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What is Separation Anxiety?

Separation Anxiety is defined by the DSM as developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached. In children and adolescents it must be present for at least four weeks and in adults at least six months. This anxiety is considered excessive and inappropriate to the situation. It is more common in children and may include extreme fears of other things that may be encountered when separated, such as dogs or bad people. It is common that children will express this anxiety as a fear of death of either a loved one or them self while separated, or as a general feeling of not being safe when separated from their main person off attachment. It can be more common in families that are very close; however, any family dynamic can be present. Possibly the largest area of functioning negatively impacted by social anxiety is school, as school refusal is very common. Unfortunately, social anxiety can be mistaken for bad behavior as children who suffer with it can be demanding, oppositional, or attention seeking. They need frequent reassurances, which can place a lot of demand on an adult caregiver. On the other hand, some children with separation anxiety are overly pleasing and compliant, in order to avoid being rejected by care givers. Children will also frequently complain of somatic complaints due to the anxiety, such as stomach aches. Other symptoms of separation anxiety in children are: reluctance to spend the night away from home, school refusal, somatic complaints, constant worry about losing someone they love, nightmares, fear of being alone in general, or fear of catastrophic event.

In adults symptoms may present much differently. It is important to note that symptoms must be present before age 18 in order to meet criteria for a diagnosis of separation anxiety. As an adult, someone with separation anxiety will generally have one person that they are attached to, very commonly their spouse. Even the thought of being separated can cause anxiety or panic. When they are with their safe person or focus of attachment they may be overbearing leading to overwhelming the other person or causing resentment or distress between the two of them. Other symptoms in adults is the avoidance of being alone, fear of harm coming to them self or the ones they love when separated, panic attacks, somatic complaints, and frequent difficulties in occupational settings due to poor performance or attendance caused by the fear of leaving.

Diagnostic Criteria:

Three or more of the diagnostic criteria must be present and cause clinically significant distress or impairment in order to qualify for a diagnosis of separation anxiety.

  • recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
  • persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
  • persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
  • persistent reluctance or refusal to go to school or elsewhere because of fear of separation
  • persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
  • persistent reluctance or refusal to go to sleep without being near a near a major attachment figure or to sleep away from home
  • repeated nightmares involving the theme of separation
  • repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

How is Separation Anxiety Treated?

Psychotherapy is the most effective treatment. A therapist will utilize talk therapy and Cognitive Behavioral Therapy to address the thoughts and emotions, teaching a child or adult to replace negative or irrational thoughts that lead to the anxiety, while introducing coping skills to help cope with the emotions when they arise. For young children, play therapy is also an effective tool to assist with separation anxiety.

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