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Topic » Separation Anxiety Disorder

Separation Anxiety Disorder

Separation Anxiety Disorder site

Separation anxiety disorder is an anxiety disorder wherein a child becomes fearful or nervous when away from home or is separated from his/her loved ones.

What Is Separation Anxiety Disorder?

Separation Anxiety Disorder (SAD) is an anxiety disorder where the sufferers feel extremely anxious or afraid when separated from the people they are attached to. Separation anxiety is a common part of development for children between the age of six months and three years. It usually disappears around the age of 2.

This condition 1 is a serious emotional concern characterized by extreme fear or anxiety when the child is away from their caregiver. The primary difference between normal separation anxiety and separation anxiety disorder is the intensity of the child’s fear when a parent is out of sight and how it interferes with their normal activities every day.

Although this condition is relatively common, it can significantly impair a child’s social and emotional development. The duration of this condition may persist for at least four weeks. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the duration of the separation anxiety disorder symptoms should last for at least six months.

Children are especially prone to developing this disorder in times of stress; however, separation anxiety goes away with age. If not, a child with SAD grows into an adult with SAD. Others may experience it only in adulthood. An adult with this condition can behave in a controlling way or be overprotective of his/her own children.

What Happens During Separation Anxiety Disorder?

Babies and toddlers often display clingy behavior in the initial years of childhood. A child with this disorder tends to develop anxiety and fear related to separation from their parents or attachment figures or when anticipating separation. Some children often develop physical symptoms such as headaches or vomiting.

The fear of separation tends to interfere with the daily activities of the child, like going to school or playing with other children. It is important to keep in mind that this anxiety is considered normal in the developmental phase 2 between the months of early infancy and till the age of two. It is normal until they reach 3 to 4 years of age.

Parents may feel upset and find it difficult to leave their child when the child refuses to leave their side. But it is important to practice normal separation in order to develop the child’s confidence and help him/her be independent and self-sufficient.

Sometimes overprotective and over-involved parenting behaviors become a contributing factor in developing the separation anxiety disorder symptoms. Experts also believe that an imbalance of two chemicals in the brain—norepinephrine, and serotonin—-may also be a factor in developing this disorder. It is important to seek medical attention in case the child displays signs of separation anxiety beyond their developmental age.

Prevalence Of Separation Anxiety Disorder

Studies 3 estimated that almost 75% of children with this disorder exhibit some form of ‘school refusal’ behavior. They also tend to face more obstacles at school than their peers. According to a 2015 study 4, those with obsessive-compulsive disorders are more likely to experience separation anxiety as an adult.

Researchers 5 estimate that about 43.1 percent of people who experience separation disorder other than as children, develop this condition after 18 years of age. Studies 6 show that separation anxiety disorder in children has a prevalence rate of 3–4%.

There appears to be significant cultural variation in the prevalence of SAD. Research 7 investigating this disorder shows that it occurs more in western societies than in eastern societies.

Read More About DSM 5 Here

Signs And Symptoms Of Separation Anxiety Disorder

Symptoms Of Separation Anxiety Disorder
Separation Anxiety Disorder

A child should gradually be able to separate and grow independent from his/her parental figures with age. Normal separation anxiety indicates healthy advancements in a child’s cognitive maturity and is not considered a behavioral problem. It is important to notice if and when a child shows symptoms even after the developmental age.

There are several symptoms associated with this disorder, such as:

  1. Clinging to parents
  2. Extreme and severe crying
  3. Refusal to do things that require separation
  4. Developing temporary physical illness (such as headache or vomiting)
  5. Violent and emotional temper tantrums
  6. Refusal to go to school
  7. Poor academic performance
  8. Inability to interact healthily with other children
  9. Refusing to sleep alone
  10. Nightmares about being separated
  11. Fear of being alone
  12. Unrealistic anxiety that something horrible would happen to the parent if the child leaves
  13. Refusing to go to sleep without the parent or the caregiver
  14. Bedwetting
  15. Intense fear or guilt

The diagnostic criteria for separation anxiety disorder in DSM-5 state that a person with SAD may experience:

  • Unusual distress about being separated from a person or a pet
  • Excessive worry that the loved one will be harmed if left alone
  • Heightened fear of being alone
  • Experiencing physical symptoms when they realize they will be separated from the other person
  • Excessive anxiety about being left alone
  • The need to know where a spouse or a loved one is all the time

Read More About Anxiety Here

What Causes Separation Anxiety Disorder?

Causes Of Separation Anxiety Disorder
Separation Anxiety Disorder

The factors that can contribute to SAD are a combination of biological, cognitive, environmental, and behavioral factors. Some of its most common causes are mentioned below:

1. Psychological Factors

An analysis 8 found that children are likely to develop this condition with parents who are diagnosed with a psychological disorder. Mothers who have had adverse experiences—such as maltreatment and severed attachments with their own caregivers—tend to develop similar responses with their own children.

Many psychologists suggest that early traumatic separation from parental figures can increase the likelihood of developing SAD, phobias, and other depressive disorders.

2. Environmental Factors

SAD can also occur due to a stressful or traumatic life event such as the loss of a pet or a loved one or parental divorce. Other environmental factors 9 include changing of schools/neighborhoods/countries, natural disasters, or other events that force them to be separated from parental or caregiver figures.

Studies 10 also reveal that separation anxiety disorder in adults is triggered by stressful life experiences such as going away to college, moving out for the first time, or becoming a parent.

3. Genetic And Physiological Factors

A genetic predisposition 11 may be present in children with SAD. Studies 12 found that heritability was estimated at 73% in a community sample of 6-year-old twins, with higher rates in girls. A child’s temperament can also impact the development of SAD. Timid or shy behaviors may be referred to as “behaviorally inhibited temperaments” where the child may experience anxiety when they are not familiar with a particular location or people

Read More About Genetics Here

Risk Factors Associated With Separation Anxiety Disorder

Separation anxiety disorder in children is more likely to occur in cases involving:

  • A family history of anxiety or depression
  • Shy or timid personalities
  • Low socioeconomic status
  • Overprotective parents
  • Lack of appropriate parental interaction
  • Problems dealing with kids their age
  • Chronic illness
  • Stress
  • Other anxiety disorders (such as panic attacks, social anxiety disorders, or phobias)
  • Obsessive-compulsive disorder
  • Depression

It can also occur in stressful life situations, including:

  • Moving to a new home
  • Switching schools
  • Divorced parents
  • The death of a close family member or a pet
  • Staying in a hospital away from home

Read More About Stress Here

Diagnosis Of Separation Anxiety Disorder

It is important to seek medical attention in case you see symptoms and signs of separation anxiety disorder in children. The doctor will evaluate the patient and run some physical medical tests to rule out underlying medical conditions. Next, he/she will recommend a mental health professional to treat the symptoms. The psychologist will interact with the child and the parents to ascertain which factors are triggering the symptoms.

To be diagnosed with this condition, an individual must display at least three of the following criteria:

  • Recurrent excessive distress when anticipating or experiencing separation from home or from parental figures
  • Persistent and excessive worry about losing parental figures or about any possible harm that may come to them such as illness, injury, disasters, or death
  • Persistent and excessive worry about experiencing an untoward event such as getting lost, being kidnapped, having an accident
  • Persistent reluctance or refusal to go out, away from home, to school, or elsewhere because of fear of separation
  • Persistent and excessive fear of or reluctance about being alone or without parental figures at home or in other settings.
  • Continuous reluctance or refusal to sleep away from home or go to sleep without a parental figure
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms such as headaches, stomach aches, nausea, or vomiting when separated from parental figures or anticipated.

Diagnostic Tools For Separation Anxiety Disorder

The Separation Anxiety Avoidance Inventory (SAAI) 13 is the only tool that is used for the diagnosis of separation anxiety disorder. It requires both the children and parents to take the assessments to arrive at a correct diagnosis. Other assessment tools are also present to identify the presence of anxiety disorders and that includes the following:

  • Screen for Child Anxiety Related Emotional Disorders (SCARED) 14
  • Preschool Age Psychiatric Assessment (PAPA) 15
  • Multidimensional Anxiety Scale for Children (MASC) 16
  • Separation Anxiety Assessment Scale, Child and Parent Versions (SAAS-C/P) 17
  • Spence’s Children’s Anxiety Scale (SCAS) 18
  • Fear and Avoidance Hierarchy (FAH) 19
  • Fear Survey Schedule for Children-Revised (FSSC-R) 20
  • Revised Child Manifest Anxiety Scale (RCMAS) 21
  • State-Trait Anxiety Inventory for Children (STAIC) 22
  • Social Phobia and Anxiety Inventory for Children (SPAI-C) 23
  • Dyadic Parent-Child Interaction Coding System II (DPCIS II) 24

However, a 2017 review 25 confirms that the most common drawback of these tests is that they have limited ability to administer to young children under the age of 6 or 7 due to their underdeveloped cognitive and linguistic ability.

How Do You Cure Separation Anxiety Disorder?

In mild cases, it doesn’t require any kind of treatment. In severe cases or when the child refuses to go to school or interact with people in general, it’s best to seek medical attention. The main aim 2 of separation anxiety disorder treatment is to reduce the child’s anxiety and create a safe and secure environment.

The central tenets of treatment for separation anxiety disorder involve medication and therapy, including:

1. Psychotherapy

Several psychotherapy options are adopted to treat separation anxiety disorder in children. These are as follows:

A. Cognitive-behavioral therapy (CBT)

CBT is the main form of treatment for SAD. Cognitive Behavioral Therapy is used to recognize the negative thoughts and patterns that are responsible for the behavioral disorders in children. Once it is recognized, it is altered with positive thoughts and patterns to attain the desired outcome.

CBT 26 aims to help children develop coping strategies to handle separation anxiety when away from their caregivers. This therapy aims to reshape children’s thought processes that govern their fearful behavior.

Read More About Cognitive Behavioral Therapy (CBT) Here

B. Family therapy

This therapy 27 is used to resolve conflicts among family members and to improve communication. Family therapy may be used to understand the behaviors that may be negatively impacting children and causing SAD. In family therapy sessions, children may also be taught coping strategies to manage this type of anxiety.

C. Parent-child interaction therapy

According to a 2017 study 28, “Parent-child interaction therapy (PCIT) is an evidence-based approach originally intended to treat disruptive behavior problems in children aged 2 to 7 years”. This type of treatment therapy has three phases, including:

i. Child-directed interaction

It focuses on improving the quality of the parent-child relationship, by encouraging warmth, attention, and praise. This phase will enable the child to strengthen his/her feelings of security.

ii. Bravery-directed interaction

This educates parents about why their child is experiencing separation anxiety disorder symptoms. The child’s therapist will develop a bravery ladder and teach the child to understand how to manage anxious thoughts and emotions.

iii. Parent-direct interaction

It teaches parents to communicate effectively with their children. This can help parents to manage their poor behavior and conduct and work towards bettering themselves as parental figures.

2. Medications

There are no specific medications for this disorder. Children cannot be prescribed antidepressants. In the case of older adults, antidepressants may be prescribed if other treatment methods are not effective. The doctor may also prescribe other types of medication 29 if they think it is necessary. These include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressant
  • Calcium modulator
  • Azapirone
  • Reversible inhibitor of monoamine oxidase (RIMA)

Children must be closely monitored to keep a track of any side effects associated with medication.

Prevention Of Separation Anxiety Disorder

There are no established preventive measures for SAD, especially for young children. However, in case separation anxiety disorder symptoms are detected, it is advisable to seek professional help. Early diagnosis and treatment may help to ease this condition and manage its symptoms better.

Creating a secure and loving environment for your child can be used as a preventive measure. Paying attention to your child’s needs is an essential part of developing a positive parent-child relationship. This may help with the anxiety and fear that your child is facing.

Read More About Parenting Here

Parenting Tips To Ease Your Child’s Anxiety

Even though this condition is not preventable, there may be several steps that parents can take to ensure that the process of separation is easy and safe for their child/children. These steps can help the child learn to do things like going to school without clinging to a parent or similar attachment figures. Such measures include:

1. Practicing separation with your child

Try to practice separation by leaving your child with a caregiver for a short distance and time. As and when your child gets used to it, you can leave for long periods.

2. Scheduling separation after naps or feedings

Babies usually display clingy behavior after napping and feeding. Hence, scheduling separation after naps or feedings can help with the process of separation.

3. A positive goodbye ritual

Practice a happy goodbye ritual and make sure that the baby knows that you will be back. It can be as simple as a special wave or a goodbye kiss right before you leave.

4. Leave without making a big deal

Tell your child that you are leaving to run some errands and then leave. Don’t stall or make it a big deal.

5. Keep your promise

It is important to keep your promise and return at the time you promised to come back to your child/children. This helps children’s trust and confidence during separation.

6. Make new surroundings familiar

Along with the comfortable surroundings that your baby likes to be in, it is important to introduce them to new surroundings and make them familiar too. This can include having a babysitter while you are away or visiting a park you normally don’t.

7. Hiring a consistent primary caregiver

If you are hiring help, make sure it’s the same caregiver every time you are away to avoid inconsistency and confusion in your child’s life.

8. Try not to give in to your baby’s tantrums

We often tend to give in when we see our child crying when we leave. Give reassurance to your child that he/she will be fine while you are away. Setting consistent daily routines can help your child adjust to separation.

Takeaway

SAD is a common occurrence in children, but it goes away with age. Even though this disorder is a rare occurrence in adulthood, in adults, separation anxiety causes relationship difficulties and reduced quality of life. Adults may undergo therapy and medication to help them ease their symptoms.

Children often recover from this disorder with therapy. However, their symptoms may come back, especially during stressful occasions. Recovery is more likely to be successful when the child and the family collectively undergo treatment to get to the root of the issue and resolve it.

Separation Anxiety Disorder At A Glance

  1. Separation Anxiety Disorder (SAD) is an anxiety disorder wherein a child becomes fearful or nervous when away from home or is separated from their loved ones.
  2. SAD is common in children, but they eventually grow out of it.
  3. SAD is rare in adults.
  4. The separation anxiety disorder symptoms include clinginess, severe crying, violent tantrums, poor academic performance, etc.
  5. It is caused by several psychological, environmental, and social factors.
  6. SAD can be easily managed with therapy and medication.

Frequently Asked Questions (FAQs)

1. At what age does separation anxiety occur?

Separation anxiety and fear of strangers are very common in young children, but they usually grow out of it. However, separation anxiety disorder has an onset between the ages of 6 months and 3 years.

2. Does separation anxiety affect sleep?

Separation anxiety can lead to disrupted sleep in both children and adults.

3. Can separation anxiety affect older adults?

Separation anxiety isn’t only seen in children. Adults also suffer from it. In adults, separation anxiety manifests as extreme fear that bad things will happen to the important people in their lives or unhealthy attachment issues.

4. Can separation anxiety disorder go away on its own?

Separation anxiety, usually witnessed in young children, goes away as they grow up. When it becomes a disorder, it follows a long-lasting course and doesn’t go away on its own. In adults, separation anxiety disorder is often treated with therapy and medication.

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