Fear of Separation: An Anxiety Disorder

When I first started going to pre- primary school, I saw my friends, including me, also crying so much before entering the classroom, hugging their parents tightly with a feeling of fear and did not want to come inside the classroom. At that time, I wondered why this happened, we cried, and behaved like this! But now, when I see the same situation of children in my workplace at school, as a psychologist, I understand that this is nothing but a distress of children as they are separated from their caregivers, which we term as Separation Anxiety.

 When human infants and infants of other species are separated from their parents or caregivers, they show distress and fear, which is known as separation anxiety. Around 4-5 per cent of children suffer from this condition. They often express this anxiety through different emotions, like either they cry or showing anger. It is a part of the development phase of each and every child. When they grow up, the level of separation anxiety disorders slowly reduces. For example, when a child enters the age of 5-6 years, the child can go to play with other children without any hesitation, and they learnt throughout the development that they are separated from their caregivers just for sometimes when they go to school or for other activities, and it’s a temporary process.

Is separation anxiety common in adults?

Several epidemiology studies have shown that 2% to 5% of children and adolescents have anxiety disorders at any point in time, and the earliest anxiety disorder to develop is separation anxiety disorder. Some children, although they develop properly with age both physically and mentally, have difficulties showing a sense of independence and continue to feel stressed when their loved ones or caregivers are not around. Even they have nightmares of separation anxiety and always become concerned over it.

This may continue till their adulthood. When these fears, anxiety and worry start in the early phase of a child and increase with other development stages, then it is called separation anxiety disorder. For example, a couple who have been dating for 10 years and live together, but one of them always feel worry about the partner at any time when he goes out to the office and continuously messages him or tries to connect, then in this situation we term this condition as separation anxiety disorder. 

Difference between Separation Anxiety and Separation Anxiety Disorder

Separation Anxiety is a normal and healthy adaptive response until the age of three years. It disappears with time and does not create any difficulties in functioning. Here, medical or psychological treatment is not required.

 If it goes beyond and occurs with children from four years to above, then it becomes separation anxiety disorder. It can persist for many years, depending on the level and cause a significant impact on daily functioning. It required proper medical or psychological treatment under experts.

What are the actual signs and symptoms of Separation Anxiety Disorder?

Diagnostic and Statistical Manual ( DSM) 5 describes that the signs and symptoms should last in children and adults for at least 3-4 weeks, and three of the eight types of symptoms must be present. The categories of these symptoms are: 

1. A person should experience excessive distress when they are separated from their attachment figure or loved one.
2. Always worry about the loss of an attachment figure or harm to them, like getting into an accident while travelling or dying from an illness.
3. A person worries about some events that can separate them 
4. Unwillingness to leave home for fear of separation 
5. Fear of being alone
6. Reluctance to sleep without an attachment figure 
7. Nightmares related to separation 
8. Physical symptoms like a headache or stomachache

Read More: Childhood Fears and Their Relation to Mental Health Disorders

The actual causes of SAD, both in children and adults, are mentioned below:

1. Genetic and biological factors: If there is a family history related to anxiety disorder, especially from parents, then sometimes it will increase the chances of developing it in the children. 
2. Brain Chemistry: Our brain activities and chemicals are strongly involved in our lives. If there are any difficulties in our neurotransmitters, such as serotonin and norepinephrine, it can lead to anxiety. It also has an effect on the amygdala, a part of the brain that is responsible for the fear factor. If there is an imbalance, the amygdala contributes to a high level of fear and anxiety, which causes separation anxiety disorders.
3. Childhood Trauma:  Children who faced separation in their early life, for example, divorce of parents, moving to hostels during the early stage of life, death of a close one or moving to a new city or school every year, must be the reason for it. 
4. Overprotective Environment: Some parents or caregivers are overprotective towards their children or loved ones. Even if they are not allowed to go outside without their parents, this may lead to fear and dependency and increase the level of separation anxiety among those children.
5. Substance abuse: Research shows that consuming high levels of alcohol and drugs daily can increase the chances of separation anxiety because it affects our brain chemistry and behaviour. Even if a pregnant mother takes alcohol or drugs during her pregnancy, it will immediately affect the baby, and after that, it may cause anxiety.

Read More: Why Childhood Trauma Can Lead to Obsessive Thinking and Perfectionism

Treatment for Separation Anxiety Disorder:

• Cognitive Behavioural Therapy (CBT): During cognitive Behavioural Therapy, a person with separation anxiety can learn how to face and manage the distress and thoughts about uncertainty and fear of separation.

• Family Therapy: Family therapy, it raises awareness and educates the family about separation anxiety disorder. It helps to change the family patterns and improve the relationships in a better way. Also, it provides new techniques to the parents on how to treat those who have separation anxiety disorder, to learn how to support emotionally and encourage confidence.

• Exposure therapy: Here, the triggered situation is explored in front of the person who has this disorder to manage anxiety and feel confident. But this therapy does not apply to all.

• School Involvement:  The environment of a school is another successful key to this treatment. The supportive environment of school helps a child to form a positive connection, security and improve the level of coping skills. Use of positive reinforcement helps to develop a stronger connection to them. 

There is no specific medicine for separation anxiety disorder. If other types of therapy and treatments become ineffective, then some Antidepressants and some other medicines are used only for adults. This is a decision that the child’s parents and adults are carefully considering. Separation Anxiety disorder can be cured, but with experts and with proper diagnosis, support and treatment.

References +

Ray, William J (2015), Separation Anxiety Disorder, Abnormal Psychology, Neuroscience Perspectives on Human Behaviour and Experience, 304-317.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.), 115