Table of ContentsView AllTable of ContentsWhat Is Separation Anxiety?SymptomsDiagnosisCausesTreatmentCoping
Table of ContentsView All
View All
Table of Contents
What Is Separation Anxiety?
Symptoms
Diagnosis
Causes
Treatment
Coping
Any parent who has handed over a reluctant child to a caregiver has seen separation anxiety in action. Separation anxiety is a condition in which a person feels extreme fear or distress when separated from an emotional attachment, such as a parent, a loved one, or a place they feel safe, like their home. While the tears can be heartbreaking, the good news is separation anxiety is a normal part of child development and usually gets easier with time.
Verywell / Brianna Gilmartin
When separation anxiety occurs in older children, adolescents, or adults, or when it causes debilitating anxiety, it is considered separation anxiety disorder (SAD). Unlike typical separation anxiety, SAD is intrusive and may require treatment such as behavioral therapy, other psychotherapies, positive reinforcement, or medications, depending on the person’s age and the severity of their symptoms.
Some symptoms of SAD overlap with symptoms ofpanic disorderand other types ofanxiety disorders. If you suspect you or your child has SAD, it’s a good idea to see a healthcare provider to get a nuanced and accurate diagnosis.
Separation Anxiety Confusion
At about the age of 8 months, babies develop a sense of selfhood and begin to learn object permanence but don’t quite fully comprehend its complexities.They know they exist separate from other people, and they understand that a parent or loved one exists even after they have left their presence, but they aren’t always convinced their beloved person is coming back.
This anxiety can rear its head even if the child knows and trusts the person in whose care they have been placed. Ask any childcare provider, and they will tell you how frequently a child will cry when dropped off, then quickly settle in once their parent has left.
As a child matures emotionally, and begins to trust that people who leave come back, separation anxiety tends to resolve on its own.
While separation anxiety is a normal part of development in young children, it is not considered typical in older children, teens, and adults. When separation anxiety occurs in people outside of early childhood and has a negative impact on the individual’s well-being, social functioning, family life, academic or work performance, and physical health, it may be regarded as SAD.
Accounting for 50% of diagnoses in children seeking treatment for mental health, SAD is the most common pediatric anxiety disorder.By adolescence, roughly 8% of youth have met diagnostic criteria for SAD at some point in their lives.
Though we tend to associate separation anxiety with children, some research suggests that at some point in their lives, up to 6.6% of adults will experience SAD.
When To Worry About Separation AnxietySeparation anxiety is a normal part of a child’s development and cognitive maturation, not a behavioral problem. It should only be considered a problem if it interferes with a child’s quality of life or delays development.
When To Worry About Separation Anxiety
Separation anxiety is a normal part of a child’s development and cognitive maturation, not a behavioral problem. It should only be considered a problem if it interferes with a child’s quality of life or delays development.
Every child has meltdowns, even older children.
Common symptoms of SAD include:
SAD can manifest in physical symptoms, including:
School is a major stressor for older children with SAD.An older child or adolescent may exhibit school-specific behaviors like feigning illness or experiencing headaches, stomachaches, and other ailments when it is time to go to school. These illnesses go away once the child is allowed to stay home but reappear before school the next day.
For older children, SAD symptoms are not limited to times of separation.SAD can manifest in a number of ways even when the child is home and/or with their parent or loved one. Older children with SAD may:
While for children, the attachment figure is usually a parent or guardian, for adults it may be a spouse, a partner, or a friend.
Adult separation anxiety disorder (ASAD) can be debilitating. ASAD can cause problems with job performance, including lack of concentration, coming in late or leaving worry, or difficulty maintaining employment.
ASAD may manifest when a person is dealing with the breakdown of a relationship or the death of a loved one. A parent may even suffer from ASAD when their child becomes more independent and no longer relies solely on them for companionship.
If your child is still experiencing separation anxiety past the age of 3 or 4 when it is developmentally normal, SAD may be the culprit. When suspected, SAD is usually diagnosed after the age of 6 or 7.
To be diagnosed with SAD, children must show symptoms for at least four weeks. To meet the criteria for a SAD diagnosis, adults must experience symptoms that impair function for at least six months.
To diagnose adults with SAD, healthcare providers primarily rely on self-reports. Because children cannot reliably be assessed with adult self-reports, parents and healthcare providers must use other methods.
The Children’s Separation Anxiety Scale (CSAS) lists child-accessible questions such as, “Does your belly hurt when you have to leave your mom or dad?”, and “Do you worry about getting lost?” that can help a healthcare provider assess if a child is experiencing symptoms of SAD.
While scientists don’t fully understand what causes SAD, they believe it is related to biological, cognitive, and environmental factors.
Environment
SAD symptoms often appear after a change or stress in a child’s life. Even a positive change can cause a child to feel anxious. Some changes that might trigger or exacerbate SAD include:
Parental Mental Health
Parenting Style
Parenting style is linked to attachment theory—how our early experiences with attachment affect our mental health and our ability to bond with other people.
SAD appears to be associated with attachment anxiety—anxiety experienced about relationships with people who are important in our lives.
Parenting that is overly critical, overly controlling, or overprotective can interfere with a child’s development of autonomy, and contribute to anxiety disorders. The effects of parenting style are seen both in childhood and after a person enters adulthood.
Temperament
Children with SAD do not like change. When something is new or different, they tend to react negatively and respond with avoidance, fear, or suspicion. They can also have a difficult time self-regulating their emotions when they feel anxious or scared.
Adults with SAD try to avoid confrontation. They also tend to lack self-directedness—the ability to be goal-oriented, resourceful, and adaptive to situations.
Economics
How socioeconomic status (SES) affects childhood anxiety is complex and depends on a number of factors including the type of anxiety, and if income is evaluated at an individual household level or a neighborhood level.
Most children with anxiety disorders come from middle- to upper-income families. In contrast to this, those with SAD tend to come from low-income homes. This suggests that financial stresses within a family may lead to insecurity in younger children.
Contingency Management
Cognitive Behavioral Therapy (CBT)
The first go-to treatment for SAD is CBT. Studies show it to be an effective treatment for anxiety disorders including SAD, without the side effects that can come with medication.
CBT focuses on the “here and now” rather than the underlying cause of the condition. The goal of CBT is to change learning and thought patterns that are unhealthy or cause problems and replace them with ones that are adaptive and productive.
With CBD, it isn’t just the child whose approach and behavior needs to change. Parents, teachers, and other significant figures in the child’s life need to commit to changing their responses to the child’s anxiety, reinforcing the child’s progress.
Treatment usually takes twelve to sixteen weeks but may require “refresher” sessions here and thereafter treatment has finished.
Exposure Therapy
Exposure therapy is more controlled than simply not running away from things that scare us. Treatment usually falls into four phases, worked through in order.
Exposure therapy is considered successful once the person with SAD has worked through all of the situations on the list, and has reduced their anxiety to appropriate levels for their age and development.
Medications
While selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating SAD, due to the potential of side effects and the lack of availability for FDA approved SSRIs available for children under six, medication is rarely prescribed as the first-line treatment to children with SAD. It may be administered if first-line treatments such as CBT are not effective.
For adults, SSRIs may be prescribed on their own, but they are more effective as part of a combination therapy. Although this can vary, they are typically taken for six months then gradually tapered off.
Whether developmentally normal separation anxiety or SAD, separation can be hard on young children and their parents. To make the transition easier for young children, parents can:
For adolescents and adults living with SAD, it may be helpful to follow coping strategies for anxiety.
A Word From Verywell
If your older child or teen—or you—develop SAD, breathe easier knowing that help is available. With proper treatment, SAD can become a thing of the past.
If you or your child are struggling with SAD, contact theSubstance Abuse and Mental Health Administration (SAMHSA) National Hotlinefor treatment and support group referrals at 1-800-662-HELP (4357).
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kids Health from Nemours.Separation anxiety.Ehrenreich JT, Santucci LC, Weiner CL.Separation anxiety disorder in youth: phenomenology, assessment, and treatment.Psicol Conductual. 2008;16(3):389-412. doi:10.19012Fjaba.2008.16-389Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007%2Fs10802-013-9788-ySilove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S.The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.BMC Psychiatry. 2010;10(1):21. doi:10.1186/1471-244X-10-21Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007/s10802-013-9788-yThe American Academy of Child and Adolescent Psychiatry.Children who won’t go to school.Manicavasaga V, Silove D, Curtis J.Separation anxiety in adulthood: a phenomenological investigation.Comprehensive Psychiatry. 1997;38(5):274-282. doi:10.1016/s0010-440x(97)90060-2Administration SA and MHS.Table 15, dsm-iv to dsm-5 separation anxiety disorder comparison.Méndez X, Espada JP, Orgilés M, Llavona LM, García-Fernández JM.Children’s separation anxiety scale (CSAS): psychometric properties. Franken IHA, ed.PLoS ONE. 2014;9(7):e103212. doi:10.1371/journal.pone.0103212Allen JL, Blatter-Meunier J, Ursprung A, Schneider S.Separation Anxiety Daily Diary. American Psychological Association; 2014. doi:10.1037/t33228-000Fox AS, Kalin NH.A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. AJP. 2014;171(11):1162-1173. doi:10.1176/appi.ajp.2014.14040449Dabkowska M, Araszkiewicz A, Dabkowska A, Wilkosc M.Separation anxiety in children and adolescents. In: Selek S, ed.Different Views of Anxiety Disorders. InTech. doi:10.5772/22672Vine M, Stoep AV, Bell J, Rhew IC, Gudmundsen G, McCauley E.Associations between household and neighborhood income and anxiety symptoms in young adolescents.Depression and Anxiety. 2012;29(9):824-832. doi:10.1002/da.21948Petry NM.Contingency management: what it is and why psychiatrists should want to use it.Psychiatrist. 2011;35(5):161-163. doi:10.1192/pb.bp.110.031831Seligman LD, Ollendick TH.Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 2011;20(2):217-238. doi:10.1016/j.chc.2011.01.003DC Department of Behavioral Health, Prevention and Early Intervention Programs, Healthy Futures.Understanding separation anxiety in infants and young children.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kids Health from Nemours.Separation anxiety.Ehrenreich JT, Santucci LC, Weiner CL.Separation anxiety disorder in youth: phenomenology, assessment, and treatment.Psicol Conductual. 2008;16(3):389-412. doi:10.19012Fjaba.2008.16-389Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007%2Fs10802-013-9788-ySilove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S.The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.BMC Psychiatry. 2010;10(1):21. doi:10.1186/1471-244X-10-21Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007/s10802-013-9788-yThe American Academy of Child and Adolescent Psychiatry.Children who won’t go to school.Manicavasaga V, Silove D, Curtis J.Separation anxiety in adulthood: a phenomenological investigation.Comprehensive Psychiatry. 1997;38(5):274-282. doi:10.1016/s0010-440x(97)90060-2Administration SA and MHS.Table 15, dsm-iv to dsm-5 separation anxiety disorder comparison.Méndez X, Espada JP, Orgilés M, Llavona LM, García-Fernández JM.Children’s separation anxiety scale (CSAS): psychometric properties. Franken IHA, ed.PLoS ONE. 2014;9(7):e103212. doi:10.1371/journal.pone.0103212Allen JL, Blatter-Meunier J, Ursprung A, Schneider S.Separation Anxiety Daily Diary. American Psychological Association; 2014. doi:10.1037/t33228-000Fox AS, Kalin NH.A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. AJP. 2014;171(11):1162-1173. doi:10.1176/appi.ajp.2014.14040449Dabkowska M, Araszkiewicz A, Dabkowska A, Wilkosc M.Separation anxiety in children and adolescents. In: Selek S, ed.Different Views of Anxiety Disorders. InTech. doi:10.5772/22672Vine M, Stoep AV, Bell J, Rhew IC, Gudmundsen G, McCauley E.Associations between household and neighborhood income and anxiety symptoms in young adolescents.Depression and Anxiety. 2012;29(9):824-832. doi:10.1002/da.21948Petry NM.Contingency management: what it is and why psychiatrists should want to use it.Psychiatrist. 2011;35(5):161-163. doi:10.1192/pb.bp.110.031831Seligman LD, Ollendick TH.Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 2011;20(2):217-238. doi:10.1016/j.chc.2011.01.003DC Department of Behavioral Health, Prevention and Early Intervention Programs, Healthy Futures.Understanding separation anxiety in infants and young children.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kids Health from Nemours.Separation anxiety.Ehrenreich JT, Santucci LC, Weiner CL.Separation anxiety disorder in youth: phenomenology, assessment, and treatment.Psicol Conductual. 2008;16(3):389-412. doi:10.19012Fjaba.2008.16-389Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007%2Fs10802-013-9788-ySilove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S.The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.BMC Psychiatry. 2010;10(1):21. doi:10.1186/1471-244X-10-21Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007/s10802-013-9788-yThe American Academy of Child and Adolescent Psychiatry.Children who won’t go to school.Manicavasaga V, Silove D, Curtis J.Separation anxiety in adulthood: a phenomenological investigation.Comprehensive Psychiatry. 1997;38(5):274-282. doi:10.1016/s0010-440x(97)90060-2Administration SA and MHS.Table 15, dsm-iv to dsm-5 separation anxiety disorder comparison.Méndez X, Espada JP, Orgilés M, Llavona LM, García-Fernández JM.Children’s separation anxiety scale (CSAS): psychometric properties. Franken IHA, ed.PLoS ONE. 2014;9(7):e103212. doi:10.1371/journal.pone.0103212Allen JL, Blatter-Meunier J, Ursprung A, Schneider S.Separation Anxiety Daily Diary. American Psychological Association; 2014. doi:10.1037/t33228-000Fox AS, Kalin NH.A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. AJP. 2014;171(11):1162-1173. doi:10.1176/appi.ajp.2014.14040449Dabkowska M, Araszkiewicz A, Dabkowska A, Wilkosc M.Separation anxiety in children and adolescents. In: Selek S, ed.Different Views of Anxiety Disorders. InTech. doi:10.5772/22672Vine M, Stoep AV, Bell J, Rhew IC, Gudmundsen G, McCauley E.Associations between household and neighborhood income and anxiety symptoms in young adolescents.Depression and Anxiety. 2012;29(9):824-832. doi:10.1002/da.21948Petry NM.Contingency management: what it is and why psychiatrists should want to use it.Psychiatrist. 2011;35(5):161-163. doi:10.1192/pb.bp.110.031831Seligman LD, Ollendick TH.Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 2011;20(2):217-238. doi:10.1016/j.chc.2011.01.003DC Department of Behavioral Health, Prevention and Early Intervention Programs, Healthy Futures.Understanding separation anxiety in infants and young children.
Kids Health from Nemours.Separation anxiety.
Ehrenreich JT, Santucci LC, Weiner CL.Separation anxiety disorder in youth: phenomenology, assessment, and treatment.Psicol Conductual. 2008;16(3):389-412. doi:10.19012Fjaba.2008.16-389
Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007%2Fs10802-013-9788-y
Silove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S.The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.BMC Psychiatry. 2010;10(1):21. doi:10.1186/1471-244X-10-21
Cooper-Vince CE, Emmert-Aronson BO, Pincus DB, Comer JS.The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis.J Abnorm Child Psychol. 2014;42(3):417-428. doi:10.1007/s10802-013-9788-y
The American Academy of Child and Adolescent Psychiatry.Children who won’t go to school.
Manicavasaga V, Silove D, Curtis J.Separation anxiety in adulthood: a phenomenological investigation.Comprehensive Psychiatry. 1997;38(5):274-282. doi:10.1016/s0010-440x(97)90060-2
Administration SA and MHS.Table 15, dsm-iv to dsm-5 separation anxiety disorder comparison.
Méndez X, Espada JP, Orgilés M, Llavona LM, García-Fernández JM.Children’s separation anxiety scale (CSAS): psychometric properties. Franken IHA, ed.PLoS ONE. 2014;9(7):e103212. doi:10.1371/journal.pone.0103212
Allen JL, Blatter-Meunier J, Ursprung A, Schneider S.Separation Anxiety Daily Diary. American Psychological Association; 2014. doi:10.1037/t33228-000
Fox AS, Kalin NH.A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. AJP. 2014;171(11):1162-1173. doi:10.1176/appi.ajp.2014.14040449
Dabkowska M, Araszkiewicz A, Dabkowska A, Wilkosc M.Separation anxiety in children and adolescents. In: Selek S, ed.Different Views of Anxiety Disorders. InTech. doi:10.5772/22672
Vine M, Stoep AV, Bell J, Rhew IC, Gudmundsen G, McCauley E.Associations between household and neighborhood income and anxiety symptoms in young adolescents.Depression and Anxiety. 2012;29(9):824-832. doi:10.1002/da.21948
Petry NM.Contingency management: what it is and why psychiatrists should want to use it.Psychiatrist. 2011;35(5):161-163. doi:10.1192/pb.bp.110.031831
Seligman LD, Ollendick TH.Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 2011;20(2):217-238. doi:10.1016/j.chc.2011.01.003
DC Department of Behavioral Health, Prevention and Early Intervention Programs, Healthy Futures.Understanding separation anxiety in infants and young children.
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