Separation anxiety disorder
(The psychiatry bible)
Separation anxiety disorder
- Developmentally 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)
- 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, stomach-aches, 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.
Early Onset: if onset occurs before age 6 years
Sensible Psychology Definition
Being fearful of being away from the familiar ‘comfort zone’ of a home or some other place or a particular person or people.
Fear of being parted from a beloved person is common in early childhood and is usually a significant component of childhood anxiety.
In the DSM, there is the criterion that this fear must have started before age 18 to qualify as true ‘separation anxiety’.
However, we have encountered numerous adults who have experienced the onset of such fears only in their adult years.
Separation worries, whether they occur in a 9 year old child going to school or a 49 year old businesswoman travelling to an out of town conference, manifest in exactly the same way.
So our sensible psychology definition knows no age restriction (1) when it comes to this debilitating anxiety.
Separation anxiety: What’s in a diagnosis?
It is important not to reach out for a psychiatric diagnosis of people’s problems too readily without very careful consideration of what should be considered a normal part of human experience.
Most children and many adults go through periods of feeling insecure and reluctant to be away from their emotional comfort zone for too long. Often this is a passing phase or indicative of wider back ground stress, such as starting a new job.
Feeling frightened to be apart from a particular person, particular people or a particular place can come about as a result of panic attacks or other stresses that can manifest at any time in life.
Separation anxiety and early learning
In children, it is important to look at early experiences and personality to gain an understanding of why this particular child may have developed separation anxiety.
Early separation from a loved parental figure, early conflict in the family and/or other stresses, ‘learning’ fear from an anxious parent or being overly protected and ‘molly-coddled’ can all condition a child to fear separation.
Children who develop very good levels of connection with their parents very early (as compared with kids who don’t bond so well with their care givers) tend to find it easier to be separated from their loved one and home. (2) So feeling more connected to your parents or parent may mean it’s less likely you’ll suffer separation anxiety.
Most children grow out of this fear and a ‘gently gently’ gradual approach, spending a little longer each day away from the comfort zone, until such time as the child can take their own comfort zone with them inside of themselves, so to speak, will resolve this issue.
Separation anxiety in adults
We’ve seen many adults who have found themselves feeling worryingly scared to be away from their partners, their home and even specific geographical areas such as their town, county or country. The origin of this fear may be anything from a single traumatic experience, a series of traumatic incidents, having confidence knocked by debilitating side effects of medication, relationship problems, to simply an excess of stress, however caused.
The fact is, being over-stressed can set off all kinds of psychological and physical manifestations, and in some people this translates to the ‘separation anxiety’ more commonly associated with young childhood.
The widespread use of email, texting and other forms of instant electronic communication may also exacerbate separation anxiety in adults (and children), in that we can feel ‘abandoned’ if we are not in constant email or text contact, or someone hasn’t replied for half an hour.
The impact of separation anxiety
Parents or carers of a child with separation anxiety can feel overwhelmed, guilty and sometimes even angry at the child – because living with someone who gets frightened if you’re out of sight for a while is a potentially huge stress in itself.
Adults living with another adult with this condition can feel as if their lives are being controlled, or even manipulated, as everything they do has to be okayed or vetoed by the person with the difficulty.
The individual who has the separation anxiety may find themselves getting even more fearful if they allow their fear to dictate their behaviour (because we tend to build more fear around what we avoid) and may lose out on opportunities to make new friends, maintain older friendships, make business or work contacts and enjoy life generally. And of course long term stress also has physical health implications. (3)
When separation anxiety lifts, a whole new world of possibility opens up.
Treatment for separation anxiety
Cognitive Behaviour Therapy (CBT) is commonly used to help children with separation anxiety, sometimes combined with play therapy and/or family therapy involving all the members of the family. Drug treatment is rare (fortunately, from our point of view), but anxiolytics and anti-depressants may be prescribed (see Drugs and medications). Adults with separation anxiety are more likely to receive medication.
The sensible psychology approach
Our view (backed by research) is that children can learn to be more confident. (4) We often use story therapy to help children adopt greater confidence and emotional independence, because stories can be the perfect medium for delivering psychotherapy in children.
Adults are also perfectly capable of learning new ways to manage insecurities and fears, though they may have more ingrained limiting beliefs and habits to overcome than children.
By focussing on and building up personal resources such as courage, optimism and self calming techniques, and by using hypnosis to rehearse greater emotional independence, most people, children and adults, can be helped out of separation anxiety pretty quickly.
- Cyranowski JM, Shear MK, Rucci P, Fagiolini A, Frank E, Grochocinski VJ, Kupfer DJ, Banti S, Armani A, Cassano G. (2001, December 27). Adult separation anxiety: psychometric properties of a new structured clinical interview. Journal of Psychiatric Research, 2002 Mar-Apr;36(2):77-86
- Kagan, J. (1983) ‘Stress and coping in early development’. In N. Garmezy and M. Rutter (Eds), Stress Coping and Development in Children. McGraw-Hill.
- See Glaser R and Kiecolt-Glaser J. (1988) Psychological influences on immunity. American Psychologist, 43.
- For example, the psychologist Robert O’Connor wanted to research how socially withdrawn preschool children could learn to integrate with other kids. You know, the sort of child who stands and watches their peers playing games but are too timid and shy to join in. O’Connor worried that a long-term pattern of isolation could result and persist even into adulthood unless the trend for social self-isolation was reversed early on. So he made a film containing eleven different scenes in a nursery-school setting. Each scene began by showing a different solitary child watching some ongoing social activity and then actively joining the activity, to everyone’s enjoyment. O’Connor then selected a group of the most severely withdrawn children from four preschools and showed them his film. The impact of showing the film to very shy, withdrawn children was amazing. The shy kids who watched the film immediately began to interact with their peers at a level equal to that of the normal children in the schools. Even more astonishing was what O’Connor found when he returned to observe six weeks later. While the withdrawn children who had not seen O’Connor’s film remained as isolated as ever, those who had viewed it were now leading their schools in amount of social activity. It seems that this twenty-three minute movie, viewed just once, was enough to reverse a potential pattern of lifelong social diffidence. See Cialdini, R., Influence: The Psychology of Persuasion
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