Separation Anxiety – Causes, Signs and symptoms

Separation Anxiety

Also called: Separation Anxiety Disorder

Summary

Separation anxiety is a phase in some children’s lives where they become anxious during separations from a parent or other primary caregiver. It usually takes place between the ages of 8 months and 14 months.

Children with separation anxiety may display symptoms such as crying, begging or screaming when separated from a parent. They may have nightmares about separation from parents or complain of various physical ailments. Depressed mood, excessive levels of worry about being lost or kidnapped, and fear of sleeping alone are other symptoms associated with separation anxiety.

In most cases, separation anxiety is treated as a normal stage of child development. Children will grow out of this phase as they develop a better understanding of the world and learn to trust that their parents will return to them.

However, children who continue to experience intense separation anxiety into preschool or elementary school years may have separation anxiety disorder.Research indicates that separation anxiety disorder is associated with an increased risk of developing other mental disorders (e.g., eating disorders) later in life.   

Historically, separation anxiety disorder has been diagnosed in children. However, researchers are currently investigating the prevalence of this disorder in adults, and the relationship between adult separation anxiety disorder and the childhood disorder.  Psychotherapy and medications are typically used to treat separation anxiety disorder.

About separation anxiety

Separation anxiety is a common developmental stage in young children’s lives when they become anxious during separations from a parent or other primary caregiver. Separation anxiety can also include fears of being separated from the home. For most children, this phase occurs between the ages of 8 months and 14 months.

During their first six months of life, babies typically have no fear of being separated from their parents as long as the child’s basic needs are being met. Newborn children typically do not fully understand that their parents are unique beings. They are also not frightened by new experiences or situations because they have not yet developed a sense of what is ordinary and what is potentially dangerous.

However, sometime between the ages of 4 months and 7 months, a baby begins to understand that things and people exist even when they are not within sight. This concept is known as object permanence, and it coincides with a child’s growing understanding of their parents or caregivers as unique people.

By the time children are between 8 months and 14 months old, they have developed a sense of what is familiar and safe and may feel threatened when meeting new people or encountering new places. Although children this age feel a growing sense of independence, they remain unsure of themselves and are still dependent on their caregivers. As a result, children may feel fear when separated from parents or primary caregivers in an unfamiliar place.

Parents should not be alarmed when their children enter the phase of separation anxiety. Although it is normal to feel somewhat guilty about leaving children who resist such separations, parents should understand that this stage of development is normal and helps children learn to live within their environment. Usually by age 2, children have learned that parents who are out of sight have not disappeared for good and will eventually return. Around this time, children also learn to trust in people other than their parents.

The timing for when separation anxiety occurs varies substantially from child to child. It can begin as late as 18 months of age and last until the child is 30 months old. Some children never show signs of separation anxiety.

Children who appear to have moved out of the stage of separation anxiety may occasionally regress back to it, particularly during periods of high stress. For this reason, it is important that parents show their children love and support in uncertain or stressful circumstances, such as during hospital visits. For example, parents should offer reassurance that they will not abandon the child and – when separation is necessary – should tell the child exactly where they will be waiting.

Children who continue to experience intense or extreme separation anxiety into preschool or elementary school years may have separation anxiety disorder. In this condition, the child fears being lost from family members and often is convinced that something terrible (such as accidents or illness) is likely to occur during periods of separation.

Separation anxiety disorder tends to form in children who belong to close-knit families. In some cases, it develops after an episode of stress in a child’s life, such as the death of a relative or pet, an illness, or a move to a new neighborhood or school. Research indicates that children who experience separation anxiety disorder are also more likely to develop other mental disorders (e.g., eating disorders) later in life. Separation anxiety disorder usually requires medical attention.

Historically, separation anxiety disorder has been diagnosed in children. However, researchers are currently investigating the prevalence of this disorder in adults, and the relationship between adult separation anxiety disorder and the childhood disorder.

Signs and symptoms of separation anxiety

Children in the stage of development referred to as separation anxiety may display symptoms such as crying, begging or screaming when separated from a parent during times of stress. When parents try to leave children with a babysitter or daycare provider, the child may cry, cling to the parent and resist the attention of others. During this normal developmental phase, children may have nightmares about separation from parents, wet their pants during the day and may complain of various physical ailments, such as headaches and stomachaches.  They also may express feelings such as:

  • Distress when separated from a parent or other primary caregiver
  • Fears about losing a parent or primary caregiver
  • Reluctance to go to places – such as daycare facilities or schools – where the child may be separated from parents or primary caregivers
  • Reluctance to sleep without a parent or primary caregiver nearby

Children who experience intense or extreme feelings of separation anxiety into their preschool or elementary school years may have separation anxiety disorder. Children with this condition may have panic attacks or experience other panic symptoms (nausea, vomiting, shortness of breath) before a parent leaves. Children with separation anxiety disorder may demand to know the whereabouts of their parents or caregivers and may become preoccupied with reunion fantasies. They may complain that no one loves them or that they wish they were dead, and may become demanding and in need of constant attention.

Additional symptoms associated with separation anxiety disorder include:

  • Depressed mood
  • Excessive levels of worry about being lost or kidnapped, or of harm coming to themselves or their parent or caregiver
  • Extreme feelings of unhappiness or homesickness when separated from home
  • Fear of sleeping alone
  • Refusal to attend school or camp, or to visit or sleep at friends’ homes
  • Shadowing parents or caregivers by following them around the house

Diagnosis and treatment of separation anxiety

There are no actual medical tests to diagnose separation anxiety, as it is considered a normal stage of child development rather than a mental disorder. In most cases, treatment for separation anxiety will not be necessary, as the condition will likely pass on its own over time. Children diagnosed with separation anxiety may be given a mild sedative in some stressful circumstances, such as before a medical procedure.

Severe cases of separation anxiety that last beyond the age of 2 may indicate separation anxiety disorder and require a mental health evaluation. As part of this analysis, a child may be asked to speak with a mental health professional and the parents or primary caregivers may provide a list of the child’s symptoms and a description of any family history of mental illness.

Separation anxiety disorder may be diagnosed when a child has separation anxiety that begins before 18 years of age, lasts for at least four weeks and causes significant distress or impairment of social, academic or other important areas of functioning.  When separation anxiety develops suddenly in an older child, it may be representative of a different problem such as being abused or bullied. In addition, separation anxiety disorder is not diagnosed if symptoms are primarily the result of other mental disorders such as panic disorder or schizophrenia.

Psychotherapy is the main treatment for separation anxiety disorder. It focuses on helping the child tolerate separations from the parent or caregiver. Medications such as antidepressants may also be used to treat children with separation anxiety disorder. Antidepressants are a complex class of medications. A physician may need to adjust the dosage or completely change the prescription to find a medication that provides optimal results with minimal side effects. In addition, certain patients cannot take antidepressants. The U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Prevention methods for separation anxiety

Although separation anxiety itself cannot usually be prevented, parents can help to lessen its impact. For example, parents can try to schedule everyday departures from their children during a time when the child is well-fed and well-rested, and thereby less likely to act up out of tiredness, hunger or restlessness.

Parents should also avoid starting childcare or changing childcare providers during the ages of 8 months to 1 year, when children are most susceptible to separation anxiety. Gradually introducing children to strangers – such has having a new babysitter visit before caring for the child – can help reassure children. Perhaps most importantly, parents should always return when they say they are going to return. Children will never develop the confidence they need to move out of the separation anxiety stage unless parents give them a foundation of trust upon which the child can build.

Parents are encouraged to try to be present in situations where the child is likely to experience extreme anxiety or other duress. For example, children who are preparing for medical procedures are particularly vulnerable to feelings of insecurity. It is important for parents and hospital staff to clearly explain the situation that is about to unfold to the child, and crucial to reassure the child that parents will remain close by. Children may be particularly reassured to know exactly where the parents will be waiting.

Parents must be careful in how they respond to a child’s behavior during the separation anxiety stage. If the parent always comes rushing back to the child after a tantrum, the child will learn to use this behavior to prevent the parent from leaving. Instead, parents can remain calm and confident while saying quick goodbyes that clearly communicate that the child is loved and that the parent will return at a specified time (such as “after lunch” or “before dinner”). It is important to maintain a consistent pattern of goodbyes and returns, which will help the child to establish trust.

Questions for your doctor

Preparing questions in advance can help parents to have more meaningful discussions with their physicians regarding their children’s conditions. Parents may wish to ask their doctor the following questions related to separation anxiety:

  1. How can I tell if my child’s behavior is a sign of normal separation anxiety or separation anxiety disorder?
  2. What are the most common symptoms of separation anxiety?
  3. What can I do to ease my child’s separation anxiety?
  4. When will my child outgrow his/her separation anxiety?
  5. Should I be concerned if my child never experiences separation anxiety?
  6. How is separation anxiety disorder typically diagnosed?
  7. How long can I expect my child’s separation anxiety disorder to last?
  8. Are there any treatments available for my child’s separation anxiety disorder?
  9. I realize that separation anxiety is a normal part of child development, but can separation anxiety disorder be prevented?
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