Have you ever felt a lot of fear and anxiety when leaving someone very close to you, be it your mother, father, child, or even your partner, for a while? It is normal for young children to be reluctant to leave their mother and go to school, to cry. But what if this fear and anxiety goes beyond normal levels and becomes so great that it interferes with daily activities? That is when we need to be a little concerned about this.
What is Separation Anxiety Disorder?
Simply put, Separation Anxiety Disorder is a mental health condition that can affect both children and adults. A person with this condition experiences excessive, uncontrollable fear and anxiety when they are separated from a close person (an attachment figure), or when they think they will be separated. This fear and anxiety is far greater than the cause, and is not typically age-appropriate.
You've probably heard that babies cry when their mother leaves, and that's called "separation anxiety." It's actually a normal part of baby development . It happens as they learn about the world. It usually subsides around the age of 3.
However, for some older children, this fear of separation goes beyond what is considered normal for their age. That's when doctors consider diagnosing it as Separation Anxiety Disorder . Sometimes, adults who didn't have these symptoms as children can also develop this condition.
Separation Anxiety Disorder can disrupt daily life. Children with this condition may not be able to go to school at all. Adults may not be able to go to work or have difficulty concentrating.
But don't worry, this doesn't have to be like this forever. If you think you or someone you know may have this condition, see a doctor. They can talk to you and recommend therapy or medication if necessary.
What are the symptoms of this condition?
A person with Separation Anxiety Disorder may have at least three of the following symptoms:
Commonly seen symptoms:
- Feeling intense distress when separated from an attachment figure or when thinking about being separated.
- Constant fear that the person you are attached to will suffer harm (such as injury, death) or become ill .
- Constant fear of being separated from the person you are attached to due to personal problems (such as getting lost, being kidnapped).
- Reluctance or refusal to leave the house, go to school, or work due to fear of separation.
- Being afraid of being alone (even in a room at home) without the person you are attached to.
- Reluctance or refusal to sleep without the person you are married to.
- Frequent nightmares about separation from the person you are involved with (e.g., a fire, murder, etc.).
- Physical symptoms (such as stomachaches, headaches, vomiting, nausea) may occur when you are separated from your partner or when you feel like you are about to be separated. Young children and adults may experience palpitations or dizziness (these are less common in young children).
How to recognize separation anxiety in young children?
The way these symptoms appear may vary slightly depending on the age of the child. For example, a preschooler may not be able to put into words what they are feeling. They may simply be sad, crying, or upset . An older child may be able to describe bad dreams and fears.
Imagine that no matter how much your child cries about not being able to go to school, you force them to go to school. Then the child may be sad and uninterested in school. They may have difficulty concentrating on their studies, and they may seem to have no interest in joining in with other children. These things may be noticed by the child's teacher.
If they have to be away from home for a few days (for example, on a school trip or staying with relatives), a child with separation anxiety may become very homesick and anxious until they return home. Sometimes, they may become angry and aggressive toward anyone who feels like they are being separated from their parents.
How to recognize separation anxiety in adults?
It's normal to worry a little about someone when you're in love. It's a part of life. But the stress that comes with separation anxiety disorder goes beyond the fear itself. It can also start to interfere with your work and relationships. For example, you might miss work because you want to be with your loved one, or you might feel like calling and texting them constantly to see if they're okay, and you might feel restless waiting for them to respond.
When you're in this state, you may not always realize that your fears and anxieties are higher than normal. Perhaps it's when your child or partner gets angry that you're constantly checking up on them that you realize that your anxiety is out of control.
Why does separation anxiety disorder occur?
Researchers still don't know exactly what causes this, but they believe it's likely a combination of both genetics and environmental factors . For example, a person may be born with a genetic mutation that affects the way certain chemicals in their brain work.
But genetics alone may not be enough to cause this type of disease. Often, an environmental factor —such as a major life change or an adverse childhood experience—is also involved. These factors can cause epigenetic changes , which are changes in the chemicals that bind to your genes and affect how they work. For example, some epigenetic changes can affect the way your body's cells "read" genes that control stress.
What are the risk factors?
A child may be at increased risk of developing Separation Anxiety Disorder if:
- If you lose someone close to you (e.g. through death).
- If you face a stressful situation like your parents' divorce .
- Whether you change schools or move to a new place .
- If anyone in the family has (biologically related) anxiety disorders .
Risk factors for developing Separation Anxiety Disorder in an adult:
- Losing a loved one.
- A loved one getting sick .
- Big life changes (e.g. moving, starting a relationship, becoming a parent).
- Having been diagnosed with an anxiety disorder as a child.
- Having been diagnosed with other anxiety or mental health disorders in adulthood.
What complications can arise from this condition?
Separation Anxiety Disorder can disrupt your life and make it difficult to do the things you want and want.
Effects on children:
- Difficulty concentrating on schoolwork, resulting in falling behind in classes.
- Difficulty getting along with other children and participating in social activities .
- Missing opportunities to learn, develop social skills, and become more independent .
Effects on adults:
- Difficulty concentrating on work or other responsibilities.
- Conflicts in their relationships, especially with those they are involved with .
- Missing opportunities to travel or engage in other important activities .
How is Separation Anxiety Disorder diagnosed? (Diagnosis)
How do doctors diagnose diseases?
Doctors do the following to diagnose separation anxiety disorder in adults:
- Talking to you about your symptoms .
- You will be asked to fill out a questionnaire that focuses on your symptoms and experiences. Your answers will help the doctor diagnose (or confirm that it is not) separation anxiety.
Separation Anxiety Disorder in children is diagnosed by talking to the parents or caregivers as well as the child. Your pediatrician may have you (and your child if they are old enough) fill out a questionnaire. They may also ask you verbal questions about your child's behavior and what you have observed.
Sometimes doctors may refer you or your family to a psychiatrist or psychologist for further help to confirm the diagnosis.
What are the diagnostic criteria? (DSM-5-TR)
Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR®) to diagnose separation anxiety disorder and other mental health conditions that may affect you/your child.
According to the DSM-5-TR, all of the following must be true to be diagnosed with Separation Anxiety Disorder:
- At least 3 of the 8 possible symptoms mentioned earlier must be present.
- These symptoms must be present continuously - for at least 4 weeks in children, and 6 months in adults.
- These symptoms must cause significant distress to the person concerned, or interfere with daily activities (such as going to school or work) .
- These symptoms cannot be explained by any other diagnosis .
For a long time, doctors only diagnosed separation anxiety disorder in adults if they had it as children. But the DSM-5-TR removed the condition from the category of a condition that was usually diagnosed before the age of 18 and classified it as an anxiety disorder . Doctors now accept that it can occur in adults of any age, even for the first time.
Identifying other comorbidities
Doctors also use the DSM-5-TR to identify comorbidities . This means that a person has other medical conditions in addition to the main diagnosis (in this case, separation anxiety). A person can have two or more mental health conditions. Then, the symptoms can overlap and affect each other in ways that are difficult to distinguish.
For example, it is common for a child with Separation Anxiety Disorder to also have Generalized Anxiety Disorder or a specific phobia .
Adults with separation anxiety disorder often have one or more of these co-morbid conditions:
- Agoraphobia ( extreme fear of open or crowded places)
- Generalized Anxiety Disorder
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Personality Disorders
- Post-Traumatic Stress Disorder (PTSD)
- Social Anxiety Disorder
- Specific Phobia
- Depression
By identifying skin conditions, doctors can tailor treatment to the individual's specific needs . For example, treatment may include different types of therapies or several types of medications.
Do we also need to think about cultural differences?
Some cultures value a strong sense of interdependence between family members. This means that family members are closer and more dependent on each other than in other cultures. This kind of interdependence is not the same as separation anxiety disorder. Doctors also take these cultural differences into account when diagnosing this condition.
What are the treatments for this? (Treatment)
The first line of treatment for separation anxiety disorder is psychotherapy , specifically a type of therapy called cognitive behavioral therapy (CBT) . CBT helps a person understand how their thoughts affect their actions.
Other treatment options:
- Dialectical Behavioral Therapy (DBT) : This helps a person find a balance between accepting who they are and accepting change.
- Family Therapy : This helps improve relationships between family members. During this time, everyone in your family is also made aware of Separation Anxiety Disorder.
Medications
If talking therapies don't help enough, you or your child may need medication. Your doctor will explain exactly what type of medication is best and how long you should take it.
Medicines given to children
Doctors sometimes use a class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs) for separation anxiety disorder in children 6 years of age and older. Specific medications that are recommended include:
- Fluoxetine (Prozac®)
- Sertraline (Sertraline - Zoloft®)
- Paroxetine (Paroxetine - Paxil®, Pexeva®)
Possible side effects include insomnia, vomiting, and changes in appetite. One of the more serious concerns about using SSRIs in children is the increased risk of suicidal ideation .
Your child's doctor will watch closely for signs of suicidal thoughts. They will need to check in with your child frequently (called follow-ups), perhaps once a week for the first month, then every two weeks for the next month. They will also tell you what to watch for at home.
Important: At any point in this process, even before your child starts taking medication, don't hesitate to talk to your child's doctor about any questions or concerns you may have.
Medications for adults
Your doctor may prescribe antidepressants like SSRIs or anti-anxiety medications like benzodiazepines .
Your doctor will tell you more about the possible side effects and risks of the specific medications you are taking. For example, benzodiazepines can be addictive (habit-forming) . SSRIs can increase the risk of suicidal thoughts or behavior , especially when you first start taking them.
Every medication has risks and benefits. Together you and your doctor can find the best treatment option for you.
If you are thinking about suicide, or if you are worried that your child is thinking about suicide, call 1926 (Sri Lanka's National Mental Health Helpline). There is someone available 24/7 to help you.
How will this situation turn out? (Outlook)
How are the children doing?
Children who receive treatment—especially if they start early—do well . They go to school, make friends, and gradually learn to be more independent. Many do not continue to have these symptoms into adulthood, and they do not have difficulties during transitions like going to college or getting married. Some children just need a little extra help to understand how important the independence you know is to them and to enjoy it. With that support, they can see the world as a place full of opportunities, even when you are not around.
But if left untreated, children with separation anxiety disorder can have difficulty with schoolwork. They may also resist situations that involve risk or change, which can limit their opportunities to learn and grow. They are also at greater risk of developing other mental health conditions later in life, such as panic disorder or agoraphobia .
How is the situation of the elderly?
Your doctor can tell you what to expect in your specific situation. Separation Anxiety Disorder affects everyone a little differently. Also, people respond differently to treatment. Therapy alone may be enough to control your symptoms, or you may need medication, either temporarily or long-term.
It's hard to predict how you'll feel in a few years, or even next month. But by working closely with your doctor to manage your condition, you'll have the best chance of reducing anxiety and gaining more control over your thoughts.
Follow the treatment plan your doctor gives you, and attend all follow-up appointments. Your doctor will need to check how your medications are working and if you have any side effects.
Can Separation Anxiety Disorder be prevented?
There is still no known way to prevent separation anxiety disorder.
As a parent or caregiver, the best thing you can do to support your child's mental health is to communicate openly with them. Make them feel like they can talk to you about anything they have on their mind. Also, reassure them that you are there for them and that you are just a phone call away, even when they can't see you. You can also talk to your pediatrician about ways to make it easier for your child to adjust to school and other activities outside the home.
When should you see a doctor?
If you or your child has symptoms of separation anxiety disorder, see a doctor.
If a doctor prescribes medication for you or your child, let them know right away if you notice any of these things:
- New or changing side effects .
- Behavioral changes .
- If symptoms do not improve or get worse .
Again, if you are thinking about suicide, or if you are worried that your child is thinking about suicide, call 1926 (Sri Lanka's National Mental Health Helpline). There is someone available 24/7 to help you.
How common is this condition? (Prevalence)
Separation Anxiety Disorder is the most common anxiety disorder among children under the age of 12. It affects about 4 out of 100 children in this age group.
Among adults, separation anxiety disorder affects between 1% and 2% of the population in the United States. While this may seem like a small number, that means that about one in 50 adults has the condition. Imagine, if you're in a crowded restaurant, there's a good chance that at least one or two people there are living with separation anxiety disorder.
It's normal to worry about the people you love, especially when they're going through new situations. Maybe your child just started off at university, and if they don't text you for a while, you might wonder if they're okay. But those worries keep simmering in the back of your mind and eventually go silent. With separation anxiety disorder, it's like the volume of those worries is turned up to the max, and the button that controls them doesn't seem to work. The worry about the person you love drowns out everything else.
Children with separation anxiety disorder experience this as well. These fears and anxieties cause them a lot of stress, making it difficult for them to focus on schoolwork, play with friends, and have fun.
Finally, take-home message
Separation Anxiety Disorder can be life-threatening, no matter what age it starts. If you or your child is experiencing symptoms of separation anxiety disorder, don't hesitate to talk to a doctor. They are prepared to diagnose and treat the condition.
Remember:
- This is not your fault or your child's fault. This is a treatable health condition.
- Asking for help is not a sign of weakness. It's a sign that you care about yourself and your child.
- With proper treatment, life can return to normal.
- You are not alone. There are many people struggling with these situations, and there are those who can help.
So, take courage and take the necessary steps. You and your family can be healthy and happy!
` Separation Anxiety Disorder, Anxiety, Mental Health, Children's Mental Health, Adult Mental Health, Treatment
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