Separation Anxiety Disorder in Children and Adults

Some children, often described as clingy, demanding, or intrusive, may have a mental health condition called separation anxiety disorder.  Separation anxiety, however, is not just a disorder of childhood.  Some adults also meet the criteria for this condition.  In fact, research suggests a significant number of older individuals with separation anxiety developed the condition as adults.

In this article, we review the diagnostic criteria for separation anxiety disorder in children and adults and then consider the condition’s risk factors and treatment.

separation anxiety disorder

Diagnosis and risk factors

According to the DSM-5, the latest edition of the diagnostic manual of mental disorders, separation anxiety disorder is associated with excessive or developmentally inappropriate anxiety related to separation from an attachment figure (often a parent/caregiver in children; a romantic partner, in adults).  The disorder is characterized by three or more of the following:

  • Distress and anguish when about to separate or when anticipating it.
  • Unwillingness to leave home (e.g., to go to school/work).
  • Fear of being alone.
  • Being unwilling to sleep without the parent (in children) or romantic partner (in adults) nearby.
  • Separation-related nightmares.
  • Excessive worries about possible harm to or loss of an attachment figure (e.g., due to injury or illness).
  • Constantly worrying that an event, such as an accident, could result in separation from the attachment figure.
  • Somatic complaints (e.g., stomachache, headache, palpitations, nausea, dizziness) when anticipating separation.

These symptoms must be present for a month or longer in children, or six months or longer in adults.

The prevalence of separation anxiety is approximately 1-2% in adults and 4% in children.

Risk factors for separation anxiety disorder include:

  • Genetics: 73% heritability.
  • Physiology: Hypersensitivity to carbon dioxide.
  • Parental behavior: Being intrusive or overprotective.
  • Environmental factors: Life stress and loss.  Some examples are personal illness, illness or death of a family member or pet, going to college, starting a romantic relationship, and immigration.

Separation anxiety disorder commonly co-occurs with other anxiety disorders, such as specific phobias (e.g., animal phobias) and generalized anxiety disorder.

The treatment of separation anxiety disorder

Separation anxiety can cause significant distress and dysfunction.  It interferes with a child’s development and education (e.g., because of school refusal).  And it negatively affects many aspects of an adult’s life.  For instance, young adults with this condition may find it very stressful to leave their parental home (e.g., to go to college), travel by themselves, or begin a new romantic relationship.

So, what are the best ways to treat separation anxiety disorder?

There are no empirically validated interventions specifically designed for separation anxiety disorder. However, both medications (e.g., selective serotonin reuptake inhibitors or SSRIs) and psychotherapy (e.g., cognitive behavioral therapy) are effective in treating anxiety disorders.

The psychological approach to treating separation anxiety disorder may include the following components:

  • Education about the disorder and its treatment.
  • Social skills training to improve social competence.
  • Self-monitoring and other cognitive techniques to identify and challenge anxious thoughts.
  • Graded exposure: Progressive exposure to increasingly anxiety-provoking situations (e.g., gradually increasing the duration of separation).
  • Coping and stress management techniques to reduce anxiety during periods of separation.

Family involvement can be helpful as well.  Why?  Because attachment figures or other people in the family might unintentionally model or reinforce the patient’s avoidant behavior.  For instance, an attachment figure’s mental health issues (e.g., anxiety, depression, paranoia) or maladaptive behaviors (e.g., invasions of privacy) can make the process of separation more difficult.

Finally, to reduce general anxiety, positive lifestyle changes—regular exercise, sufficient sleep, balanced nutrition, and others—may also be recommended.