Separation Anxiety Disorder

     Overview

Separation anxiety is a fairly common anxiety disorder that affects children and young adolescents. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), a child with separation anxiety experiences recurrent excessive anxiety beyond that expected for the child's developmental level. This anxiety results from separation or impending separation from the child's attachment figure (e.g., primary caretaker, close family member). As defined, this condition affects children younger than 18 years and occurs over a period of at least 4 weeks.

Characteristic features of separation anxiety disorder include severe distress, fear, or worry leading to impairment of functioning and frequently accompanied by somatic symptoms such as headaches or stomachaches.

     Symptoms

Symptoms of separation anxiety disorder include the following:

• Subjective feeling of anxiety

• Unrealistic worries about the safety of loved ones

• Reluctance to fall asleep if not near the primary attachment figure

• Excessive dismay (ie, tantrums) if separation from the primary attachment figure is imminent

• Nightmares with separation-related themes

• Homesickness

• Psychosomatic symptoms such as headache, dizziness, lightheadedness, nausea, stomachache, cramps, vomiting, muscle aches, and heart palpitations

     Causes

Separation anxiety is a developmentally normal characteristic in infants and toddlers younger than 4 years upon separation from their primary attachment figure. Mild distress and clinging behavior are anticipated for short periods of time when young children are separated from their primary caregivers (attachment figures) in situations such as daycare or initial exposure to school. Short-term developmental fears such as fear of the dark are expected in young children and are generally not severe enough to interfere with daily functioning or result in long-term difficulty.

Research studies indicate that some children who are overly fearful early in life may eventually develop anxiety disorders that result in substantial impairment. Significant symptoms of anxiety may emerge when a child enters school for the first time and is expected to adjust to daily separation from a parent or caregiver. In some cases, initial separation anxiety resolves over the first few weeks of school, while less commonly, the anxiety does not resolve spontaneously and worsens over time. Children who persist with significant anxiety disorders may have difficulty adjusting to the classroom leading to compromised academic performance.

Researchers have hypothesized that children who develop separation anxiety disorders may have altered sensitivity to endocrine influences such as maternal cortisol, and the way in which they process emotionally intense experiences of separation. It is well known that certain parts of the brain (such as the amygdala) are involved in modulating the processing of emotional experiences.

Bullying and experiences of recurrent social rejection may contribute to the development of separation anxiety in vulnerable children and adolescents.