How To Deal With Separation Anxiety

Anxiety is the world’s most commonly experienced mental health condition, one that can take many forms – including separation anxiety.

Separation anxiety is a type of anxiety experienced most frequently during early childhood, although older children, adolescents, and adults can suffer from this difficult type of anxiety.

This article will explain the theories behind separation anxiety and are outlined alongside suggestions for dealing with separation anxiety in children and adults.

At The Center • A Place for HOPE, we have 38 years of leadership treating mental health issues including anxiety, childhood trauma, and dysfunctional relationships. Our articles are written to help you to understand what might be happening in your own life, and to suggest helpful ways to deal with your issues.

 

Ancestral, attachment theory, and separation anxiety

To understand separation anxiety, it’s important to understand the theory of how humans evolved to build relationships with each other.

From the beginning, humans were wired to best operate within a group. Individuals who relied upon themselves without anyone to protect them were more likely to starve, end up as prey, or a lack of procreation would mean their genes would simply die out. On the other hand, those ancestors who operated in groups had an advantage over those operating as individuals. We are descended from the ancestors who successfully survived (those who operated in groups) which explains why humans continue to need close contact with others.

This need for contact with others begins at birth and the first year of an infant’s life is critical. Babies are incredibly vulnerable, relying on caregivers for their survival. Our early relationships with these caregivers form the foundation for how we all make sense of our place in the world alongside others. This is known as attachment theory and was developed by John Bowlby in 1958^[1].

You can read more about attachment theory and its impact on adult relationship patterns here.

According to attachment theory, babies with caregivers who are consistent, responsive, and tuned in to the baby’s needs and moods, develop a bond which is known as secure attachment. This happens between the ages of 6-24 months.

 

What is separation anxiety?

At the same stage of development, infants can become distressed when parted from their primary caregivers, often expressing their distress through following or calling out to their departing caregiver or crying.

This is known as separation anxiety, and it is a normal developmental process designed to keep the infant close to their caregiver in order to maximize protection and therefore survival.

 

Separation anxiety in children

Separation anxiety is a universal developmental process that usually peaks between 12-18 months, and its effects can differ from person to person.

One of the main factors in determining severity of separation anxiety is how much experience an infant has of being separated from their caregiver, with those unaccustomed to being apart exhibiting greater distress.

Likewise, infants who have several caregivers exhibit less separation anxiety. Caregivers’ behavior before any separation also has an impact, as preparing infants for the separation, suggesting an activity to do during the separation, and returning after a short period seems to reduce levels of distress.

A study in 1978^[2] found that securely attached infants express distress at being separated from a caregiver, and their separation anxiety decreases when the caregiver returns. For insecurely attached infants, the response may be either more magnified or less apparent distress when the caregiver leaves. Notably, their separation anxiety may not reduce on the return of their caregiver.

By around two years of age, children’s brains have typically developed the cognitive and behavioral capacity to tolerate periods of separation. However, for some children, separation anxiety continues until the age of three or four which coincides with beginning pre-school activities.

 

Diagnosing Separation Anxiety Disorder

Beyond this point, children experiencing separation anxiety may be diagnosed with Separation Anxiety Disorder (SAD), which is defined by the American Psychiatric Association (APA) as:

Separation Anxiety Disorder is an excessive display of fear and distress when faced with situations of separation from the home and/or from a specific attachment figure. The anxiety that is expressed is categorized as being atypical of the expected developmental level and age. The severity of the symptoms ranges from anticipatory uneasiness to full-blown anxiety about separation.

The symptoms for those under 18 years must be present for at least four weeks.
Parents and caregivers may begin to suspect their child is suffering from symptoms that could be diagnosed as Separation Anxiety Disorder if they display at least three of the following criteria:

• Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures
• Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death
• 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
• Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
• Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
• Repeated nightmares involving the theme of separation
• Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated

 

How common is Separation Anxiety Disorder?

Separation Anxiety Disorder is the most frequently occurring anxiety disorder in children and adolescents, according to a 2009 study^[3], and is thought to affect up to 50% of the anxiety disorders referred for mental health treatment. Girls are affected more frequently than boys.

 

What are the causes of separation anxiety?

The exact cause of separation anxiety is unknown, but there are several factors that can contribute to developing the disorder. These include the death of a loved one or pet, changing schools, divorce/separation of parents, or a disaster of some kind that separates an individual from their loved ones.

In some cases, parental overprotectiveness or intrusiveness may be associated with Separation Anxiety Disorder.

 

Separation Anxiety Disorder in adults

Until 2013, Separation Anxiety Disorder only appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in relation to under 18s. However, it is now considered a diagnosable condition for adults, and is believed to affect around 7% of adults. For those who experienced Separation Anxiety Disorder in childhood but did not receive treatment, around ⅓ will continue to suffer symptoms of Separation Anxiety Disorder into adulthood.

The DSM-V (the current version of the DSM) specifies a duration of six months in order to diagnose Separation Anxiety Disorder in adults.

Young adults with Separation Anxiety Disorder may display different symptoms. These may include difficulty and anxiety around leaving their parents’ home, beginning a romantic relationship, and/or becoming a parent themselves.

 

How to manage separation anxiety

Practice short periods of separation

This can be as simple as telling your child you are going into a different room, leaving for a few minutes, and then announcing your return. Children may be confused or emotional initially, but will soon learn that you always come back.

Practice this over a period of days and weeks, if possible. You can increase the period of time you are apart from the child, ensuring that they are safe and not in any danger while you are in a different room.

Set the scene

Clearly explain to the child what is going to happen and who will be caring for them in your absence. A photograph of the nanny or teacher can be helpful to refer to.

Talk about what you will do together when reunited. Plan something you both enjoy, where possible.

Where possible, make sure the child is not hungry, sick, or tired before the period of separation, as this can worsen feelings of anxiety.

Give the child plenty of love and reassurance before leaving.

Honor the child’s emotions

It can be very distressing to see a child crying, upset, or asking you to stay. It’s tempting to try to minimize the child’s distress by saying they are being silly or that their reaction is disproportionate.

Try to remain calm and understanding, acknowledging the child’s feelings and reassuring them that you will return.

If you are also feeling anxious or upset, the child may pick up on these feelings so try to find ways to steady yourself before a separation.

While it can be tempting to sneak away while the child is distracted, this can make future separations more difficult so try to remain confident and steady. Smile and remind your child that you will return.

Transitional objects can help with separation anxiety

A transitional object is a meaningful item that can help bridge the transition between home and nursery, or when a child is separated from their caregiver. Research^[4] has shown that children routinely touch their transitional objects during periods of separation, and that transitional objects reduce separation anxiety.

Many of us use transitional objects without even realizing, such as meaningful jewelry (e.g. wedding rings, lockets), a photo in a wallet, a particular fragrance, song, or item of clothing etc. They are the keepsakes we cherish that remind us of another person, another time, and another place, all of which can evoke happy thoughts and memories, and make us feel secure.

For children, typical transitional objects include plush toys, stuffed animals, security blankets, or bottles/pacifiers, but there are plenty of creative ways you can help your child to find something that holds meaning for them.

Examples of transitional objects for children suffering with separation anxiety include:

• An item of your clothing that smells like your fragrance, such as a scarf, handkerchief, or a ribbon tied to the child’s backpack
• A small rock or pebble, perhaps found on a family trip together. You could decorate it together to make it extra special
• A picture of you and/or other members of the family, pets etc. Laminating the picture will make for a more robust transitional object!
• A sticker or badge attached to their shirt (and a matching/complementary sticker or badge attached to your clothing, where appropriate)
• A hand-drawn tattoo on their hand. Again, you could place the side of both your hands together, and then draw a picture. You each have half a picture that is whole when you are reunited.
• Where age-appropriate, there are items of jewelry that work along the same lines i.e. you each wear a half that makes up a whole when together.

The final three items on this list are important as it’s not uncommon for parents and caregivers to also experience separation anxiety when away from their child. Transitional objects such as photos or videos on their phones can be helpful in reducing this anxiety.

 

Treatments for Separation Anxiety Disorder

For those suffering with clinically-diagnosed Separation Anxiety Disorder, there are several treatment options.

Behavioral and Cognitive-Behavioral therapies focus on modeling and rewarding positive behavior, and systematic desensitization. Systematic desensitization involves exposing a sufferer of Separation Anxiety Disorder to increasingly challenging scenarios over a period of time, designed to expand the patient’s tolerance of the anxiety in order that they experience little or no difficulty before moving on to the next scenario.

Family therapy involves working with a mental health professional to look at the dynamics within the family, exploring family history, possible triggers, and emotional regulation. This equips parents/caregivers to support their child, as well as supporting the child to better understand why they might be experiencing Separation Anxiety Disorder.

Pharmacological treatments may be appropriate, such as anti-anxiety medication, and are often used in collaboration with therapy.

 

Treatment at The Center • A Place for HOPE

The Center • A Place for HOPE is an award-winning mental health treatment facility offering Whole Person Care to treat the entire you – your mind, body, and spirit. We take the time to get to know you personally, then tailor a personalized treatment program to your needs. As a result, we help create longer-lasting change and recovery.

Reach out to us today and let us guide you on your journey towards self-love, self-confidence, and more satisfying relationships. Contact our admissions team now.

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[1] Bowlby, J. (1958). The nature of the child’s tie to his mother. The International Journal of Psychoanalysis, 39, 350–373.
[2] Ainsworth, M., 1978. The Bowlby-Ainsworth attachment theory. Behavioral and Brain Sciences, 1(3), pp.436-438.
[3] Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am. 2009 Sep;32(3):483-524. doi: 10.1016/j.psc.2009.06.002. PMID: 19716988; PMCID: PMC3018839.
[4] Triebenbacher SL, Tegano DW. Children’s use of transitional objects during daily separations from significant caregivers. Percept Mot Skills. 1993 Feb;76(1):89-90. doi: 10.2466/pms.1993.76.1.89. PMID: 8451155.