Separation Anxiety

United Brain Association (UB) has a good section on separation anxiety. The following is quoted and reformatted from its What is Separation Anxiety Disorder? page. 

Separation Anxiety Disorder Fast Facts

Separation anxiety disorder (SAD) is characterized by feelings of fear and worry centered around separation from parents, other family members, or loved ones.

Separation anxiety is a normal stage of development for children, but SAD symptoms are not appropriate for a child’s age and tend to be more severe.

SAD sometimes affects adolescents and adults.

People with a family history of anxiety or other mental illnesses are at a higher risk of developing SAD and other anxiety disorders.

People with a family history of anxiety or other mental illnesses are at a higher risk of developing SAD and other anxiety disorders.

What Causes Separation Anxiety Disorder?

Scientists don’t yet fully understand what causes separation anxiety disorder. An individual’s risk for developing anxiety or an anxiety disorder is probably due to a complex interaction of genetic and environmental factors.

Risk factors for SAD include:

• Exposure to traumatic or stressful situations involving separation (loss of a loved one, severe illness of a loved one, loss of a pet, divorce, moving, changing schools)

• Extreme shyness or inhibition in childhood

• Family history of anxiety or other mental illnesses

Is Separation Anxiety Disorder Hereditary?

People with a family history of anxiety or associated mental disorders have a higher risk of developing separation anxiety disorder themselves, suggesting an inherited component to anxiety. However, scientists have not identified a single gene definitively associated with separation anxiety or other anxiety disorders. Instead, anxiety is likely the result of a coincidence of multiple genetic and environmental factors.

How Is Separation Anxiety Disorder Detected?

Early detection and treatment of SAD can lessen the severity of symptoms and increase the likelihood of successfully controlling the disorder. Watch for signs of excessive or age-inappropriate separation anxiety at crucial points, including:

• Elementary school age (SAD commonly emerges in third or fourth grade)

• After holidays or school breaks

• After a lengthy illness

• After a loss-related life change (e.g., death of a loved one or pet, divorce, moving)

How Is Separation Anxiety Disorder Diagnosed?

Diagnosis of SAD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that SAD or another anxiety disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.

• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for separation anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

The DSM criteria for SAD include:

• Fear or anxiety about separation is excessive and inappropriate for the patient’s age.

• The anxiety lasts at least four weeks in children or adolescents or six months in adults.

• Another mental illness does not explain the symptoms.

• The symptoms cause significant distress or impairment.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Separation Anxiety Disorder Treated?

Psychotherapy is often used to treat the symptoms of separation anxiety disorder. However, in some cases, medications may help control some of the SAD’s symptoms.

Psychotherapy

Psychotherapy is often the most effective approach to controlling separation anxiety. The most common therapeutic approach is cognitive-behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them.

Medication

Antidepressant and anti-anxiety medications may be used to treat and manage SAD. Individual medication plans depend on the patient’s age, responsiveness to other treatments, and the severity of their symptoms. Medications alone, without psychotherapy, are not recommended, and drug treatments are typically not appropriate for young children.

• Selective serotonin reuptake inhibitors (SSRIs). These antidepressant drugs work by increasing the levels of serotonin, a neurotransmitter chemical in the brain. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.

• Benzodiazepines. These anti-anxiety medications work relatively quickly to control symptoms. However, they may lose their effectiveness over time. Therefore, they are typically used only when antidepressants are not effective.

How Does Separation Anxiety Disorder Progress?

SAD typically responds well to treatment. Most children treated for the disorder see a complete resolution of symptoms within 3-4 years. However, untreated separation anxiety can lead to potentially severe complications, including:

• Depression

• Relationship problems

• Problems at school or work

• Other anxiety disorders

How Is Separation Anxiety Disorder Prevented?

There is no known way to prevent separation anxiety disorder. However, children who observe their parent’s anxiety are more likely to develop an anxiety disorder themselves. Because of this, parents with anxiety disorders should get treatment from a mental health professional to reduce the likelihood that their children will develop the condition.

Some strategies may also help parents control or prevent episodes of their child’s separation anxiety:

• First: seek help from a mental health professional as soon as possible.

• Second: adhere to the treatment plan prescribed.

• Third: help your child plan for situations that cause anxiety.

• Fourth: encourage your child to be independent as appropriate for their age.

Separation Anxiety Disorder Caregiver Tips

Separation anxiety disorder often exists alongside other mental health and brain-related conditions, a situation called co-morbidity. Here are a few of the disorders commonly associated with SAD:

• Depression and anxiety are among the most common comorbid mental disorders.

• SAD and panic disorder are often comorbid.

• People with SAD may have other anxiety disorders as well.

• Obsessive-compulsive disorder (OCD) and SAD are often associated with one another.

• Post-traumatic stress disorder (PTSD) shares many symptoms with other anxiety disorders, including SAD.

• Alcoholism and substance abuse have been linked to SAD by some studies.

Separation Anxiety Disorder Brain Science

Scientists believe that anxiety symptoms come from activity in the parts of the brain that control emotions and our reactions to them. These parts of the brain are collectively called the limbic system. The limbic system is associated with anxiety in several ways:

• The amygdala, the part of the brain responsible for detecting threats, may be hyperactive and may misidentify causes for fear or worry when none exist.

• An overactive amygdala may persistently cause the hypothalamus to trigger the hormonal response that produces the physical symptoms of anxiety.

• Communication between the amygdala and the prefrontal cortex (PFC) may be impaired. The PFC is responsible for triggering a rational response to threats, and it may not be able to do so when it is unable to communicate with the amygdala effectively.

• The hippocampus, the part of the brain responsible for processing long-term memory, may be underdeveloped or dysfunctional in the case of anxiety. As a result, it may have a preference for retaining stress-related memories rather than more rational memories.

References:

United Brain Association 2023, Separation Anxiety Fast Facts, Accessed on August 22, 2023, <https://unitedbrainassociation.org/brain-resources/separation-anxiety-disorder/>.