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Separation Anxiety Disorder

Allan N. Schwartz, LCSW, Ph.D. Updated: Jan 22nd 2007

"Good-night, good-night! parting is such sweet sorrow That I shall say good-night till it be morrow." Juliet to Romeo in act 2, scene 2 of Romeo and Juliet.

In the above Shakespearean quote, Juliet is proclaiming her love to Romeo and cannot wait until tomorrow when they will meet again. Children with separation anxiety disorder are also unable and unwilling to go to bed for fear of being away from their parents. However, the reasons for not wanting to be away from their parents are different in children than for Juliet in the famous play.

What is separation anxiety disorder and why does it occur?

First, it is important to understand that children go through a normal stage of separation anxiety. I always point out to friends and family that if their infant between the ages of 9 and twenty four months cry when the parent is away or when a stranger comes into the room it is a good thing. It is good because the crying is the result of anxiety when confronted by something new that could come between infant and mother. This is a development milestone because cognitive development has reached the level where the infant knows the difference between people who are familiar and people who are strangers. In addition, the infant recognizes what is familiar and what is unfamiliar in their environment.

When children first begin going to school they may experience some separation anxiety as they adjust to being away from home and parents for the first time.

Separation Anxiety Disorder becomes a serious problem when it interferes with the ability of the child to go to school, bed or anywhere new or without the parent.

Symptoms of Separation Anxiety Disorder (Diagnostic and Statistical Manual IV:

1. Recurrent distress and worry when separation from home and parents is expected.

2. Persistent worry that something terrible will happen to parents when there is a separation.

3. Refusal to go to school for fear of being away from home and parents.

4. Refusal to go to bed out of fear of loss of or separation from parents.

5. Following parents around from one room to the next for fear of separation and being alone.

6. Constant complaints about headaches, stomach aches, nausea, vomiting, etc. when separation is expected.

In addition, these problems last for at least four weeks and interfere with the child's ability to function at school with regard to learning and socializing.

Problems with Diagnosis:

A. Younger children do not talk about or verbally express their fears and anxieties. Therefore, it is important that parents be alert to the types of symptoms listed above. If there is any doubt then parents should seek an evaluation and diagnosis of their child.

B. It can be difficult to diagnose separation anxiety disorder because there is overlap with other anxiety disorders. For example, social phobia or the fear of being with other children can be confused with separation anxiety. Then, too, a stressful event can cause any child or adult to become anxious. It is not the temporary presence of anxiety that is the problem. Rather, it is the fact that the anxiety persists and or weeks or months that indicates there is a problem.

C. There are many reasons why a child mght refuse to go to schoo that have nothing to do with separation anxiety. For instance, a bully at school who is threatening a child will most definitely discourage the youngster from wanting to go.

Why Does Separation Anxiety Disorder Occur?

It is not clear why separation anxiety disorder occurs. Research shows that anxiety disorders run in families so that there is a genetic component. In addition, children and adolescents who experience separation anxiety disorder often go on to develop other types of anxiety disorders during adulthood. In addition, separation anxiety disorder can and does plague some adults and not only younger people.

John Bowlby was the psychiatrist who did a lot of work in the area of attachment. According to attachment theory anxiety disorders have a lot to do with the parenting experiences children have with their mother. Those children who learn that their mother is reliable form secure attachments and those children who learn that their mother is not reliable develop anxious attachments.

Whether you agree with Bowlby or not one of the clues to helping youngsters with separation anxiety disorder does lie in this theory.

Treatment for Separation Anxiety Disorder:

It is important that children and adolescents not be ignored if they are experiencing this disorder because of the way it interferes with their lives and the probability that other anxiety disorders will develop.

1. Cognitive and Behavioral Therapies are important in treating separation anxiety disorder.

A. cognitive therapy helps children address and correct the fearful and unrealistic thoughts about separation from family.

B. behavioral therapy is used to desensitize and accustom the child or adolescent to separation from home.

2. Family Therapy is important in helping parents learn how to reassure their child that they are reliable and will be present and available after the separation has ended.

Please E. Mail us about questions or experiences with separation anxiety disorder.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    New separation anxiety in my 3 year old. - - Sep 4th 2011

    My almost 3 year old daughter suddenly has separation anxiety.  Looking at books and online info it seems like this is not abnormal but I am just curious if she is the "typical" 3 year old or it is more severe.  She used to go to bed/nap wide awake and completely by herself now she cries hysterically if you try to put her in her own room.  Also, just a recent as a month ago she would set and play/watch tv while I went to a totally different part of the house to cook, do laundry, etc. Now I can't even go to the bathroom alone!  I feel horrible but it is extremely exhausting too.  I just want to know if this is normal and if there is any advise to help ease us through these times.  Or if this is an extreme case and I need to seek professional help.  She is starting preschool soon and I want to make this trasisition as smooth as possible.

    anxiety - Lisa - Jan 4th 2010

    Hi,

    My son is expeiencing something,he is 13,and his Dad passed a year & half ago.He lives with  me(Mom),step dad,and little brother(3).His Dad & I were always in a custody dispute,so I am sure that is an impotant piece of the puzzle.

    Briefly,he gets what I call panic attacks when he is sick with a fever,he becomes scared,wants to leave the house,heart pounds,& this lasts for about 10 ,15 minutes.

    We recently moved,and he has freinds at school but they never come over & he never wants to go over to a friends.he wants to be homeschooled to be with his little brother.He does all sports the school offers,he gets good grades,& loves girls.

    So he is normal,however,he doesn't like to sleep alone,has to have noise in his room,he wakes me up often because he is worried,or had a bad dream.Last couple of nights he wants me near,can't sleep very well,and keeps saying he doesn't want me to ever go away.So I know he has some thing,I need some confirmation.

    He was in counceling for about a year,and about a year after his Dad died..his counselor thought he would be fine.I tried to contact his old counselor,and he didn't get back to me.

    Now that I have read over my sons symptoms,it seems pretty obvious doesn't it...please comment...Thank you,L

    My husband and I don't have the best communication,but he & my son have found common ground,and do well together,although he doesn't understand the dynamics of all that is involved,due to his own "stuff" around his family.

    We are working on becoming a better couple.

    separation anxiety from twin and mother - Mary - Nov 2nd 2009

    Can separation anxiety cause school age children to have behavior problems and academically loose interest in school altogether?  Because my son possesses these problems and has been evaluated by the school district and labeled with emotional disturbance.  Society says these type of kids have some type of ADD/ADHD. I don't know what to believe of which my son has?

    Diagnosis of 10 year old - Allan N. Schwartz, PhD - Aug 10th 2009

    Hi Gina,

    Given the heavy loading for Bipolar Disorder in the family and the fact that recent research shows that even children can have this disorder, it is possible that your step child has Bipolar. However, it is entirely possible that, with all the chaos on her life, such as divorce and parental loss, that she could very well have separation anxiety or depression and even Major Depression.

    I would suggest that the treating therapist, have the child evaluated by a Child Psychiatrist, and properly diagnosed. Cognitive Behavioral Therapy could work for her even at her early age. I would act quickly so that this child begins to experience the types of interventions that can truly help her.

    By the way, family therapy should be made part of the treatment picture.

    Dr. Schwartz

    Diagnosis - Allan N. Schwartz, PhD - Aug 10th 2009

    Hi Gina,

    You are really describing an awful situation for your step daughter. Well, there is some very recent research that confirms the fact that even children can carry the diagnosis of Bipolar Disorder. It is possible (this is only a general opinion and nothing more) that she could be experiencing some of the symptoms of childhood Bipolar Disorder.

    I would recommend that the treating therapist have her seen by a child psychiatrist and evaluated for this.

    Of course, if it is not Bipolar disorder that she has, it could very well be separation anxiety or, possibly, childhood depression, and that would be no surprise.

    Dr. Schwartz

    Separation Anxiety -vs- Early Onset Mood Disorder - Gina - Aug 10th 2009

    I have a 10 year old step daughter who has been exhibiting signs of Separation Anxiety for the past 4 months. She has only spent 15 days with her mother this summer and her mother is starting her 3rd job in 2 years.  She has been part of a divorced family since she was 5 and we have no verbal communication with eachother as adults. Her mother is Bi-Polar (4 of 6 people in her immediate family have been diagnosed) and I often worry that my step daughter may be experiencing early onset to this mood disorder.  She sees a therapist 2 x's a month and I feel like we are going in circles (being divorced has such complications with 50/50 parenting) you have to first agree to see someone else, the child has to reestablish a relationship with the new therapist... etc.etc.etc

    Do you have any advice for a local therapist who specializes in the two areas for adolescents?

    Is anyone else dealing with this type of situation as it relates to divorce and separation anxiety?

    Thanks -Gina

    You are correct - Allan N. Schwartz, PhD - Jul 24th 2009

    Hi Laura and Jennifer,

    Actually, I agree with both of you. Remember, I stated in the article that we do not know what really causes separation anxiety. Also, I would not be quick to diagnose separation anxiety disorder in a 10 or 13 year old just because they do not want to do sleep overs. There is no implication that you are not good moms. I am sure you are.

    Also, I completely agree that no child should be forced to do sleep overs. Force never works and I do not recommend it.

    As long as your children have friends, go to school, do nicely in school, sleep well and get along at home, there is nothing to worry about.

    These articles are written for the general public and, therefore, do not apply to everyone in every situation. Just your awareness of your children points to the fact that you are great moms.

    Keep up your good work and feel free to ask any questions that do apply or might apply to your children.

    Dr. Schwartz

    my daughter is 12 and half and still won't sleep over - Laura - Jul 24th 2009

    My daughter is 12 and half years old.  She will not go to sleep overs.   When she used to try, i had to go and get her at all hours in the night as she kept the whole family awake with her crying for wanting mum.    I now have stopped the sleep overs altogheter with her agreement and will try again in the future but only once she is ready.    My daughter goes to school and has plenty of friends, she just won't do sleep overs.   I don't think the theory that children suffer from separation anxiety because parents were not available to them  when babies, as my daughter ihas been my life since she was  born and I was and still am, always there for her.  The problem, I think,  is that I was and still am too available for her every wish hence she does not need to go and look anywhere else for amusement and comfort as she gets plenty of it at home.

    - Jennifer Fleming - Feb 27th 2009

    Hi,

    I would like to comment on seperation anxiety in the above noted 10year old. My daughter is 10years and also will not 'do' sleep overs, as a counselor in Post Traumatic Stress Disorder, I comprehend that one must NEVER push a child into doing things that cause excess anxiety. Unfortunately due to society we feel our 'child' must be able to do sleepovers and lots of clubs etc, and if they cant there must be something wrong? This is NOT true, you have to accept it is part of her personality, what the child needs is excess love and reassurance that its OK to not do sleepovers until she'he is ready..pushing the child will just add to it. A child will learn courage through Love, not through undue pressure. My daughter Vomits if she is on sleepovers. I since have stopped them all until SHE is ready, not when I feel she should be! She also doesnt like clubs, but she is very balanced and knows exactly who she is, she has a lot of self confidence for the things SHE wants to do, she will always try new things as long as I reassure her and give her confidence through excess love. I accept her the way she is. I love her the way she is, I dont want her to be like other children, thats the point..accept your child..remove the 'anxiety' and reassure her that you love her regardless of wether she can 'do' sleepovers or not..dont be pressured by others. Following you around is just another point that she needs your reassurance, she will feel so bad about herself if she feels you are upset because she wont do sleepovers and this will make her worse.She will grow out of it. In the meantime, let her be who she is and remove all unnecessary pressure.It will mean the world to her, and it will help you if you 'let it go'... 

    10 yr old and can't sleep over a friends - Natalie - Jan 18th 2009

    For the past few months, getting my almost 10 yr old daughter to make it past 10:00 pm at a friends has been...well..not happening.

    She's come home crying wanting me, missing me and unfortunately, it's starting to affect her relationships with her friends. 

     It's important to note that it's not every single time - maybe every 3rd time. 

    What can I do?  Most of the articles talk about infacts to 5 yrs of age.  She's almost 10. 

    She does follow me around the house, would rather go to the store with me than play with her friends,  and the sleepover issue, but she does sleep in her own room every night and goes to school with no problem.  What can we do?  HELP!

    separation axiety - alex - Dec 29th 2008

    i have one year old twins and they wont sleep in there room without us.  they fall asleep in there room with us in it. thirty minutes later they wake up screaming bloody murder. they only stop when we hold them. once we let go they start all over again heeeeeeeelllllllpppppp

    anxiety separation in twins - Inge Flynn - Jul 7th 2007

    Can axiety disorder caused by separation of a 4 year old child from it's fraternal twin and mother cause seizures?

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