According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), separation anxiety disorder is primarily characterized by an individual’s fear of leaving home or parting from certain individuals. This anxiety must exceed what is expected at the individual’s age and developmental level.
Diagnostic Criteria for Separation Anxiety Disorder DSM-5 309.21 (F93.0)
In order for a separation anxiety disorder to be made, an individual must meet the following criteria:
- He or she experiences excessive or unwarranted fear or anxiety due to separation from whoever he or she is attached to, as demonstrated by 3 (or more) of the following:
- Regular excessive distress when separated from home or from certain individuals.
- Regular excessive worry about losing these individuals or about them being harmed.
- Regular worry about experiencing an unfortunate event (such as getting lost or ill) that causes separation from their attachment figures.
- Persistent reluctance or refusal to go anywhere or do anything out of fear of separation.
- Persistent reluctance or refusal to sleep away from home or from the attachment figures.
- Frequent nightmares about separation.
- Frequent complaints of physical symptoms, such as headaches or nausea, when he or she is separated from attachment figures or anticipating this separation.
- The individual’s fears and anxiety are persistent, lasting at least 4 weeks in children and adolescents and at least 6 months or longer in adults.
- This separation fear or anxiety causes clinically concerning distress or impairment in important areas of life.
- The individual’s excessive fear of separation cannot be attributed to another mental disorder.
Some individuals may also grow miserably uncomfortable when away from home or their attachment figures. Additionally, depending on their age, they may fear monsters, the dark, kidnappers, sicknesses, and other situations that may appear threatening to themselves and their loved ones.
Separation Anxiety Disorder in Children
Children with separation anxiety disorder may refuse to go to school, which can lead to academic struggles and social isolation. They also may grow severely angry and aggressive with someone who is forcing the separation. Additionally, very young children may make unusual reports such as seeing frightening creatures and strange people peering into their room. Ultimately, children with this disorder can be described as demanding, intrusive, and in need of constant attention.
Who Is at Risk of Developing Separation Anxiety Disorder DSM-5 309.21 (F93.0)?
Separation anxiety disorder typically develops at some point during childhood and possibly (but less often) during adolescence. There are periods of greater severity as well as remission. And while anxiety about separation and avoidance of it may persist through adulthood, most children with separation anxiety disorder are not impaired by anxiety disorders throughout their lifetimes.
Only a few certain individuals may be at a greater risk of developing separation anxiety disorder: those who experience major life stresses (e.g. losing a relative or moving) and those who may inherit the disorder from their parents.
Treatment for Individuals Suffering with Separation Anxiety Disorder
Separation anxiety can be treated in a couple different ways depending on the severity of the disorder:
Cognitive Behavioral Therapy: This form of therapy will help the individual to understand and manage his or her fears and anxiety. Exposure therapy, a more specialized version of cognitive behavioral therapy, may also be effective. It works to expose individuals to separation in small increments, which will help reduce their anxiety over time. Typically, parents are also trained how to respond in a productive way to anxiety, as to not unintentionally reinforce it.
Medication: Sometimes psychotherapy alone is not enough to manage symptoms. In these instances, medication may be prescribed to relieve the individual’s distress. A few effective medications in treating separation anxiety disorder include SSRIs and anti-anxiety medications.
Separation Anxiety in Our Best (Furry) Friends
Even dogs can experience separation anxiety when they’re apart from their favorite humans. This shouldn’t come as much of a surprise, as they’re capable of feeling emotions just like we are. Dogs may urinate, drool, bark and howl excessively, chew up objects, pace the room, and try to escape when they’re feeling an onset of separation anxiety. Some may appear agitated when their owner is getting ready to leave, while others seem simply depressed. While it is not completely evident why dogs develop separation anxiety, it may be due to a few reasons:
- Change in guardian or family: Separation anxiety can certainly result from being taken to a shelter or being adopted by a new family.
- Change in schedule: If a dog isn’t used to being left alone for long periods of time, a sudden increase in the owner’s absence can trigger separation anxiety.
- Change in home: Simply moving to a new home can spark the development of separation anxiety in a pup.
An individual with Separation Anxiety Disorder experiences a continuous and inordinate amount of anxiety when separated (or expected to be separated) from another person. In children, the anxiety is usually because of separation from a parent or caregiver, and the amount of distress is more than what is normal for the child’s development level. In adults, the attachment is typically a partner or close family member. A rather common anxiety disorder, it is diagnosed in children and teens when the separation exists for a minimum of a month and for at least one-half year for adults. Separation Anxiety Disorder can be related to panic attacks that stem from a co-existing panic disorder.
Children who don’t want to leave their parents have a difficult time going to school, visiting friends at their houses and even staying in a room alone. Adults may experience difficulties with moving to a new home, getting married or acting independently.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)*, Separation Anxiety Disorder may be associated with panic attacks that exist because of a simultaneous panic disorder.
*The DSM-5 is published by the American Psychiatric Association.
Signs of Separation Anxiety Disorder DSM-5 309.21 F93.0
When an individual develops extreme fear or anxiety regarding separation from a person with whom he is attached, he will have a minimum of three of the following criteria in order to be diagnosed with Separation Anxiety Disorder.
- Abnormal distress when separation is discussed or of the experience of being separated from another person with whom the individual is attached to (parent, caregiver).
- Extreme fear that something harmful will happen to the person he is attached to.
- Continuous worries that something will happen unexpectedly to cause separation from the person he is attached to.
- Refuses to leave the person.
- The individual has nightmares about being separated.
- He has anxiety about going to sleep and being separated from the other person.
- Complains about physical problems/illness when separation will occur.
- The anxiety lasts for a minimum of a month in children and teens and usually one-half year in adults.
- The anxiety causes a negative impact in social settings, school, careers and other areas.
To be diagnosed with Separation Anxiety Disorder, an individual must have extreme distress and/or not be able to function in social settings, school, a career or other areas. In addition, the condition can’t be because of another mental illness (agoraphobia, generalized anxiety disorder, psychotic disorders).
Causes of Separation Anxiety Disorder DSM-5 309.21 F93.0
Separation Anxiety Disorder has no single cause, but most mental health professionals think its development occurs when genetic, physiological and environmental factors work simultaneously.
It has been found that nearly 75 percent of the people who meet the criteria for the disorder have a family history of Separation Anxiety Disorder. It is thought to be inherited from a first-degree relative who also has the disorder.
Just like other anxiety disorders, it has been identified that people with Separation Anxiety Disorder often have chemical imbalances in their brains. The neurotransmitters that regulate mood and impulses may not be regulated in the individuals with the disorder and can lead to anxiety symptoms. Their response to stress is prevented and can cause a heightened startle response to small triggers or to anticipated danger or fear.
When a person experiences stress in his life, such as the loss of somebody close, experiencing a disaster or trauma that has separated him from his loved ones or has a history of being separated from his parents or caregivers during childhood, the disorder may develop.
In addition, with romantic codependent relationships, the symptoms of the disorder will show if the person is unable to adjust when his partner is away.
Facts About Separation Anxiety Disorder DSM-5 309.21 F93.0
- Separation anxiety is a normal part of development in infants and children until about three or four years of age. This may happen when they experience mild distress and clinginess when they are apart from their parents or caregivers.
- Originally, Separation Anxiety Disorder was thought to be a childhood condition. However, it is also recognized as an adult disorder.
- About 78 percent of adults with the disorder developed it in adulthood.
- Adults can experience the disorder in relation to the separation from a partner or when a child moves away from home.
- The disorder can impact an individual’s ability to complete everyday tasks, as well as socially.
- People who have the disorder are more apt to have another anxiety or mood disorder.
Life With Separation Anxiety Disorder DSM-5 309.21 F93.0
Children with Separation Anxiety Disorder often seem sad and withdrawn. They have difficulty focusing when they are apart from the person they are attached to.
The child may feel like something terrible will happen to the person he is attached to. He may be afraid of flying and automobiles for fear that a crash or accident will cause the loss of the person he is attached to.
When the child doesn’t want to separate from the person he is attached to, he will often try to get out of going to school, which may result in social and academic problems. In addition, the extreme worrying and difficulties with sleeping (when the child refuses to go to bed because of separation) may cause problems on the job and in other functioning for the parent or caregiver. Dealing with the clinginess and explosive behaviors of the child can be exhausting.
Adults with the disorder may appear controlling, overprotective and dependent. They may have difficulties in keeping a job, which can cause financial problems, as well as social conflicts.
Treatment for Separation Anxiety Disorder DSM-5 309.21 F93.0
Treatment that includes medication and psychotherapy has better success for lessening the symptoms of Separation Anxiety Disorder.
Exposure Therapy is commonly used to treat children with the disorder. The child is gradually exposed to the situation that causes him distress– being away from a caregiver. He is separated at increased distances slowly until he is able to accept being apart.