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Adults with separation anxiety disorder have heightened, functionally impairing fears about being apart from their attachment figures. The mental health condition might cause them to experience a panic attack when their spouse goes to work, or have recurring nightmares about the death of someone they love. Though separation anxiety in children tends to be more focused on a parent, adult separation anxiety disorder (sometimes called A-SepAD or ASAD) may involve a romantic partner, a child, a pet, a parent, or any other close relationship. ASAD can have an adult-onset, or be a continuation of childhood separation anxiety disorder (CSAD).
Most guides to separation anxiety disorder give you the diagnostic criteria in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), offer a few treatment possibilities, and leave it at that. But this guide covers some broader ground, bringing in perspectives from evolutionary psychology, false suffocation alarm theory, tend-and-befriend theory, and even Buddhism. Because unlike young children with separation anxiety, adults are more likely to possess the intellectual capacity and maturity to interrogate their disabling fears – and learn how to manage them. They just need the right information and support, at the right time. So let’s get started.
What Are the Symptoms of Separation Anxiety in Adults?
In the DSM-5, published by the American Psychiatric Association, the eight symptoms of separation anxiety disorder (309.21 (F93.0)) are the same for both children and adults:
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Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
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Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
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Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
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Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
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Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
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Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
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Repeated nightmares involving the theme of separation.
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Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.
In the case of adults, however, at least three of the above symptoms must be present for roughly six months, whereas a child’s developmentally inappropriate symptoms need only persist for one month.
There are other signs of separation anxiety that tend to show up in adults. They include the following:
- Repeatedly calling or texting a loved one when they’re away
- Being overly strict, intrusive, and/or overprotective with children
- Difficulty focusing when they’re apart from their attachment figure
- Worrying their adolescent or teen will not need them anymore as they gain independence (sometimes called reverse separation anxiety)
- Persistent fear that a romantic partner will leave the relationship
- Staying in an unhealthy relationship past its expiration date
- Depending inappropriately on parents, or being over-involved in their lives
- Making excessive demands on family members
- Trouble sleeping when their loved one is away
- Obsessively checking the location of their loved one’s electronics
- Difficulty coping with life transitions such as moving
- Not having their own friends
- Marked distress when technology-based interactions are disrupted (i.e. a cell phone is lost)
- Feelings of vulnerability
- Morbid jealousy
- Desperation to keep attachment figure close, even to the point of aggression
- High levels of absorption in the other person
- Intentionally limiting travel or work outside the home
There’s considerable overlap (comorbidity) between separation anxiety disorder and other mental health conditions like generalized anxiety disorder (GAD), mood disorders, panic disorder, and agoraphobia. Research shows that 54% of bipolar patients have co-occurring ASAD. So it may be difficult to distinguish between symptoms of separation anxiety and symptoms of co-occuring disorders. But in separation anxiety, fear and distress always involve an attachment figure.
Is Separation Anxiety in Adults Common?
The DSM-5 states that adult separation anxiety disorder has a 12-month prevalence of 0.9%-1.9%. The 2006 National Comorbidity Study Replication (NCS-R) determined that adult separation anxiety disorder has a lifetime prevalence of 6.6% in the US. Over 75% of American adults develop the condition in adulthood, not childhood. The NCS-R also determined that most people with ASAD go untreated, or are only treated for comorbid conditions. ASAD continues to be underrecognized.
In 2015 the American Journal of Psychiatry published results from the World Health Organization (WHO) showing that the lifetime prevalence of separation anxiety disorder across countries averaged 4.8%. These same World Mental Health Surveys showed that 43.1% of cases had an adult onset.
Differential Diagnoses for Adult Separation Anxiety Disorder
Adults with separation anxiety disorder tend to have enough impairments in their daily life to seek professional help. Three quarters of people with ASAD receive treatment for emotional problems, but only 68% of those people get support that focuses on their separation anxiety. In clinical settings, their ASAD symptoms may be confused with those of another mental health condition, such as the following:
- Post-traumatic stress disorder (PTSD)
- Specific phobia
- Panic disorder – People with ASAD may have panic attacks, but their primary fear is of separation
- Generalized anxiety disorder (GAD) – People with GAD may worry about something happening to their loved ones, but that is usually just one of numerous themes
- Social anxiety disorder
- Agoraphobia – Someone with agoraphobia may fear being alone because they need to feel that help is available
- Obsessive-compulsive disorder (OCD)
- Codependency
- Anxious attachment or insecure attachment
- Dependent personality disorder (DPD)
- Illness anxiety disorder
- Bereavement or complicated grief
In romantic relationships, it might be difficult to distinguish between symptoms of adult separation anxiety and toxic, controlling behaviors or codependency. You have to examine what specific feelings or beliefs are causing the behaviors.
What Can Cause Separation Anxiety in Adults?
The jury is still out on the definitive causes of separation anxiety in adults. It’s a relatively new diagnosis, and until the latest revision of the DSM, it was classified as one of the “Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence” — not as an anxiety disorder that could have an adult onset. But psychologists have some working theories for what causes ASAD.
Most early research into the disorder began with the attachment angle. That is, an adult with separation anxiety disorder must have internalized some negative aspect of their formative relationships in childhood. Let’s look more closely at that. All mammals have evolved to feel a measure of anxiety when separated from their caregivers. Because humans are helpless, squishy little things when they’re born (called altriciality), they depend on their parents for survival. Normal, physiological separation anxiety (SA) kicks in when a human really begins moving, around the age of six to 12 months, and wanes around age four. But according to Bowlby’s attachment theory, later social development can be shaped by an early caregiver’s responses to a child’s need for security. So can early parental behavior cause someone’s separation anxiety disorder? It’s unclear. Perceived parental rejection and parental overprotectiveness in childhood are both associated with ASAD, but there’s little evidence that an anxious or insecure attachment style causes the disorder.
Other potential causes of separation anxiety in adults include the following:
- Early family adversity or dysfunction
- Exposure to major disasters or trauma, and related fear for personal safety
- Life stress, transitions, and events, especially loss
- Complicated grief
- Genetics (based on twin studies, SA’s heritability is estimated at 73%)
- Enhanced amygdala function, though so far all the evidence of ASAD biomarkers is tentative
- Cognitive biases in information processing
- Neuroticism (a personality trait)
Lastly, people with separation anxiety and people with panic disorder (PD) both seem to have an exaggerated emotional and respiratory sensitivity to CO2. According to false suffocation alarm theory, the human body has a built-in emotional response to changing oxygen levels, which we’ve evolved to keep us safe from harm. The panic attacks of someone with SA or PD might reflect their carbon dioxide hypersensitivity.
Separation Anxiety in Parents
Most parents have probably experienced a form of separation anxiety at one point or another. The first time they leave their baby with a sitter, for example, or the first day of school or daycare. And the modern world seems full of credible risks to children — no wonder we’re fearful. But Western culture also tends to encourage an autonomy-supportive parenting style, where we place value on raising resilient, independent children who won’t cling to their parents into old age. Granted, it’s not always easy to let go.
According to the tend-and-befriend theory in evolutionary psychology, women have evolved an inclination to respond to stress by leaning into prosocial behaviors. Namely, they take care of their children and make contact with their friends when they perceive that they’re under threat. In the old hunter-gathering world, this behavior would help moms increase chances of survival for themselves and their offspring. So it serves an adaptive purpose to “tend and befriend” when parents are stressed.
But when maternal separation anxiety or paternal separation anxiety prevents our kids from developing autonomy and feelings of confidence, that “tending” is no longer adaptive. In fact, it can be stifling. It’s also not good for Mom and Dad’s mental health.
How Do You Treat Adults with Separation Anxiety?
People with separation anxiety disorder may not respond as well to standard anxiety and depression treatments like cognitive behavioral therapy (CBT), so it’s important to diagnose them accurately. Therapists should focus on their core anxieties and specific separation fears. There are currently no specific medications or therapies for ASAD. But experts might utilize any of the following to help alleviate extreme separation fears:
- Self-soothing strategies and coping mechanisms
- Psychoeducation
- Mindfulness-based interventions (MBIs)
- Journaling
- Couples therapy
- Family counseling
- Systematic desensitization or graduated exposure therapy
- Acceptance and commitment therapy (ACT), which addresses experiential avoidance
How Do You Deal with Separation Anxiety in Adults?
Separation anxiety in adults shouldn’t be dismissed. It’s incredibly painful and limiting for the person with the disorder. It can cause numerous functional impairments and avoidance behaviors. And it’s a major risk factor for additional disorders and mental health issues. So how do you deal with it? The first-line treatment is individual, family, or marital therapy, as mentioned in the section above. But ASAD can also be dealt with today, right now, by challenging your perspectives.
In the Buddhist religion, “attachment” is associated with suffering. But a better English translation of attachment from the Buddhist texts is actually “thirst” or “craving.” There’s nothing wrong with feelings of love and attachment and enjoyment of the people you care about. But when those feelings become a clinging and a longing, they’re liable to inflict suffering.
Another important Buddhist concept is that of first darts and second darts. The first dart is unavoidable pain, that which is out of our control. Because life is impermanent and forever in a state of flux, pain is inevitable. The second dart is suffering, the self-inflicted wound. The second dart is how we interpret our pain. How we say to ourselves, “I’m mad about this pain,” or, “I can definitely prevent this pain in the future.” You can feel this suffering in your body in the form of tension and tightness. It’s your mind jumping through hoops to try to avoid that original pain.
But what if you accepted uncomfortable or distressing feelings instead? When you love someone, it feels intolerable that you would lose them. But anticipating that pain can prevent you from truly enjoying your time in their presence. You will devote most of your energy to avoiding loss, rather than feeling complete. What if you could acknowledge your fear, then release it, and be more mindful of the here and now? If you’re apart from the person you love, you can let your body remember how it feels to be with them, and try to calm your nervous system (self-soothe). You can internalize those good feelings, instead of ruminating on the fearful ones, insisting in your heart that things should never change. In this way you can still experience profound love for your attachment figure, but that love will be less of a burden on you — and on them. Love is wholesome, but clinging is not a wholesome means of achieving it.
