Separation Anxiety Disorder Introduction

Separation anxiety disorder (SAD) is a disorder that mostly affects children and adolescents, although there is evidence that even adults can develop this condition. Separation anxiety disorder is an anxiety disorder characterized by excessive anxiety that exceeds the normal level expected for the child's developmental stage and is triggered by the separation from home or "major attachment figures" such as parents or caregivers. (1)

Separation anxiety is an expected and normal developmental phase in infants and toddlers age 3 to 4, and represents a healthy response in young children confronted with separation from their home, parents, or attachment figures. It usually causes a mild level of distress (the baby or toddler gets upset or starts to cry) and clinging behaviors that usually disappear shortly after the separation moment. Separation anxiety at younger ages indicates the development of a healthy attachment, and it should not interfere with normal functioning. However, when the separation causes severe, persistent anxiety and a significant clinical distress that affects the social, academic, or other areas of functioning, the child may suffer from separation anxiety disorder.

In order for a separation anxiety disorder diagnosis to be established, the severe distress and fear caused by separation from attachment figures must last for a period of 4 weeks.

Separation anxiety disorder is a condition that affects a child's life by limiting their ability to engage in age-related daily activities. Children with separation anxiety disorder become extremely upset when they have to be separated from their parents and display significant clinical distress. Even the anticipation of a possible separation triggers a severe level of anxiety and agitation in the children. When separated from their parents or attachment figures, children need to know where their parents are, they need to stay in touch with them, and they fear possible fatal accidents or illnesses that can happen to them or to their parents. When away from home, these children become homesick or experience high levels of discomfort to the point of misery, and they strongly desire to return home.

Children with separation anxiety disorder often experience the fear of being lost and never being reunited with their family, and when away from home and their attachment figure, they become preoccupied with the reunion fantasy. They also fear traveling by themselves and avoid participating in activities that involve being away from home (such as camps, visiting and sleeping over to friend's houses, or even running errands).

In some cases, children refuse to be alone in the room requesting somebody to keep them company or they prefer to stay close to the parents even if inside the home. Some children have difficulties falling asleep unless somebody stays with them and during the night they might try to sneak into the parents or sibling bed.

Some children can have nightmares during the night, which are the expression of their fears.

Separation anxiety disorder can develop after the experience of a traumatic event such as the death of a parent, attachment figure, or pet, the illness of the child or significant figure in the child's life, changing schools or moving into a new area, neighborhood, or country. The onset can be as early as preschool age or any time before the age of 18, although a late onset (around teenage years) is not common.

In the United States, the prevalence of separation anxiety disorder ranges between 1.3 percent in teenagers age 14-16 to 4.1 to 4.7 percent in children age 7-11. Girls seems to be more affected by this disorder than boys.

Conditions & Diseases: Psychological & Mental Health

Separation Anxiety Disorder