Separation anxiety disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 21, 2016
StartDiseasesSeparation anxiety disorder

Separation anxiety disorder is a condition that more commonly affects children than adults. Typically it occurs when a child is distressed when he or she is away from a parent or caregiver. Treatment includes medication and extensive behavioral therapy that heavily involves the parent.


Definition & Facts

Separation anxiety itself is a normal part of human development. It occurs in babies at around eight months of age and lasts until the age of two. Separation anxiety disorder is when the condition persists past that age, especially once a child is old enough to go to school.

It is estimated that up to 5% of children suffer from the disorder and that 30% of them will be diagnosed as mentally ill in adulthood. Many times separation anxiety disorder occurs following a traumatic incident involving the loss of a home or family member.

Symptoms & Complaints

Children suffering from separation anxiety disorder have an unrealistic but unrelenting fear that bad things will happen if their parent or guardian isn't nearby. This is usually coupled with the sense that something bad will happen to their parent or guardian while they are separated.

Children with this disorder will not want to go to school and will claim to have a stomachache or headache when pressed. While it may seem like a simple lie to get out of school, many kids with this disorder actually do suffer from physical symptoms like headaches or even vomiting caused by the threat of separation.

They will refuse to go to sleep at night if their caregiver isn't nearby or if they think the caregiver will leave later in the evening. Many children with the disorder will refuse to sleep over at another person's house if the parent isn't there. They have an intense fear of being alone and some suffer from intense nightmares. The majority of kids with separation anxiety wet the bed.

Many times these children will break down and plead or have temper tantrums when separation is imminent. The temper tantrums can escalate into violence either to themselves or whomever is nearby. Kids with the disorder often perform poorly in school and have a great difficulty socializing with other children.


Separation anxiety is often caused by a traumatic incident in the child's life. Common incidents include an illness that forced the child to stay in the hospital, the death of a loved one, or a change in school or living situation. It can also be caused by parents who are overly protective.

Some theorize that the disorder might be caused by the parent's own sense of separation anxiety which is then transferred to the child. Often a family where separation anxiety occurs has a toxic element where the parent actually feeds the child's anxiety.

Divorce can play a major role if a child lives with one parent and never sees the other, especially if a parent just left home one day and never returned. Frequently kids with separation anxiety have relatives who suffer from mental illnesses such as anxiety and depression. They frequently come from poor families and grow up in poverty which may play a factor, possibly due to shame or a fear of being judged that is transferred from the parent to the child.

Diagnosis & Tests

The symptoms of separation anxiety disorder in children are often not difficult to notice. It is easy for teachers or parents to see that the child has a mental illness and to refer the child to a doctor. Once symptoms are confirmed, a doctor will evaluate the child's medical history and will perform a physical examination.

Sometimes a blood test will be conducted to determine whether the child has a physical illness or if the symptoms are a result of a side effect from a medication contributing to the child's behavior. If there is no physical cause, then the doctor will refer the child to a mental health professional. Usually the doctor will select a specialist who is trained to deal with younger patients. Children under the age of 6 are considered to have "early onset" separation anxiety and will be given different treatment than older patients. The criteria for diagnosing separation anxiety disorder includes:

  • The condition existing for 4 weeks or more
  • The patient is under the age of 18
  • The behavior is impairing social or academic functioning
  • Identification of 3 or more symptoms from a specific separation anxiety disorder checklist that includes nightmares, refusal to sleep without the caregiver nearby, and a general refusal to leave the caregiver that results in tantrums or vomiting

Treatment & Therapy

Separation anxiety disorder is treated through a combination of therapy and medication. Usually the child is prescribed antidepressants and they are carefully monitored for possible side effects. The children are given cognitive behavior therapy, which teaches coping skills to help handle anxiety. These skills include things like deep breathing and relaxation techniques.

Often there will be interaction therapy where the therapist works with the parent and the child together. The therapy begins with a focus on teaching the parent the proper way to give the child a feeling of warmth and attention. Then the therapist will establish a plan and a reward system while using a chart to map out the child's triggers. A reward system is put into place to encourage the child to develop coping skills.

The final phase of therapy teaches the parent how to properly communicate with the child and how to manage the child's bad behavior. Once that is completed, the school environment is evaluated to identify possible triggers. Usually a plan is put into place that allows the child to call the parent from school if something goes wrong. The child's teacher is contacted and instructed to try to help the child socialize in a positive way with the other children.

Prevention & Prophylaxis

Currently there is no clear way to prevent separation anxiety disorder. Because it is often triggered by an unforeseen event such as a death in the family or a divorce, it can manifest quite suddenly. The key to handling it well is to identify it right away and immediately get help.

If the child is left to their own devices, the condition will likely get worse. Perhaps the best preventative measure is to foster a sense of independence in a child and to build up their self-esteem in a healthy way. Giving a child the tools to handle going to school or spending time alone may be the best prophylaxis.