From Cathleen Henning Fenton,
Your Guide to Panic Disorder.
FREE Newsletter. Sign Up Now!

About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

Does your child feel anxious about leaving home or going somewhere without you? Does the anxiety cause sleep difficulties and other physical symptoms? Is the problem keeping your child from enjoying normal routines, including school and social activities? If so, you may want to learn more about separation anxiety disorder.

If your child is an infant or toddler, then separation anxieties are normal. If you feel the anxiety is unusual, discuss it with your child's physician. Early-onset separation anxiety disorder is possible in children younger than six, so your physician will be able to help you understand whether or not the anxiety is unusual. Separation anxiety disorder generally occurs in older children or adolescents (younger than 18 years of age).

The Symptoms

To diagnose a child or adolescent with separation anxiety disorder, a doctor, psychologist, or other treatment provider will use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), from the American Psychiatric Association. For separation anxiety disorder, these criteria include the following:

• Ongoing anxiety or distress about leaving home, being away from a parent (or other caregiver), and/or the anticipation of these kinds of separation

• Ongoing anxiety or worry about losing a parent (or other caregiver) or about the parent/caregiver being harmed

• Ongoing anxiety or worry that the child will be separated abruptly from the parent/caregiver, such as by being kidnapped or getting lost

• Resistance to attending school or otherwise leaving home or the parent/caregiver

• Fear about or resistance to being home alone or even in other settings without the parent or an adult present

• Refusal to go to sleep without the parent/caregiver nearby and/or anxiety about sleeping away from home

• Ongoing nightmares about separation and related anxieties

• Ongoing physical symptoms when there is separation or anticipated separation, including dizziness, headaches, nausea, or palpitations

To be considered separation anxiety disorder, the following criteria must also be met:

• The symptoms should last for at least 4 weeks.

• The symptoms should begin when the child is younger than 18 years old.

• The symptoms cause significant distress in the child and/or the symptoms interfere with social and/or academic functioning.

• The symptoms are not resulting from another anxiety or psychiatric disorder.

Who Has Separation Anxiety Disorder

A report by the U.S. Surgeon General's Office estimates that about 4 percent of children and adolescents have separation anxiety disorder. Although studies show that an equal number of boys and girls are treated for separation anxiety disorder, survey studies show that more girls have the disorder. Children and teenagers who live in dangerous neighborhoods may be over-diagnosed with this disorder -- these young people probably have reasonable fears of leaving home.

Reasons for Separation Anxiety Disorder

Although the precise cause for separation anxiety disorder is not known, there are certain risk factors for the disorder. These include the following:

• Death or illness in the family
• Moving to a different home
• Trauma (including physical or sexual assault)

Children with separation anxiety disorder tend to come from close-knit families. The disorder sometimes runs in families, and researchers are still looking for the precise role of both genes and the environment in separation anxiety disorder.

Treatment for Separation Anxiety Disorder

Separation anxiety disorder can sometimes go away on its own; however, it may come and go, and it may be severe at times. The disorder may lead to panic disorder with agoraphobia when the person is older. If the person continues to have separation anxiety disorder as an adult, he or she may have difficulty moving, getting married, and later being separated from the spouse and/or children.

As with all anxiety disorders, early intervention means more successful recovery. Treatment for separation anxiety disorder includes therapy, medication, or a combination of the two.

Therapy may consist of cognitive-behavioral techniques and/or psychodynamic therapy. Cognitive techniques would include identifying thoughts that may cause the anxious feelings and developing coping strategies. Behavior therapy would include exercises to help the child face the anxiety. In psychodynamic therapy, the child would talk about underlying fears and worries.

Selective serotonin reuptake inhibitors (SSRIs) have been shown to help children with separation anxiety disorder and other anxiety disorders, in research studies. Other antidepressants and benzodiazepines have not been shown to help.

_Sources:

Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. American Psychiatric Association. 1994.

Mental Health: A Report of the Surgeon General. Office of the Surgeon General. US Department of Health & Human Services.