The Signs of Separation Anxiety
By Marie Miguel
Updated December 05, 2018
Reviewer Audrey Kelly, LMFT
What is separation anxiety?
Separation anxiety is a mental health condition in which a person is overly and excessively anxious and fearful about being separated from home or loved one. An individual feels a strong attachment to this person or place. The Diagnostic Manual of Mental Disorders (DSM)-5 provides characteristics and other information about mental-health disorders, and it places separation anxiety disorder with obsessive-compulsive and other related anxiety disorders.
In most cases, these symptoms last at least four weeks in children and six months or longer in adults. Separation anxiety affects sufferers in academic, professional, social, personal and other realms - preventing functioning (theravive.com). In some ways, separation anxiety mimics drug-withdrawal and depressive symptoms (Scientific American). Heredity and other sociological factors also impact the development of separation anxiety disorder in babies, children, and adults. Studies indicate that approximately 73 percent of those who meet some or all of the DSM-5 requirements for separation anxiety disorder have a family history of the mental-health disorder (Shaker Clinic).
According to the DSM-5 Section 309.21 (F93.0), separation anxiety disorder is recognized when a person exhibits the following characteristics:
- "Recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures;
- Persistent and excessive worry about losing significant attachment figures or about possible harm to them, such as illness, injury, disasters or death;
- 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;
- Persistent reluctance or refusal to go out, be away from home, go to school, go to work, or elsewhere because of fear of separation;
- Persistent and excessive fear or reluctance about being alone or without major attachment figures at home or In other settings;
- Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure;
- Repeated nightmares involving the theme of separation; and
- Repeated complaints of physical symptoms (e.g., Headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated" (theravive.com).
In 2014, the induction of the new DSM-5 edition began categorizing adults with separation anxiety. In previous editions and practices, separation anxiety only applied for those under age 18. The former long-standing diagnosis for adults with separation anxiety tended to be a panic disorder, generalized anxiety order or agoraphobia (NCBI). Separation anxiety can affect people of all ages, including babies, children, and adults (Psychology Today). It can even affect pets.
Risk factors of separation anxiety include the following:
- "Being female;
- Having a family history of separation anxiety disorder or other mental health condition;
- Personal history of another mental health condition
- Experiencing the loss of a loved one
- Experiencing an abrupt major life change in which one is separated from a loved
- Being in an unhealthy, codependent, romantic relationship" (Shaker Clinic).
Separation Anxiety in Babies
Separation anxiety in infancy is a common stage, although it may alarm parents and caregivers. Babies usually experience distress during the absence of an attachment figure, such as a parent or other caregiver (Psychology Today). When an infant is hungry, tired, needs a clean diaper or experiences another form of distress, he or she may have more signs of separation anxiety.
Once the baby develops cognitive skills, such as the acknowledge of permanence, he or she may notice a parent is gone. The child may be alone in his or her crib, and because of reliance on the parent for everything, this could cause more cases of separation anxiety. As the baby matures, he or she may or may not grow out of the separation anxiety in infancy (healthychildren.org).
Babies could show symptoms of separation anxiety by nine months old, although some babies could show signs as early as four months old (healthychildren.org). The normal stages of separation anxiety in babies usually end around age 2, when children become more independent and start understanding that their loved ones will be around later - even if they are not in sight at the moment (Psychology Today).
Separation Anxiety in Children
Separation anxiety is the most common disorder in children under age 12. If a child has separation anxiety, he or she may remain attached to parents in an excessive nature. Signs of separation anxiety in children include: introduction of physical symptoms (nausea, vomiting, headaches and more), refusal to be in a separate room from their parents, not wanting to spend the night with friends or stay for after-school activities, being "attached at the hip" with an attachment figure and exhibition of noticeable emotional changes (sadness, withdrawn behavior, trouble focusing) (Psychology Today).
A child may complain of a headache or stomachache on Sunday night, the night before he or she returns to school. The child may neglect to give parents field-trip information and may not want to ask to spend the night at a friend's house (anxietybc.com).
If a toddler has skipped separation anxiety in the infancy stage, he or she may begin showing signs of the disorder in toddlerhood. While many toddlers (and parents) undergo the "Terrible Two" stage, separation anxiety could make this stage more challenging. It is common for toddlers to become cranky due to hunger, fatigue, sickness and other factors; furthermore, they also could notice when their parents are away from them.
Preschool-age children could also be anxious upon separation, especially when they attend preschool classes away from their parents for the first few times (healthychildren.org). If separation-anxiety behaviors and thoughts persist after preschool years and until age 18, then parents could choose to consult a professional about their child or teen's separation anxiety (healthychildren.org).
Separation Anxiety in Adults
Often, a child who showcases separation anxiety disorder will deal with the same symptoms as an adult. In addition, an adult with separation anxiety may feel incredibly homesick when they are away from their home or a loved one. They may show avoidance behaviors and refuse to go places alone, have nightmares about separation from their attachment figure, have certain agoraphobia, show excessive interest in their spouse's and children's whereabouts and more (Psychology Today). Also, an adult with separation anxiety disorder may be incredibly envious, mooch off others, feel stuck in their relationships and be overly strict with their children (The Calm Clinic).
Separation anxiety in adults can also lead to stressful situations in their relationships. Parents with separation anxiety experience difficulties when their children turn into adolescents and adults. Their children's increased independence and thoughts of their own cause distress for anxious parents. In essence, this could cause tension between parents and their children (Separation Anxiety).
Separation anxiety disorder could also impact romantic relationships as well. Perceived and actual separation from a partner could cause a person to become depressed and have higher levels of cortisol, the human stress hormone. Many studies have indicated that monogamous animals often have higher emotional attachment hormones, oxytocin, and vasopressin. Adults may experience withdrawal-like symptoms, irritable behavior and changes in sleep patterns (Scientific American). While some partners could be understanding, the person on the other end of the separation anxiety sufferer could tend to rebel against the clingy and controlling behaviors (theravive.com).
According to many researchers, parent/child separation anxiety could set the stage for romantic separation anxiety. Social psychologist Lisa Diamond of the University of Utah states, "We think about parent-child relationships and adult romantic relationships as being fundamentally different, but it really boils down to the same functional purpose: creating a psychological drive to be near the other person, to want to take care of them, and being resistant to being separated from them" (Scientific American).
Separation Anxiety in Pets
For those with pets, it could be challenging to leave your dog, cat or other pet at home. They give sad glances with their large eyes, begging for their "human" to remain home with them. It is common for dogs to have separation anxiety disorder. A dog may become agitated or depressed when the dog parent leaves for the day, thus using the bathroom in the house, barking, being destructive, pacing back and forth and trying to escape. A loss in a dog's life can lead to separation anxiety, as well as schedule changes and a new home (ASPCA).
While cats are considered to enjoy more alone time, they may also experience separation anxiety from their human family members. Some signs of separation anxiety in cats are incessant meowing when the cat parent leaves, using the bathroom outside of the litter box, not eating when the cat parent is not home, eating too much too fast and being destructive with furniture and other items (catbehaviorassociates.com).
It is important to speak with a veterinarian about these behaviors in dogs and cats, as they could mimic other disorders or diseases. Behavioral changes, such as not giving out treats to reward separation anxiety behaviors, could be one way to curb the issue (catbehaviorassociates.com).
Treatments for Separation Anxiety
Separation anxiety in children can be remedied by the attachment figures by reassuring children that their parents or other figures will return. Saying a calm "I will be back soon" instead of teasing with "stop being a baby and crying" can go a long distance with a child with separation anxiety disorder. Create a secure environment for your child and remain calm, practicing control when leaving or preparing to leave your separation-anxious child (Psychology Today).
Other remedies include:
Being consistent with daily schedules, such as drop-off and pick-up times.
Keep your goodbyes short and sweet.
Promise to return - and keep that promise.
Speak in child terms. For example, instead of giving your child a specific pick-up time, say something like, "I will come to get you after you learn your ABCs and have your nap. I will pick you up before dinnertime."
Build in some apart time in your schedule, starting with smaller chunks of time at the beginning (healthychildren.org).
It is important for parents to attempt to be calm when addressing anxiety-driven behavior and reward behaviors in which the child did not show separation behaviors. If that does not work, seek a professional to treat the child's separation anxiety with cognitive-behavior and exposure therapies, as well as systematic desensitization (theravive.com).
Adults with separation anxiety can receive treatment in myriad ways, including anti-anxiety medications, changes in diet and lifestyle, adaptations in parenting styles and Psychotherapy (Psychology Today). Some of the same separation anxiety therapies for children may also help adults, such as systematic desensitization, which the practice of learning to be alone and feel OK and calm with that fact.
Support groups are also a viable option (The Calm Clinic). The recent incorporation of adults over age 18 into the separation anxiety DSM-5 has also paved the way for gray areas in treatment. Studies have shown that adults with separation anxiety disorder been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments." The need for more treatment options is imminent (NCBI).
If you or a loved one shows signs of separation anxiety disorder, consider talking with a mental health professional near you.
^ Separation Anxiety. Psychology Today. https://www.psychologytoday.com/conditions/separation-anxiety. Accessed March 14, 2017.
^ Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis. D. Silove. https://www.ncbi.nlm.nih.gov/pubmed/25453710. Written July 2, 2014. Accessed March 14, 2017.
^ Separation Anxiety Disorder DSM-5 309.21 (F93.0).Dr. Nancy Hurst, Ph.D. http://www.theravive.com/therapedia/Separation-Anxiety-Disorder-DSM-5-309.21-(F93.0). Accessed March 14, 2017.
^ Separation Anxiety in Parents of Adolescents: Theoretical Significance and Scale Development. Ellen Hock. http://onlinelibrary.wiley.com/doi/10.1111/1467-8624.00279/full. Written January 2001. Accessed March 14, 2017.
^ Why It Hurts to Be Away from Your Partner. Erica Westly. Scientific American. https://www.scientificamerican.com/article/why-it-hurts-to-be-away/. Written February 1, 2009. Accessed March 14, 2017.
^ How To Manage Adult Separation Anxiety. The Calm Clinic. http://www.calmclinic.com/anxiety/types/adult-separation-anxiety. Accessed March 14, 2017.
^ How to Ease Your Child's Separation Anxiety. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/toddler/Pages/Soothing-Your-Childs-Separation-Anxiety.aspx. Accessed March 14, 2017.
^ Separation Anxiety in Cats. http://www.catbehaviorassociates.com/separation-anxiety-in-cats/. Accessed March 14, 2017.
^ Common Dog Behavior Issues: Separation Anxiety. ASPCA. http://www.aspca.org/pet-care/dog-care/common-dog-behavior-issues/separation-anxiety. Accessed March 14, 2017.
^ Separation Anxiety. AnxietyBC. https://www.anxietybc.com/parenting/separation-anxiety-disorder. Accessed March 14, 2017.
^ Signs & Symptoms of Separation Anxiety. The Shaker Clinic. http://www.shakerclinic.com/anxiety/separation-anxiety/symptoms-effects#Statistics. Accessed March 14, 2017.