Separation Anxiety Disorder
Separation anxiety disorder involves persistent, intense anxiety about being away from home or being separated from people to whom a child is attached, usually the mother.
Most children feel some separation anxiety but usually grow out of it.
Children often cry and plead with the person who is leaving and, after the person leaves, think only about being reunited.
Doctors base the diagnosis on symptoms and their duration.
Behavioral therapy is usually effective, and individual and family psychotherapy may help.
Treatment aims to enable children to return to school as soon as possible.
Some degree of separation anxiety is normal and occurs in almost all children, especially in very young children (see Separation anxiety). Children feel it when a person to whom they are attached leaves. That person is usually the mother, but it can be either parent or a caregiver. The anxiety typically stops as children learn that the person will return. In separation anxiety disorder, the anxiety is much more intense and goes beyond that expected for the child’s age and developmental level. Separation anxiety disorder commonly occurs in younger children and is rare after puberty.
Some life stress, such as the death of a relative, friend, or pet or a geographic move or a change in schools, may trigger the disorder. Also, people can inherit a tendency to feel anxiety.
Children experience great distress when separated from home or from people to whom they are attached. Dramatic scenes commonly occur during goodbyes. Goodbye scenes are typically painful for both parent and child. Children often wail and plead with such desperation that the parent cannot leave, prolonging the scene and making separation even more difficult. If the parent is also anxious, children become more anxious, creating a vicious circle.
After the parent has left, children fixate on being reunited. They often need to know where the parent is and are preoccupied with fears that something terrible will happen to them or to their parent.
Traveling by themselves makes these children uncomfortable, and they may refuse to attend school or camp or to visit or sleep at friends’ homes. Some children cannot stay alone in a room, clinging to a parent or shadowing the parent around the house.
Difficulty at bedtime is common. Children with separation anxiety disorder may insist that a parent or caregiver stay in the room until they fall asleep. Nightmares may disclose the children’s fears, such as destruction of the family through fire or another catastrophe. Children often develop physical symptoms, such as headaches or stomachaches.
Children usually appear normal when a parent is present. As a result, the problem may seem less severe than it is. The longer the disorder lasts, the more severe it is.
Behavioral therapy is used. It involves teaching parents and caregivers to keep the goodbye scenes as short as possible and coaching them to react to protestations matter-of-factly. Individual and family psychotherapy is also useful.
Enabling children to return to school is an immediate goal. It requires doctors, parents, and school personnel to work as a team. Helping children form an attachment to one of the adults in the preschool or school may help.
When the disorder is severe, drugs that can reduce anxiety, such as a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI—see Table: Drug therapy for depression), may help.
Children are prone to relapses after holidays and breaks from school. Thus, parents are often advised to plan regular separations during these periods to help children remain accustomed to being away from them.