Separation Anxiety Disorder

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


Anxiety describes an uncomfortable emotional state characterized by inner turmoil and dread over anticipated future events. Anxiety is closely related and overlaps with fear, a response to perceived and actual threats. Anxiety often results in nervousness, rumination, pacing, and somatization. Every human experiences anxiety because it is an evolved behavioral response to prepare an individual to detect and deal with threats. Anxiety becomes pathological when it is so overwhelming that there is persistent distress, a decrease in quality of life, and impairment in regular major life activities.

Anxiety disorders are the most common psychiatric disorders in children and are often underrecognized. Untreated anxiety disorders in children can significantly impair quality of life, lead to comorbid psychiatric conditions, and interfere with social, emotional, and academic development. Adults with anxiety similarly experience poorer quality of life than those without anxiety disorders, and the severity of anxiety can impact daily functioning.

Separation anxiety disorder (SAD) is one of the most common childhood anxiety disorders. SAD involves significant distress when the child is unexpectantly separated from home or a close attachment figure. SAD is an exaggeration of otherwise developmentally normal anxiety and manifests as excessive concerns, worry, and even dread of the actual or anticipated separation from an attachment figure or home.

Although separation anxiety is a developmentally appropriate phenomenon, the disorder manifests with improper intensity at an inappropriate age or in an inappropriate context. The Diagnostic and Statistical Manual of Mental Disorders (DSM), edition 4, limited the diagnosis of SAD to children and adolescents. However, in the Diagnostic and Statistical Manual of Mental Disorders, edition 5 (DSM-5), the diagnosis was extended to include adults first diagnosed with SAD in adulthood. One difference in children diagnosed with separation anxiety compared to adults is the type of attachment figures involved. In the case of children, the attachment figures are usually adults, such as parents, whereas adults experience anxiety due to actual or anticipated separation from children, spouses, or romantic partners.

Developmentally appropriate separation anxiety manifests between 6 to 12 months of age. This normative or physiological separation anxiety remains steadily observable until approximately age 3 and, under normal circumstances, diminishes afterward. Developmentally appropriate separation anxiety eventually extinguishes as a child develops a greater sense of autonomy, cognitive ability, and an understanding that a separated attachment figure will return.

More significant than expected duration or intensity of separation anxiety symptoms in children or the development of this disorder in older children, adolescents, or adults constitutes SAD. This disorder severely affects the quality of life and functioning across several areas, including school, work, social interactions, and close relationships. SAD is a gateway anxiety disorder that can lead to poor mental and physical health outcomes, including excessive worry, sleep disturbances, undue distress in social settings, poor academic performance, and somatic complaints.

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