Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.
Separation Anxiety Disorder is characterized by a developmentally inappropriate and excessive fear of becoming separated from a primary attachment figure. The term "attachment figure" simply refers to a person to whom we have a very strong emotional attachment. Separation Anxiety Disorder may affect both children and adults. However, it is more commonly diagnosed in children.
Diagnosis requires a developmental and cultural context in order to differentiate what is normal and age-appropriate versus what is disordered. For instance, it is developmentally normal for one year olds to express a high degree of distress when separated from caregivers. It is also normal for children who are just beginning daycare, preschool, or kindergarten to experience significant distress when first separated from their caregivers. Such anxiety reactions normally diminish or go away entirely within a short period of time as children adjust to these new experiences. It is not typical for children's anxiety reactions to persist after they have been at school for a week or two. For more information on the normal process of child development and the milestones typically encountered at particular ages, please visit our child development topic centers.
Children and adolescents affected by Separation Anxiety Disorder can become extremely distressed at the mere thought of becoming separated from their primary caregivers or other attachment figures. Actual separation leads to pronounced distress and agitation. This distress is persistent and frequent. This distress interferes with children's ability to engage in normal age-appropriate activities that require temporary separation from caregivers (e.g., attending school and community-based activities).
Older children, adolescents, and adults may express persistent and excessive worry that some harm will come to their primary attachment figure such as illness, injury, accident, or death. In a similar manner, they may experience persistent and excessive worry that some event may prevent them from reuniting with their attachment figure. For instance, they may refuse to leave home because they are afraid they will get lost and will be unable to return home to their primary attachment figure.
Both children and adults may express considerable reluctance or refusal to be apart from their primary attachment figure. Children may follow their caregiver or other attachment figure from room-to-room, staying close, or "clinging" to them. They may be unwilling to go to school, summer camp, or to visit friends. They will often have trouble at bedtime. Falling asleep means separation. They may insist someone stay with them until they fall asleep and may come to their parent's or sibling's beds at night. Adults may require frequent and constant contact with their primary attachment figure throughout the day. They may be unwilling to travel independently. They have difficulty holding a job because of their need to remain in constant contact with their primary attachment figure.
Nightmares may occur. These often involve themes of separation (fire, accident). When separation is anticipated or occurs, physical symptoms may be reported such as headaches, stomachache, and nausea.
For children and adolescents, the fear, anxiety and/or avoidance is persistent and lasts at least 4 weeks. For adults, it lasts at least 6 months. Treatment for Separation Anxiety Disorder is discussed in another section.