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Separation anxiety disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Adult separation anxiety disorder; childhood separation anxiety disorder

Overview

Separation anxiety disorder is a psychological condition in which an individual has excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (like a mother). Often, separation anxiety disorder is a symptom of a co-morbid condition. Studies show that children suffering from separation anxiety disorder are much more likely to have ADHD, bipolar disorder, panic disorder, and others later in life. [3] Separation anxiety disorder should not be confused with separation anxiety, which occurs as “a normal stage of development for healthy, secure babies.”

Differential Diagnosis

Separation anxiety disorder should not be confused with separation anxiety, which occurs as “a normal stage of development for healthy, secure babies.” [4] Separation anxiety occurs as babies begin to understand their own selfhood – or understand that they are a separate person from their primary caregiver. At the same time, the concept of object permanence emerges – which is when children learn that something still exists when it is not seen or heard. As babies begin to understand that they can be separated from their primary caregiver, they do not understand that their caregiver will return, nor do they have a concept of time. This, in turn, causes a normal and healthy anxious reaction.

Epidemiology and Demographics

Prevalence

The prevalence of separation anxiety disorder is:

  • 900-1,900 per 100,000 (0.9%-1.9%) in adults
  • 4,000 per 100,000 (4%) in children 6-12 months of age
  • 1,600 per 100,000 (1.6%) in adolescents[1]

Age

Present in all age groups, adult separation anxiety disorder (affecting roughly 7% of adults) is more common than childhood separation anxiety disorder (affecting approximately 4% of children). [5][6].

Risk Factors

  • Genetic predisposition
  • Life stress (especially loss)
  • Becoming a parent
  • Change of schools
  • Death of a relative or pet
  • Disaster involving periods of separation from attachment figures
  • Romantic relationship
  • Illness
  • Immigration
  • Leaving the parental home
  • New neighborhood
  • Parental divorce [1]

Diagnostic Criteria

DSM-V Diagnostic Criteria for Separation Anxiety Disorder[1]

“
  • A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
  • 1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
  • 2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
  • 3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
  • 4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
  • 5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
  • 6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
  • 7. Repeated nightmares involving the theme of separation.
  • 8. Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea,vomiting) when separation from major attachment figures occurs or is anticipated.

AND

  • B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

AND

  • C. The disturbance causes clinically significant distress or impairment in social, academic,occupational, or other important areas of functioning.

AND

  • D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder;

delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm be falling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

”

Symptoms

Separation anxiety disorder is often characterized by some of the following symptoms:

  • Recurring distress when separated from the subject of attachment (such as the mother or home)
  • Persistent, excessive worrying about losing the subject of attachment
  • Persistent, excessive worrying that some event will lead to separation from a major attachment
  • Excessive fear about being alone without subject of attachment
  • Persistent reluctance or refusal to go to sleep without being near a major attachment figure, like a mother
  • Recurrent nightmares about separation

References

  1. ↑ 1.0 1.1 1.2 1.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.


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