Separation anxiety disorder

Overview

Separation anxiety is a typical phase for many infants and toddlers. Young children often have a period where they get anxious or distressed when they have to separate from their parent or main caregivers. Examples of this can be tears at daycare drop-off or getting fussy when a new person holds them. This usually starts to improve by about 2 to 3 years of age.

In some children, intense and ongoing separation anxiety is a sign of a more serious condition known as separation anxiety disorder. Separation anxiety disorder can be identified as early as preschool age.

Your child may have separation anxiety disorder if separation anxiety seems more intense than other kids of the same age or lasts a longer time, interferes with school or other daily activities, or includes panic attacks or other problem behaviors. Most often, separation anxiety relates to the child's anxiety about being away from parents or guardians, but it could relate to another close caregiver.

Less often, separation anxiety disorder can occur in teenagers and adults. This can cause major problems leaving home or going to work.

Treatment can lessen separation anxiety disorder symptoms. Treatment may include specific types of therapy, sometimes along with medicine.

Symptoms

Separation anxiety disorder is diagnosed when symptoms are much more than expected for someone's developmental age and cause major distress or problems doing daily activities. Symptoms may include:

Repeated and intense distress when thinking about separation or when away from home or loved ones. This may include being clingy or having tantrums about separation that last longer or are more severe than other kids of the same age.
Constant, intense worry about losing a parent or other loved one to an illness, death, or a disaster or harm coming to them.
Constant worry that something bad will happen, such as being lost or kidnapped, causing separation from parents or other loved ones.
Not wanting to or refusing to be away from home because of fear of separation.
Not wanting to be home alone or somewhere without a parent or other loved one close by, if the child has reached an age where being alone might be expected.
Not wanting to or refusing to sleep away from home or to go to sleep without a parent or other loved one nearby, if the child has reached an age where these activities might be expected.
Repeated nightmares about separation.
Repeated complaints of headaches, stomachaches, or other symptoms during or before separation from a parent or other loved one.

Separation anxiety disorder may occur along with panic attacks. Panic attacks are repeated bouts of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.

When to see a doctor

Separation anxiety disorder usually won't go away without treatment and can lead to panic disorder and other anxiety disorders into adulthood.

If you have concerns about your child's separation anxiety, talk to your child's pediatrician or other healthcare professional.

Causes

Sometimes, separation anxiety can be triggered by life stress that results in separation from a loved one. Examples include divorce of parents, changing schools, moving to a new location or a loved one's death. Genetics may play a role in separation anxiety becoming separation anxiety disorder.

Risk factors

Separation anxiety disorder most often begins in childhood. But it may continue into the teenage years and sometimes into adulthood.

Risk factors may include:

Life stresses or loss that result in separation. Examples include the illness or death of a loved one, loss of a beloved pet, divorce of parents, or moving or going away to school.
Family history. Having blood relatives who have anxiety symptoms or an anxiety disorder may increase the risk of having separation anxiety disorder.
Situational issues. Experiencing some type of disaster or traumatic life event may increase the risk of separation anxiety disorder.

Complications

Separation anxiety disorder causes major distress and problems functioning at home, in social situations, or at work or school.

Disorders that can occur along with separation anxiety disorder include:

Other anxiety disorders, such as generalized anxiety disorder, panic attacks, phobias, social anxiety disorder or agoraphobia.
Obsessive-compulsive disorder.
Depression.

Prevention

There's no sure way to prevent separation anxiety disorder in your child, but these suggestions may help.

Get professional advice as soon as possible if you're concerned that your child's anxiety is much worse than others at the same developmental stage. Early diagnosis and treatment can help lessen anxiety symptoms and keep the condition from getting worse.
Follow the treatment plan to help prevent relapses or worsening of symptoms.
Get your own evidence-based treatment and support if you have anxiety, depression or other mental health concerns, so that you can model healthy coping skills for your child.

Diagnosis

Diagnosis of separation anxiety disorder involves figuring out whether your child is going through a typical stage of development or if the symptoms are serious enough to be considered separation anxiety disorder. After ruling out any medical conditions, your child's pediatrician may refer you to a mental health professional with expertise in anxiety disorders in children.

To help diagnose separation anxiety disorder, a mental health professional will likely talk with you and your child, usually together and also separately. Sometimes called a psychological evaluation, a structured interview involves talking about thoughts and feelings and behavior.

Treatment

Separation anxiety disorder is usually treated first with psychotherapy. Sometimes medicine also is used if therapy alone isn't working. Psychotherapy involves working with a trained therapist to lessen separation anxiety symptoms.

Psychotherapy

Cognitive behavioral therapy (CBT) is an effective form of therapy for separation anxiety disorder. Exposure treatment, a part of CBT, has been found to be helpful for separation anxiety. During this type of treatment your child can learn how to face and manage fears about separation and uncertainty. Also, parents can learn how to effectively give emotional support and encourage independence that suits the child's age.

Medicine

Sometimes, combining medicine with CBT may be helpful if anxiety symptoms are severe and a child isn't making progress in therapy alone. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be an option for older children and adults.

Lifestyle and home remedies

While separation anxiety disorder gets better with professional treatment, you also can take these steps to help ease your child's separation anxiety:

Learn about your child's separation anxiety disorder. Talk to your child's mental health professional to learn about the condition and help your child understand it.
Follow the treatment plan. Keep the therapy appointments for your child. Consistency makes a big difference.
Take action. Learn what triggers your child's anxiety. Practice the skills learned from the mental health professional so you're ready to deal with your child's anxious feelings during separations.

Coping and support

Coping with a child who has separation anxiety disorder can be frustrating and cause conflict with family members. It also can cause a great deal of worry and anxiety for parents.

Ask your child's therapist for advice on coping and support. For example, the therapist may suggest you:

Show calm support. Encourage your child to try new experiences, experience separation and develop independence with your support. Model bravery when facing your own distress to help when your child is facing fears.
Practice goodbyes. Leave your child with a trusted caregiver for short periods of time to help your child learn that you will return.

It's also important to have supportive relationships for yourself, so you can better help your child.

Preparing for an appointment

If you think your child may have separation anxiety disorder, start by seeing your child's pediatrician. The pediatrician may refer you to a mental health professional with expertise in anxiety disorders.

What you can do

Before your appointment, make a list of:

Your child's symptoms. Note when they occur, whether anything seems to make them better or worse, and how much they affect day-to-day activities and interactions.
What causes your child to be anxious. Include any major life changes or stressful events your child dealt with recently, as well as any past traumatic experiences.
Any family history of mental health problems. Note if you, your spouse, your parents, grandparents, siblings or your other children have struggled with any mental health problems.
Any health problems your child has. Include both physical health conditions and mental health problems.
All medicines that your child takes. Also include any vitamins, herbs or other supplements, and the doses.
Questions to ask the healthcare professional or mental health professional.

Questions to ask may include:

What do you think is causing or worsening the anxiety?
Are any tests needed?
What type of therapy might help?
Would medicine help? If so, is there a generic option?
Besides professional treatment, are there any steps I can take at home that might help?
Do you have any materials that can help me learn more? What websites do you suggest?

Feel free to ask other questions during the appointment.

What to expect from your doctor

The mental health professional is likely to ask you questions. For example:

What are your child's symptoms, and how severe are they? How do they affect your child's ability to do daily activities?
When did you first begin noticing your child's separation anxiety?
How do you respond to your child's anxiety?
What, if anything, seems to make your child's anxiety worse? What makes it better?
Has your child had any traumatic experiences recently or in the past?
What, if any, physical or mental health conditions does your child have?
Does your child take any medicines?
Do you or any of your blood relatives have ongoing anxiety or other mental health conditions, such as depression?

Be ready to answer questions so that you have time to talk about what's most important to you.