Separation Anxiety: The anxiety of being away from your loved one

Remember when you were a kid and got separated from your mom at the grocery store? Did you ever fear you were going to be abandoned somewhere when you didn’t see your parents around? Remember how scary that was? That was you experiencing separation anxiety. Find out what it is, how it affects us, how to treat it and tips in this article!

Separation Anxiety

Separation Anxiety

What is separation anxiety?

Separation anxiety, also known as separation anxiety disorder, is the fear and distress that one feels as a child and an adult when they think about being separated from home or from the people they are attached to. Everyone experiences anxiety but what makes separation anxiety different is when the anxiety exceeds what would be expected at someone’s developmental level and age. Separation anxiety is what helped keep our ancestors alive and it’s how children learn how to master their surroundings.

Within the U.S., separation anxiety is most common with people under the age of 12. The numbers range between .09% and 1.9% of children and 1.6% within adolescents who have separation anxiety. The condition is equal among both males and females.

What are the symptoms?

Some common symptoms include:

  • Worrying about harm happening to the major attachment figures
  • Refusal to leave home, work, school, or other places due to a fear of separation
  • Extreme and excessive distress when separated from the attachment figure or home
  • Too much worry about an unexpected negative event happening. Such as becoming ill or getting lost, that leads to a separation from the attachment figure.
  • Constant fear of being alone or being without the attachment figures. This is seen in children as “clinging” behavior.
  • Nightmares involving separation from the attachment figure or from home
  • Repeated physical complaints such as headaches or nausea when separated from the attachment figure or home.
  • Refusal to sleep away from home or go to sleep without the attachment figure nearby

What are the causes?

The overall causes are unknown, but some risk factors are known. It commonly happens after a big life stressor, like a loss. This loss can be the death of a pet, loved one, change of school, divorce, or a separation from loved ones for a period of time. Having overprotective or intrusive parents can also be a cause. There are lots of studies that have looked and this and believe it’s because having a parent who is always there and then suddenly isn’t can be cause for anxiety. The cause isn’t proven to be genetic yet, but there is research that hints that the condition could be genetic.

Separation anxiety is more likely to occur in children who:

  • Have a family history of depression or anxiety
  • Have issues in dealing with kids their own age
  • Are timid and shy
  • Don’t have good parental interactions
  • Have overprotective parents
  • Have low economic status

After stressful life events, separation anxiety typically occurs, as well. Such events can be but are not limited to:

  • Moving homes, cities, or schools
  • Divorce
  • New siblings
  • Family stress and tension
  • The death of a close family member

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How to diagnose separation anxiety?

While separation anxiety is normal for the first few years of one’s life, the anxiety becomes an issue when it’s too excessive for one’s age or developmental level and when beings with it some sort of dysfunction in someone’s life. In order for the anxiety to be considered a disorder, a doctor looks for distress by being separated from attachment figures in a way that is excessive for that person’s age. Sometimes the doctor can watch a parent and child play and interact in order to see if there is an underlying cause of the anxiety stemming from the parental relationship.

These symptoms must be expressed for a minimum of four weeks (children and adolescents) and six months (adults). These symptoms also must cause some sort of impairment in school, occupational, or personal daily life as a result of the anxiety.

During the diagnosis process, there is typically a health-care professional who had experience and training in understanding anxiety symptoms in children. For example, a pediatrician, child psychologist, or a child psychiatrist who interviews both the parents and the child separately. The interview with the child must be separate from that with the parents and vice versa because children and their parents will see the situation very differently and it can be quite difficult for children to hear their problems discussed. The professional will not only explore the option of separation anxiety but also other mental health issues to be sure of the diagnosis.

Assessment methods

The assessment methods can range from interviews to self-report measures to observation. The most common interviews used are the:

  • Anxiety Disorders Interview Schedule for the DSM-IV, Child-Parent Versions (ADIS-IV-C/P)
  • Diagnostic Interview Schedule for Children, Version IV (DISC-IV)
  • Schedule for Affective Disorders and Schizophrenia for School-aged Children-Present and lifetime version IV (K-SADS-IV)
Separation Anxiety

Separation Anxiety

How does it vary by age?

Separation anxiety is normal in every child’s development. It usually ends around age two when a child realizes that a parent who is out of sight at that moment will return later.

Children who have separation anxiety usually:

  • Cling to their parents excessively
  • Refuse to go to sleep without being near a parent or an attachment figure
  • Be unwilling to go camping or have a sleepover at a friends house
  • Require someone to go with them to another room in their own home
  • Headaches, nausea, vomiting

Adults who have separation anxiety usually:

  • Have nightmares about separating from someone with whom they are attached
  • Are not comfortable traveling alone or independently
  • Are overly concerned with their spouse or kids and check on them continuously

How does it vary by type of relationship?

Separation anxiety differs between different ages and types of relationships. However, it remains under the same idea: whether we are separating from our caregivers or our romantic partners, we are being separated from an attachment figure.

With children and parents, separation anxiety shows up in the sense of not wanting to be left. Whether the anxiety stems from the child not wanting to be left behind or from the parent not wanting to leave the child, there is anxiety and everyone feels it. One study was done by the Universtiy of Georgia about mothers who felt separation anxiety unsurprisingly found that mothers will experience higher levels of separation anxiety when their babies are ill- for example, with colic.

With romantic partners, it means always wanting to be with them. For example, think about how partners always try to be on the phone with each other and connected together in some way or another. A study done by the University of Utah found that couples who were away from each other between 4-7 days found it harder to sleep while away from each other. They became anxious about their relationships in general. The study even found that emotional outcomes are worse for separated couples. These bad emotional outcomes are brought on by an increase in cortisol, the stress hormone. The only thing that faintly took away the rise in cortisol was a long phone conversation. Emails, texts, and voice messages were proven ineffective in alleviating the negative experiences brought on by the separation.

How does it affect the brain?

Our brain is affected in ways that can be detrimental when it constantly feels anxiety. Our sympathetic nervous system that is in charge of our fight-or-flight mode goes crazy. This can lead to wear-and-tear on the body as well as constant fatigue. There is an influence on our long-term and short-term memory as well as in our chemical production which causes a chemical imbalance. Many also have issues falling asleep. About 54% of people say that their anxiety and stress affects their ability to drift off to sleep. There can also be complete changes in the brain- like with our ability to focus. 50% of men and 40% of women have said that they have trouble focusing if they’re anxious.

How does it affect the organs?

If we have constant anxiety, our organs can be severely damaged. Our heart can develop an array of cardiovascular problems. Our stomach and digestive tracts can lead to changes in our metabolism. One study found that a constant release of cortisol into our bloodstream will create an insensitivity and resistance to insulin. Our immune system will become less resistant. Our lungs will be weaker. Studies have shown a connection between those with anxiety and those with asthma.

Separation Anxiety

Separation Anxiety

How long does separation anxiety last?

In children, there are two peaks of separation anxiety. The first peak lasts about two to four months and happens when a baby is about six months old. About a year later, there is a second peak that happens once babies start to learn a language and have the desire to communicate. This peak usually fades once language skills improve.

Separation anxiety and types of attachment

There are four types of overall attachment styles.

A secure attachment means that people are able to regulate their positive and negative emotions, and they don’t worry about others acceptance. This attachment style stems from a warm and responsive history with their attachments- like parents, spouses, and kids.

There are three types of insecure attachment.

  • An anxious-preoccupied attachment means that someone would like to be as close as possible and intimate to someone else, but they find that others are reluctant to get as close as they would like. These people also feel that they value others more than others value that person. People with anxious-preoccupied attachment doubt their self-worth, have high emotional expressiveness, emotional dysregulation, impulsiveness, and worry.
  • A dismissive-avoidant attachment means that the person is comfortable without having close, emotional relationships because they need to feel independent and self-sufficient. They prefer that others depend on them. Often, they hide their feelings and deal with rejection by distancing themselves from the sources of rejection, such as their attachments.
  • A fearful-avoidant attachment typically shows up in people with severe loss or traumas, like childhood sexual abuse. They are not comfortable getting close to others. Although they want emotionally close relationships, they have issues with trust. They will seek less intimacy from the attachments and deny or suppress their feelings. They aren’t comfortable expressing affection.
Separation Anxiety

Separation Anxiety

Separation anxiety treatments

Separation anxiety comes with a multitude of treatments. Non-medication treatments are the first choice among professionals. However, there are also medicinal treatments if all else fails.

Separation anxiety: Non-medication

There are two commonly used non-medicinal treatments. Psychoeducational intervention is commonly used with other therapeutic treatments. A psychoeducational intervention means that the individual, family, and close friends are educated so they become knowledgeable about separation anxiety. Psychotherapeutic intervention is used when other prior attempts weren’t successful. This type of intervention includes behavioral, cognitive-behavioral, psychodynamic psychotherapy, and family therapy.

Behavioral therapy is used as a non-medication method and uses exposure-based techniques in hopes of easing the anxiety in the long-run. It can use treatments such as systematic desensitization, contingency management, and emotive imagery. The exposure happens slowly in order to reduce the anxiety overtime and be able to mainly focus on the behavior stemming from the anxiety. Cognitive Behavioral Therapy is a form of behavioral therapy that focuses on helping to reduce the feelings of anxiety by practicing exposure to anxiety-inducing situations and active metacognition in order to reduce the anxious thoughts.

Contingency management is a treatment that is most effective with younger children with separation anxiety. It revolves around a reward system with verbal or physical reinforcement. It also requires parental involvement. A written contract between the child and parent is written. The contract mentions specific goals that the child will try to reach. Once the goal is reached, the parent will provide a reward. The ultimate goal is to show signs of independence. Young children who have symptoms of separation anxiety don’t yet have the communicative abilities to express their emotions or their self-control which is why parental involvement is essential.

Separation Anxiety: Medication

Medication is also used but only in extreme cases when all other treatments have failed. There are many mixed results with those who take medication that it’s hard to say if it’s actually effective or not. There is no specific medication for separation anxiety. The medication usually prescribed for adults have also proven to be effective in children and adolescents, as well.

Tricyclic antidepressants (TCAs) are used, but they bring along mixed results. It’s been proven to be useful for kids who have a “school phobia” as well as separation anxiety. However, other studies have used the medication and a placebo and found that the placebo had the same effect.

The medication with the most promise is selective serotonin reuptake inhibitors (SSRIs) in both children and adults. More than a few studies have found that those patients who were treated with fluvoxamine were notably better than those who were treated with a placebo. Those treated with the selective serotonin reuptake inhibitor were found to have decreased anxiety symptoms with both short-term and long-term medication.

Many people also turn to animals, such as cats and dogs, as a relief from anxiety. Those with an emotional support animal (ESA) believe that the difference between unmanageable anxiety and manageable anxiety could simply be a pet. One study found that married couples who owned pets had a lower heart rate, lower blood pressure, milder stress responses, and a faster recovery time from stress when they were with their pets rather than their spouse.

Because separation anxiety is rather treatable, especially when caught early on, the prognosis is really good.

Separation Anxiety

Separation Anxiety

Tips to help separation anxiety

  • Practice separation. Leave for brief periods of time. Gradually leave for longer periods of time.
  • Develop quick goodbye rituals. Rituals are reassuring and can be a simple goodbye kiss or wave. It’s important not to make it a bigger deal than it is.
  • Try meditation. This can help relieve the overall anxiety in one’s life.
  • Minimize scary movies or shows. A person is less likely to experience anxiety and fear if the media they see isn’t fearful.
  • Have a consistent caregiver. This keep consistency and familiarity within the child’s life.
  • Be matter-of-fact. For example, “I understand that you are upset that I have to go to the kitchen, but I need to make dinner.”
  • Try anti-anxiety medication. This can help ease some of the overall symptoms.
  • Keep promises so your child knows that you will be coming home and that you can be trusted.
  • Change parenting technique. Sometimes a change of parenting can help give the child the boost they need for overcoming their anxiety.
  • Schedule departures after naps and mealtimes because the child will be less susceptible to feel anxiety because they won’t be tired or hungry.
  • Try not to give in to the anxiety and assure the child that everything will be okay
  • Be sure not to stress yourself out, too.

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