Separation Anxiety Disorder

Separation Anxiety Disorder is a condition typically diagnosed in childhood and adolescence. It is characterized by inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

• Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.

• Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.

• Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped).

• Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.

• Persistent reluctance or refusal to go to school or elsewhere because of fear of separation.

• Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings.

• Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home.

• Repeated nightmares involving the theme of separation.

• Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.

The duration of the disturbance is at least 4 weeks.

The onset is before age 18 years.

The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia.

Course

Course Separation Anxiety Disorder may develop after some life stress (e.g., the death of a relative or pet, an illness of the child or a relative, a change of schools, a move to a new neighborhood, or immigration). Onset may be as early as preschool age and may occur at any time before age 18 years, but onset as late as adolescence is uncommon. Typically there are periods of exacerbation and remission. In some cases, both the anxiety about possible separation and the avoidance of situations involving separation (e.g., going away to college) may persist for many years. However, the majority of children with Separation Anxiety Disorder are free of impairing Anxiety Disorders at extended follow-up.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.