Separation Anxiety

Although separation anxieties are normal among infants and toddlers, they are not appropriate for older children or adolescents and may represent symptoms of separation anxiety diorder.

Children with separation anxiety show developmentally inappropriate and excessive anxiety about being separated from home or from the person to whom the child is attached.  The child may be excessively distressed when separation from the major attachment figure actually occurs or when it is only anticipated.  The child may also be excessively concerned about something harmful happening to the major attachment figure when he/she is away from the child's presence.  Also, the child may persistently and excessively worry that something will happen  to him or her (eg, getting lost or kidnapped) that will result in the separation from the major attachment figure.

The child with separation anxiety may refuse to go to school because of fear of separation from parents or caretakers, or refuse to be left alone with significant adults in the home.  Some children follow parents from room to room because of fear of separation. 

A regular pattern of sleep may be a problem.  The child with separation anxiety may refuse to go to sleep without being in close proximity to the significant other person, and may refuse to go on sleep-overs at other children's homes.

Children with separation anxiety often complain of physical problems associated with the anticipation of separation, such as:  headaches, stomachaches, nausea, or vomiting.

Separation anxiety may be associated with symptoms of depression, such as sadness, withdrawal, or apathy.

A. 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:

1. Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.

2. Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.

3. Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (eg, getting lost or being kidnapped)

4. Persistent reluctance or refusal to go to school or elsewhere because of fear of separation

5. Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

6. Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home

7. Repeated nightmares involving the theme of separation

8. Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The duration of the disturbance is at least 4 weeks.

C. The onset is before age 18 years.

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

E. The disturbance does not occur exclusively during other disorders (such as Pervasive Developmental Disorder, Schizophrenia, or other Pyschotic Disorder), and in adolescence and adults, is not better accounted for by Panic Disorder With Agoraphobia.

Specify if:

Early Onset: If onset occurs before age 6 years