Overview of separation anxiety disorder

Separation anxiety disorder is characterised by excessive and developmentally inappropriate anxiety related to being away from home or separated from significant attachment figures. Anxiety can also be experienced when there is a threat of these events. The fear and anxiety that the person experiences is persistent, and leads to avoidance of separation. At the time of separation, anxiety may reach the point of panic. The disorder is associated with clinically significant distress, or impairment in social, academic or other important areas of functioning. Separation anxiety disorder was previously only recognised in children with at least 1 month of symptoms, but is now also recognised in adults and young people with at least 6 months of symptoms. It remains an uncommon diagnosis in adulthood—most patients have comorbid major depression or another anxiety disorder.

Children with separation anxiety disorder often fear that a disaster will prevent them reuniting with their parents. This leads to persistent reluctance or refusal to sleep away from home, or to go to sleep without being near a major attachment figure. Nightmares with themes of separation are common. The child may refuse to go to school or have somatic symptoms (eg headache, abdominal pain) related to school attendance. It is thought that separation anxiety disorder in childhood is associated with panic disorder or agoraphobia in adulthood.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

For considerations in managing anxiety disorders such as separation anxiety disorder during the perinatal period, see here, or for considerations in partners see here.

For information on diagnosing and differentiating anxiety disorders, see Overview of anxiety disorders.