Separation Anxiety Disorder

It is an anxiety disorder in which the individual experiences excessive fear or anxiety regarding separation from people with to whom they feel strongly attached to.

In children, this may be difficulty separating from parents or other significant caregivers such as grandparents or domestic helpers. This fear or anxiety is unusual or inappropriate for the individual's developmental age and is recurrent or prolonged and severe. The fear and anxiety is typically persistent for at least four weeks in children and adolescents and typically 6 months or more in adults, and causes impairment in social, academic, occupational and other areas of the individual's functioning.

For example, the child may experience significant anxiety and distress when having to separate from caregivers to go to school, enrichment activities or being in a room by themselves or they may avoid situations in which separation may occur. In adults, the adult may find it difficult to go to work, get married or move out of home independently.

The criteria used to diagnose Separation Anxiety Disorder include the following:

• Excessive fear or reluctance of being alone without attachment figures (e.g. at home or other settings)
• Excessive worry about losing attachment figures or possible harm to them (e.g. illness, injury, disasters or death
• Excessive worry about themselves experiencing an untoward event that may lead to separation from attachment figures (e.g. being kidnapped, getting lost, getting into an accident, becoming ill)
• Persistent reluctance or refusal to go out, be away from home, go to school, to work or other places because of the fear of separation
• Persistent reluctance or refusal to sleep away from home or go to sleep without being near attachment figures
• Recurrent excessive distress or anxiety when anticipating or experiencing separation from home or attachment figures/caregivers
• Repeated nightmares about separation from or losing attachment figures
• Repeated complaints of physical symptoms when separated or anticipating separation from attachment figures (e.g. headaches, stomachaches, dizziness

Typically, cognitive behavioural therapy is recommended to help the individual learn strategies to cope with their fear and anxiety. The individual is equipped with strategies such as relaxation training and strategies to identify unhelpful thinking styles that may underlie the anxiety they are experiencing. Therapy may also include some exposure exercises, in which the individual is gradually exposed to situations/settings which are anxiety-provoking and/or which they may have previously avoided.

Medication may also be prescribed for individuals who are experiencing greater distress to help alleviate some of the anxiety symptoms.