difficult times.
Separation anxiety and substance use
Teenagers and adults are at risk of developing harmful coping mechanisms when trying to deal with separation anxiety without support. Substances, such as alcohol, are often sought for their calming and dissociative effects in the face of intense anxiety. As many as 3 in 4 people with a substance use disorder report a form of past or current anxiety disorder. [7]
Diagnosing separation anxiety
The diagnosis of separation anxiety disorder can be made by a suitably qualified mental health professional (usually a psychiatrist). The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) provides a standard reference of symptoms to aid diagnosis.
The DSM-5-TR criteria state that the person must show “developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached”. This must be evidenced by the presence of at least three symptoms related to separation anxiety (discussed earlier in the article). [8]
Importantly, these symptoms must last for at least 4 weeks in children and adolescents, and cause significant distress or impairment to daily functioning. [8]
Diagnosing in adults
The diagnostic criteria for adult separation anxiety disorder are the same as for children. However, practitioners will focus their assessment on the impact of symptoms on work and socializing rather than on education. Additionally, symptoms typically need to last for at least 6 months for a diagnosis in adults. [8]
Treatment for separation anxiety
Treatment for separation anxiety disorder can involve a wide range of approaches. Your treatment provider will discuss options that are most suitable for you or your child. Common approaches include: [2]
- Talking therapies
- Medication (such as antidepressant or anti-anxiety medications)
- Self-management strategies (including relaxation techniques)
- School and/or social worker input
Therapy options
There are several forms of talking therapy that may be beneficial depending on your unique circumstances and background. Common therapy approaches to treating separation anxiety disorder include: [5]
- Cognitive behavioral therapy (CBT): Aims to identify negative thoughts and feelings and build positive coping strategies.
- Psychodynamic therapy: Aims to uncover the root ‘cause’ of current symptoms in past experiences.
- Family therapy: Aims to explore current relationship dynamics and facilitate positive communication.
- Social therapy: Aims to discover wider contributing factors (such as bullying at school) that may be driving symptoms.
