What are the symptoms of Separation Anxiety Disorder?

The fear, anxiety, or avoidance that children with Separation Anxiety Disorder experience is much more than what is normal for their age. Specific symptoms of Social Anxiety Disorder include:

Core symptoms

  • Distress in anticipation of or during separation from a caregiver
  • Worry that something bad will happen to a caregiver (e.g., illness, injury, death)
  • Worry that an unexpected event with result in separation from a caregiver (e.g., being lost, kidnapped, involvement in an accident, illness)
  • Reluctance or refusal to leave home (e.g., go to school, go on a playdate) due to fear of separation
  • Reluctance or refusal to be alone at home or in other settings without a caregiver (e.g., following a caregiver around the house)
  • Reluctance or refusal to sleep without being near a caregiver
  • Regular nightmares involving separation or bad things happening to caregivers
  • Regular physical complaints (e.g., stomachaches, headaches, dizziness) in anticipation of or during separation from a caregiver

How is Separation Anxiety Disorder diagnosed?

A child-adolescent psychiatrist will diagnose a child or teen with Separation Anxiety Disorder after determining whether the fear, anxiety, or avoidance the child is experiencing meets the diagnostic criteria; his or her symptoms are persistent, lasting at least four weeks; and his or her symptoms result in significant impairment in other aspects of everyday life (e.g., social, academic, etc.). Severe separation anxiety may develop in children and adolescents who, previously, had not evidenced concerns about separation.

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver in order to determine the specific nature of the child’s separation anxiety, although many practitioners also use questionnaires or behavior/emotion rating form results to support the diagnosis and quantify the severity of the problem. The practitioner will also seek to determine that the child’s or teen’s anxiety is not related to something unforeseen.

Separation Anxiety Disorder Facts

Worldwide frequency of the condition

Separation Anxiety Disorder is estimated to be present in about 4% of the world population, although this frequency varies from age group to age group. Anxiety Disorders, in general, are estimated to be present in 6.5% of the world's population. While there is no recent, specific epidemiological data for Greece, a recent review of European countries reported a 7.9% frequency

Burden of the condition in Greece

Anxiety accounts for 9.8% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. It is the most prominent mental health condition adding to the health burden of the Greek child and adolescent population. However, Separation Anxiety Disorder is often diagnosed in children <5 years of age, and anxiety does not account for any DALYs in that age group.

Gender ratio

Separation Anxiety Disorder is diagnosed equally during the preschool years, and in females more than males during school years, although estimates vary from sample to sample.

Peak age of onset

The peak age of onset for Separation Anxiety Disorder is estimated to be between 7 and 9 years. ​​​​​​​​​​​​This is somewhat later than the peak age of onset for anxiety disorders, in general, which is 5.5 years.

Proportion of the condition that emerges before age 18

According to recent data, 75.0% of individuals with Separation Anxiety Disorder will have been diagnosed by the time they are 18 years old.

What are the associated factors for Separation Anxiety Disorder?

Some common factors associated with Separation Anxiety Disorder are:

  • Genetic and familial factors. Predisposition toward an anxiety disorder most likely results from a combination of multiple genes that interact in a complex way with multiple environmental factors.
  • Environmental factors. These include adverse and stressful life events, such as the loss of a relative or pet, a relative with a serious illness, a change in school, caregiver divorce or separation, moving or immigration, and separation from caregiver during stressful periods (e.g., natural disaster).

What other disorders co-occur with Separation Anxiety Disorder?

Even though each child is different, Separation Anxiety Disorder might often co-occur with Generalized Anxiety Disorder (GAD) and Specific Phobia in children.

How is Separation Anxiety Disorder treated?

Separation Anxiety Disorder is usually treated with psychotherapy or a combination of psychotherapy and medication. Caregivers and other family members are an important part of treatment, since they can help kids and teens practice the skills they learn in therapy.

There are multiple therapies that have been shown to effectively treat symptoms of Separation Anxiety Disorder, but the one with the most evidence is a type of therapy called cognitive-behavioral therapy (CBT). CBT is an umbrella term that refers to a wide range of different cognitive and behavioral techniques. One technique called exposure. Using this technique, a therapist exposes the child to something that triggers anxiety, beginning with something very small. As the child becomes upset, the therapist teaches them ways to handle their fear. They repeat this process with bigger and bigger stressors. Group-based CBT has been shown to be particularly effective for children and adolescents.

Children and adolescents with Separation Anxiety Disorder tend to respond well to certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, sertraline, citalopram, escitalopram, and paroxetine. Other medications called serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine, are also effective for reducing anxiety in children and adolescents. Benzodiazepines (e.g., alprazolam, lorazepam, diazepam) and tricyclic antidepressants (e.g., clomipramine, amitriptyline) are not effective in children and adolescents and should not be used. Medications can have side effects, but they are safe for kids to use with proper monitoring by their Child Adolescent Psychiatrist and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

The combination of CBT and SSRIs/SNRIs can also be considered, given some studies show evidence that the combination is better than either treatment in isolation in children and adolescents.

Where to find more information

If you need more information on separation fears and reasons for concerns, you can also go to "Excessive fear of being apart from a caregiver" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2021, September 7). Separation Anxiety Disorder in children: A quick guide. https://childmind.org/guide/quick-guide-to-separation-anxiety-disorder/
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B05 Separation Anxiety Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f830200631

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http://vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Figueroa A, Soutullo C, Ono Y, Saito K. Separation anxiety (2012). In Rey J.M. (ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.
  • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381
  • Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02131-2
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
  • Vasileva, M., Graf, R. K., Reinelt, T., Petermann, U., & Petermann, F. (2021). Research review: A meta‐analysis of the international prevalence and comorbidity of mental disorders in children between 1 and 7 years. Journal of Child Psychology and Psychiatry, 62(4), 372–381. https://doi.org/10.1111/jcpp.13261

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Ayano, G., Betts, K., Maravilla, J. C., & Alati, R. (2021). The risk of anxiety disorders in children of parents with severe psychiatric disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 282, 472–487. https://doi.org/10.1016/j.jad.2020.12.134
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50
  • Lawrence, P. J., Murayama, K., & Creswell, C. (2019). Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 46–60. https://doi.org/10.1016/j.jaac.2018.07.898
  • Ståhlberg, T., Khanal, P., Chudal, R., Luntamo, T., Kronström, K., & Sourander, A. (2020). Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review. Journal of Affective Disorders, 277, 85–93. https://doi.org/10.1016/j.jad.2020.08.004

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Saha, S., Lim, C. C. W., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., Huo, Y., & McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and Anxiety, 38(3), 286–306. https://doi.org/10.1002/da.23113

Interventions

  • Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E. G., Zangani, C., Fornaro, M., Estradé, A., Fusar‐Poli, P., Carvalho, A. F., & Solmi, M. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. https://doi.org/10.1002/wps.20881Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), 245–258. https://doi.org/10.1002/wps.20346
  • Gosmann NP, Costa M de A, Jaeger M de B, et al. Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: A 3-level network meta-analysis. Patel V, ed. PLoS Med. 2021;18(6):e1003664. doi:10.1371/journal.pmed.1003664
  • Schopf K, Mohr C, Lippert MW, Sommer K, Meyer AH, Schneider S. The role of exposure in the treatment of anxiety in children and adolescents: protocol of a systematic review and meta-analysis. Syst Rev. 2020;9(1):96. doi:10.1186/s13643-020-01337-2
  • Schwartz C, Barican JL, Yung D, Zheng Y, Waddell C. Six decades of preventing and treating childhood anxiety disorders: A systematic review and meta-analysis to inform policy and practice. Evid Based Mental Health. 2019;22(3):103-110. doi:10.1136/ebmental-2019-300096
  • Wang Z, Whiteside SPH, Sim L, et al. Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatr. 2017;171(11):1049. doi:10.1001/jamapediatrics.2017.3036

Was this information helpful?
Yes!
Not really