Separation anxiety disorder (SAD) has been recognized as a disorder of children and adolescents for decades. It is a variant of a teen’s normal reaction to loss of contact with a parent or other close individual. SAD usually begins during childhood and is frequently accompanied by some impairment of functionality. Although the peak onset for SAD is at age seven to nine years, it may also begin during the teen years.
SAD may be a predictor of adult psychiatric difficulties. Studies have linked children with SAD to development of adult disorders including panic disorder, agoraphobia and generalized anxiety disorder. Studies with college students who have been diagnosed with SAD suggest that SAD is associated with eating disorders, adjustment problems and the onset of depressive disorders.
Who is likely to develop separation anxiety?
SAD shows some familial pattern with increased likelihood in siblings of children who have been diagnosed with the disorder. First-degree relatives such as parents of teens with SAD demonstrate high rates of anxiety and depressive disorders. Children of parents with panic disorders have a three fold higher risk for SAD, and the risk becomes ten fold if the parent has panic disorder plus major depression. It appears from community studies that SAD is equally distributed between the genders.
What are the symptoms of separation anxiety?
The teen with SAD will show symptoms of a distressing anxiety when separated from his or her parent. The adolescent worries excessively that an event will threaten the integrity of his or her family. In mild forms of SAD, the teen is able to tolerate brief periods of separation, but frequently requires assurances that the parent is fine. The teen is able to attend school, but may phone the parent frequently in order to be assured that he or she is safe.
However, for teens with significant SAD, behavioral problems may become manifest if a separation is to occur. The teen may have severe outbursts, arguments and violence against the parent or other authority who is initiating the separation. Teens with significant SAD may report physical complaints on school days and refuse to attend school.
How is separation anxiety evaluated?
A mental health clinician should evaluate any teen suspected of having SAD. The key elements in establishing the diagnosis may include some of the following:
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Unrealistic worry about harm that could happen to a major attachment figure
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Unrealistic worry that an event will cause a separation
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School refusal or reluctance to attend school
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Physical symptoms
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Distress upon separation
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Distress anticipating separation
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Events last more than two weeks
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Symptoms begin prior to age eighteen years
How is separation anxiety treated?
The main approach to therapy is behaviorally based, and a clinician experienced in these techniques should provide this. Family therapy is often necessary and is especially of benefit where family dysfunction complicates the teen’s clinical problems. An anxious parent who also may have a mental health disorder should be identified and treated since this frequently will help to reduce the functional impairment in the teen afflicted with SAD. Medications have been used including buspirone, fluoxetine or clonazepam, but their role is typically as an adjunct to behavioral interventions.
How is separation anxiety prevented?
A clinician experienced with this disorder should evaluate a child or teen who has early symptoms suggestive of SAD. Prior to adolescence, children with symptoms including difficulty in sleeping alone, intense distress at being left with a caretaker during preschool years and frequent school absences may suggestive of SAD. Early referral to a clinician and early treatment if indicated may help to prevent SAD affecting the adolescent.
Related topics:
Academics, anxiety disorders, depression, psychotherapy
