Separation anxiety disorder is a particularly serious mental health condition that is vastly under-diagnosed. It affects people of all ages and can have a deep impact on affected individuals’ ability to lead a healthy, fulfilling life.
Separation anxiety disorder goes undiagnosed and untreated in many affected individuals because it is not recognized due to its misleading symptomatology and because of the myths and misunderstandings that surround this serious mental health disorder.
1. Myth: Separation Anxiety Disorder Only Affects Children
Fact: Separation anxiety disorder is more common in adults than it is in children.
Studies found that the prevalence of separation anxiety disorder among adults is even higher than it is among children (6% in adults versus 3% to 5% in children and adolescents). Most adults with separation anxiety disorder never had it as kids. More than 70% of adult cases started in adulthood.
About one-third of children with an untreated separation anxiety disorder carry the disorder into adulthood. However, even children whose separation anxiety resolves often end up with the effects of the illness in adulthood and they are more likely to develop other mental health disorders later in life.
Experiencing school avoidance and social dysfunction are also possible due to untreated separation anxiety disorder. Consequences from those symptoms can reverberate into adulthood.
The psychiatric community also adhered to the myth that separation anxiety disorder only affects children. Before the publication of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, a diagnosis of separation anxiety disorder was only considered if it started before the age of 18.
2. Myth: Individuals With Separation Anxiety Need Constant Attention
Fact: Individuals with separation anxiety disorder often require little attention when around their attachment figure or they express their need for attention in covert ways, such as through social media.
Some people living with an untreated separation anxiety disorder may appear clingy to their attachment figure or refusing to go alone into other rooms of the house.
However, people with separation anxiety disorder usually do not need constant attention. When they are not separated from the person or people they are emotionally attached to, they are fine and without symptoms.
However, when they anticipate separation from an attachment figure they get significant anxiety and will try hard to prevent the separation. Sometimes, this happens only when it is time to go to school or a birthday party or for a sleepover. With adults, they may experience anxiety when they have to travel on their own or go to work. Often the person won’t express any overt symptoms of anxiety but will complain of physical symptoms, such as headache or feeling sick to avoid the separation.
Nightmares about being separated from their loved ones or about harm coming to themselves or loved ones are a common occurrence, mirroring their fears about being separated from those they care about.
People with a separation anxiety disorder may express their anxiety by excessive contact with their attachment figure by social media. This attachment can include abnormally high amounts of messaging or by excessively checking-in to make sure that everyone is safe.
3. Myth: Separation Anxiety Disorder is Always Obvious
Fact: Separation anxiety disorder is frequently misdiagnosed or attributed to school or work avoidance.
Many of the symptoms of separation anxiety disorder are physical complaints that do not have a readily obvious link to anxiety:
- Fainting spells, dizziness and light-headedness
- Disturbed sleep, nightmares
- Nausea, vomiting or stomach pain
- Muscle cramps and pains
- Chest pain
- Heart palpitations
Often a diagnosis of an anxiety disorder is not even suspected or considered until after the physical causes of the symptoms are ruled out, which takes a great deal of time and effort, especially considering the diversity of the symptoms.
Even the anxiety symptoms are sometimes excused as “being clingy.” The anxiety symptoms tend to appear most often around school attendance and are often absent on non-school days, so the child may be incorrectly labeled as lazy or as not liking school.
A study of people with anxiety disorders demonstrated that separation anxiety disorder is often undiagnosed in adults and that missing the diagnosis can have serious consequences due to the nature of the disorder. Compared to other anxiety disorders, social anxiety disorder is:
- More disabling in multiple aspects of life functioning
- Having higher levels of comorbidity with other mental health disorders (about 88.5% of adults with separation anxiety had comorbid disorders)
- More treatment resistant, including for comorbid mental health disorders
Separation anxiety may develop unnoticed in a child by the over-attachment of a parent with a separation anxiety disorder. The parent may model excessive attachment behavior for the child to learn and may encourage the child’s excessive attachment to satisfy the parent’s own obsessive need for attachment.
4. Myth: Separation Anxiety is Just a Phase
Fact: Separation anxiety disorder is a persistent mental health disorder associated with adverse functional impairments.
An anxious reaction to separation from a parent is normal in very young children and is not considered to be a disorder. Part of healthy child psychological development includes learning to regulate their reaction to separation from their caregivers. Separation reaction symptoms usually peak by age nine to 13 months and decrease after 24 months when the child starts realizing that even though the caregivers are out of sight they will return.
Normal separation anxiety should be nearly resolved by 36 months, although it may arise again when the child starts attending school. Because separation anxiety is common in younger children, the diagnosis should be considered with caution before the age of five.
When a child, especially a school-aged child, begins to show impairments in normal functioning due to anxiety over being separated from caregivers, the diagnosis of separation anxiety may be considered.
Separation anxiety in anyone but a young child is abnormal, particularly if it results in physical or mental symptoms, and occurs outside of the very early childhood years. Referring to such anxiety as, “just a phase,” can result in the affected individual remaining undiagnosed and untreated.
5. Myth: Separation Anxiety isn’t a Legitimate Disorder
Fact: Separation anxiety disorder is a specific mental health disorder with symptoms and causes that set it apart from other anxiety disorders.
Separation anxiety disorder is a distinct mental health illness with the mental and somatic (psychologically-induced physical complaints) symptoms that are typical of all anxiety disorders. However, it is distinguished from other anxiety disorders by several characteristics:
- The symptoms only occur before and during separation from parents, a spouse or another person whom there is a close emotional attachment — sometimes including a pet
- Affected individuals are obsessed with unfounded worries that something may happen to their loved one if they are not together (such as the loved one will die, be involved in an accident or get kidnapped)
- Affected individuals are obsessed with unfounded worries that something may happen to themselves if they are not with their loved one
- Having an excessive fear of being alone (unlike most anxiety disorders, which involve fear of being around people)
Preliminary laboratory research using functional imaging of the brains of people with separation anxiety disorder have shown that there are structural and functional changes in the brain that appear to be responsible for the disorder and that these changes are different from other types of anxiety. This identification of specific, measurable physical changes in the brain that are specific to this disorder further demonstrates that this is a legitimate mental health disorder.
If you or someone you care about is affected by separation anxiety and co-occurring substance use disorder, The Recovery Village can help. Call to speak with a representative to learn how addiction treatment that also addresses co-occurring mental health disorders can help people reach their recovery goals.
Figueroa, Ana; Soutullo, Cesar; Ono, Yoshiro; Saito, Kashuiko. “Separation anxiety.” IACAPAP Textbook of Child and Adolescent Mental Health, 2019. Accessed June 10, 2019. Redlich, Ronny; Grotegerd, Dominik; Opel, Nils; Kaufmann, Carolin; Zwitserlood, Pienne; Kugel, Harold; et al. “Are you gonna leave me? Separation anxiety is associated with increased amygdala responsiveness and volume.” Social Cognitive and Affective Neuroscience, February 2015. Accessed June 10, 2019. Shear, Katherine; Jin, Robert; Ruscio, Ayelet; Walters, Ellen; Kessler, Ronald. “Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication.” American Journal of Psychiatry, June 1, 2006. Accessed June 10, 2019. Silove, Derrick; Marnane, Claire; Wagner, Renate; Manicavasagar, Vijaya; Rees, Susan. “The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.” BMC Psychiatry, March 10, 2010. Accessed June 10, 2019. Stone, Lisanne; Otten, Roy; Soenens, Bart; Engels, Rutger; Janssens, Jan. “Relations between parental and child separation anxiety: The role of dependency-oriented psychological control.” Journal of Child and Family Studies, January 18, 2015. Accessed June 10, 2019.
Figueroa, Ana; Soutullo, Cesar; Ono, Yoshiro; Saito, Kashuiko. “Separation anxiety.” IACAPAP Textbook of Child and Adolescent Mental Health, 2019. Accessed June 10, 2019.
Redlich, Ronny; Grotegerd, Dominik; Opel, Nils; Kaufmann, Carolin; Zwitserlood, Pienne; Kugel, Harold; et al. “Are you gonna leave me? Separation anxiety is associated with increased amygdala responsiveness and volume.” Social Cognitive and Affective Neuroscience, February 2015. Accessed June 10, 2019.
Shear, Katherine; Jin, Robert; Ruscio, Ayelet; Walters, Ellen; Kessler, Ronald. “Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication.” American Journal of Psychiatry, June 1, 2006. Accessed June 10, 2019.
Silove, Derrick; Marnane, Claire; Wagner, Renate; Manicavasagar, Vijaya; Rees, Susan. “The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic.” BMC Psychiatry, March 10, 2010. Accessed June 10, 2019.
Stone, Lisanne; Otten, Roy; Soenens, Bart; Engels, Rutger; Janssens, Jan. “Relations between parental and child separation anxiety: The role of dependency-oriented psychological control.” Journal of Child and Family Studies, January 18, 2015. Accessed June 10, 2019.
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