The essential feature of Separation Anxiety Disorder is excessive anxiety concerning separation by a child from the home or from those to whom the person is attached. This anxiety is beyond that which is expected for the individual's developmental level.

Children with Separation Anxiety Disorder tend to come from families that are close-knit. When separated from home or major attachment figures, they may recurrently exhibit social withdrawal, apathy, sadness, or difficulty concentrating on work or play.

Depending on their age, individuals may have fears of animals, monsters, the dark, muggers, burglars, kidnappers, car accidents, plane travel, and other situations that are perceived as presenting danger to the integrity of the family or themselves. Concerns about death and dying are common. School refusal may lead to academic difficulties and social avoidance. Children may complain that no one loves them or cares about them and that they wish they were dead. When extremely upset at the prospect of separation, they may show anger or occasionally hit out at someone who is forcing separation.

When alone, especially in the evening, young children may report unusual perceptual experiences (e.g., seeing people peering into their room, scary creatures reaching for them, feeling eyes staring at them).

Children with this disorder are often described as demanding, intrusive, and in need of constant attention. The child's excessive demands often become a source of parental frustration, leading to resentment and conflict in the family. Sometimes, children with the disorder are described as unusually conscientious, compliant, and eager to please. The children may have somatic complaints that result in physical examinations and medical procedures.

Depressed mood is frequently present and may become more persistent over time, justifying an additional diagnosis of Dysthymic Disorder or Major Depressive Disorder. The disorder may precede the development of Panic Disorder With Agoraphobia.

Specific Symptoms of 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 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, stomachaches, 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.  

 

Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

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Last reviewed: By John M. Grohol, Psy.D. on 16 Oct 2010
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