Separation Anxiety Disorder

What is Separation Anxiety Disorder?

Separation anxiety disorder (SAD) is a type of anxiety disorder that causes people to feel excessive fear or distress when they are separated from their home or from someone they are emotionally attached to, such as a parent, partner, or friend. People with SAD may worry that something bad will happen to them or their loved ones if they are apart, such as getting lost, kidnapped, injured, or killed. They may also have unrealistic concerns about their own ability to cope without their attachment figure. SAD can affect people of any age, but it is more common in children and adolescents. SAD can interfere with daily functioning and quality of life, and may lead to complications such as academic problems, social isolation, or low self-esteem. SAD can be treated with psychotherapy, medication, or a combination of both.

What causes Separation Anxiety Disorder?

Separation anxiety disorder (SAD) can have various causes, depending on the person’s age, personality, history, and environment. Some of the possible causes and risk factors of SAD are:

• Traumatic events: People who have experienced a traumatic event, such as abuse, neglect, loss, illness, or injury, may develop SAD as a way of coping with the fear and stress of being separated from their loved ones or their safe place. Trauma can also affect the brain’s development and functioning, making people more vulnerable to anxiety disorders.
• Family history: People who have a family history of anxiety disorders or SAD may have a genetic predisposition to developing the condition. They may also learn anxious behaviours from their parents or relatives, or inherit certain temperamental traits that make them more prone to anxiety.
• Life stressors: People who are going through stressful life events, such as moving, divorce, death of a loved one, or change in school or work, may experience SAD as a reaction to the uncertainty and loss of stability. Stress can also affect the body’s hormonal balance and immune system, making people more susceptible to anxiety.
• Changes in environment: People who are exposed to new or unfamiliar situations, such as traveling, staying in a different place, or meeting new people, may feel anxious and insecure about being separated from their home or their attachment figure. They may also perceive the new environment as threatening or unpredictable.
• Insecure attachment style: People who have an insecure attachment style that is anxious or ambivalent may have difficulty trusting and relying on others. They may fear abandonment or rejection from their loved ones, and seek constant reassurance and validation. They may also have low self-esteem and self-confidence.

SAD can be triggered or worsened by any of these factors, or by a combination of them. However, it is important to remember that SAD is not a sign of weakness or immaturity. It is a treatable condition that can be overcome with professional help and self-care strategies.

What are the symptoms of Separation Anxiety Disorder?

Separation anxiety disorder (SAD) can manifest in different ways, depending on the person’s age, personality, and situation. However, some common symptoms and signs of SAD are:

• Excessive fear or anxiety when separated or anticipating separation from home or from a person they are emotionally attached to, such as a parent, partner, or friend. This fear or anxiety may be out of proportion to the actual threat or danger of separation, and may persist even after the separation is over.
• Panic attacks or anxiety attacks when separated or anticipating separation. These are sudden episodes of intense fear or discomfort that may involve physical symptoms such as racing heart, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, or numbness. They may also involve psychological symptoms such as feeling detached from reality, losing control, or fearing death.
• Nightmares or trouble sleeping alone. People with SAD may have recurring bad dreams about being separated from their loved ones or their home. They may also have difficulty falling asleep or staying asleep without being near their attachment figure. They may insist on sleeping in the same room or bed as their loved one, or require a nightlight, a stuffed animal, or a phone call to feel safe.
• Physical complaints, such as headaches, stomachaches, or nausea. People with SAD may experience these symptoms when they think about or face separation from their loved ones or their home. These symptoms may be a way of expressing their emotional distress, or a way of avoiding separation by staying home or seeking medical attention.
• School refusal or difficulty attending school or work. People with SAD may have trouble leaving their home or their attachment figure to go to school or work. They may feel anxious about being away from their safe place or their loved one, and worry about what might happen to them or their loved one while they are apart. They may also fear being judged or rejected by their peers or colleagues. They may make excuses, fake illnesses, throw tantrums, or beg to stay home.
• Clinginess or excessive dependence on the attachment figure. People with SAD may show extreme attachment behaviours, such as following their loved one around, holding on to them tightly, demanding constant attention and reassurance, or refusing to let them go. They may also have difficulty doing things on their own, such as playing, studying, working, or making decisions. They may rely on their loved one for everything and feel helpless without them.
• Difficulty making friends or participating in social activities. People with SAD may isolate themselves from others and avoid social situations that involve separation from their loved one or their home. They may feel anxious about meeting new people, joining groups, attending parties, or going on trips. They may also have low self-esteem and confidence and feel insecure about their social skills.
• Reluctance to leave the house or travel. People with SAD may have a strong preference for staying at home or near their attachment figure. They may avoid going out for fun, shopping, visiting relatives, or exploring new places. They may also refuse to travel by car, bus, train, plane, or boat because of the fear of being separated from their loved one or their home.
• Repeated phone calls or texts to check on the attachment figure. People with SAD may feel the need to constantly contact their loved one when they are apart. They may call or text them frequently to make sure they are safe and well, to tell them they miss them and love them, or to ask them when they will be back. They may also get anxious if they don’t hear from their loved one for a while and assume something bad has happened to them.

These symptoms can cause significant distress and impairment in the person’s daily functioning and quality of life. They can also affect the person’s relationships with their family members, friends, teachers, coworkers, and others. Therefore, it is important to seek professional help if you or your loved one has SAD.

How is Separation Anxiety Disorder diagnosed?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Diagnostic Criteria for Separation Anxiety Disorder is as follows:

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.

D. The disturbance is not better explained by another mental disorder, such as refusing to leave home because of excessive resistance to change in autism spectrum disorder; delusions or hallucinations concerning separation in psychotic disorders; refusal to go outside without a trusted companion in agoraphobia; worries about ill health or other harm befalling significant others in generalized anxiety disorder; or concerns about having an illness in illness anxiety disorder.

How is Separation Anxiety Disorder treated?

Separation anxiety disorder (SAD) can be effectively treated with psychotherapy, medication, or a combination of both. The type and duration of treatment may vary depending on the person’s age, severity of symptoms, and preference.

• Psychotherapy. Psychotherapy, also known as talk therapy or counseling, involves working with a mental health professional to reduce separation anxiety symptoms and improve coping skills. The most common form of psychotherapy for SAD is cognitive-behavioural therapy (CBT), which helps people identify and challenge negative thoughts and beliefs that fuel their anxiety, and learn to face their fears gradually and safely. CBT may also involve relaxation techniques, such as deep breathing, progressive muscle relaxation, or guided imagery, to help people calm their physical and emotional arousal. CBT can be delivered individually, in groups, or with family members. Other forms of psychotherapy that may be helpful for SAD include interpersonal therapy, which focuses on improving relationships and communication skills; psychodynamic therapy, which explores the underlying causes and meanings of anxiety; and play therapy, which uses toys, games, and art to help children express their feelings and thoughts.
• Medication. Medication can help reduce the symptoms of anxiety and make psychotherapy more effective. The most commonly prescribed medications for SAD are antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), which work by increasing the levels of certain chemicals in the brain that regulate mood and emotion. Antidepressants may take several weeks to show their full effect, and may cause some side effects, such as nausea, headache, insomnia, or weight gain. Other types of medication that may be used for SAD include anti-anxiety drugs, such as benzodiazepines or buspirone, which have a faster onset of action but may also cause drowsiness, dependence, or withdrawal symptoms; or beta-blockers, which block the effects of adrenaline and reduce the physical symptoms of anxiety, such as racing heart or trembling. Medication should be prescribed by a qualified doctor who can monitor the dosage, effectiveness, and safety of the treatment.
• Combination. Some people may benefit from a combination of psychotherapy and medication for SAD. This may provide a more comprehensive and holistic approach to addressing the psychological and biological aspects of anxiety. However, the combination may also increase the risk of side effects or interactions between different treatments. Therefore, it is important to consult with a mental health professional who can recommend the best treatment plan for each individual case.

SAD can be a challenging condition to cope with, but it can be overcome with professional help and self-care strategies. In the next section, I will discuss some tips for managing SAD.

How can you manage your Separation Anxiety Disorder?

Separation anxiety disorder (SAD) can be a difficult condition to cope with, but there are some strategies and tips that can help you manage your symptoms and improve your quality of life. Some of them are:

• Learn about the condition and its causes. Educating yourself about SAD can help you understand your condition better and reduce the stigma and shame associated with it. You can read books, articles, or websites that provide reliable and accurate information about SAD.
• Seek professional help from a mental health provider. You can also talk to your GP and/or mental health professional who can explain the nature and treatment of SAD. They can provide you with psychotherapy, medication, or a combination of both, depending on your needs and preferences. They can also monitor your progress and adjust your treatment plan accordingly.
• Practice relaxation techniques. Relaxation techniques, such as deep breathing, progressive muscle relaxation, meditation, or yoga, can help you calm your body and mind when you feel anxious or stressed. They can also help you cope with panic attacks or anxiety attacks by reducing the physical and emotional arousal that they cause. You can practice these techniques regularly or whenever you need them.
• Maintain a healthy lifestyle. Taking care of your physical health can also benefit your mental health. Eating well, sleeping enough, exercising regularly, and avoiding alcohol, drugs, caffeine, and nicotine can help you boost your mood, energy, and immunity. They can also help you prevent or manage some of the physical symptoms of SAD, such as headaches, stomachaches, or nausea.
• Stay connected with supportive friends and family members. Having a strong social support network can help you cope with SAD and reduce the feelings of loneliness and isolation that it may cause. You can reach out to your friends and family members who understand your condition and offer you emotional support, practical help, or companionship. You can also share your feelings and thoughts with them and ask for their advice or feedback.
• Seek support groups or online communities for people with similar experiences. Joining a support group or an online community for people with SAD or other anxiety disorders can help you feel less alone and more understood. You can meet people who have gone through similar challenges and learn from their experiences and coping strategies. You can also offer your own support and encouragement to others who may need it.

These are some of the tips that can help you manage your SAD. However, remember that everyone is different and what works for one person may not work for another. Therefore, it is important to find what works best for you and stick to it.

I hope this article has helped you understand more about separation anxiety disorder and how to manage it. If you have any questions, please feel free to ask.