Separation anxiety disorder: causes, symptoms, and treatments

Separation anxiety disorder is a type of anxiety disorder wherein the affected individual experiences intense worry, fear, and panic when being separated from the attachment person. Even anticipation of separation can induce symptoms of this mental illness. The disorder usually affects children and their attachment person is a parent or caregiver. Adolescents and adults can develop a separation anxiety disorder as well. Their attachment person can be a love interest. It is not the same as separation anxiety, which is a normal part of a child’s development.

The causes of separation anxiety disorder are a combination of different factors such as biological and environmental. The most significant causes include a family history of anxiety or depression, having a shy personality, low socioeconomic status, having overprotective parents, lack of adequate parental interaction, problems with peers, moving to a new home, switching schools, divorce, and death of a close family member.

Symptoms of a separation anxiety disorder include holding onto parents, excessive crying, and unwillingness to engage in activities that require separation. Other symptoms of separation disorder include bodily ailments such as migraines and nausea, the emotional fit of rage, refusal to attend school, low academic performance, failure to interact with children in a healthy way, refusal to sleep alone, and nightmares.

Treatments for separation anxiety disorder are specifically adapted to meet the needs of each patient. Treatment for detachment anxiety in children usually involves a combination of cognitive-behavioral therapy and selective serotonin reuptake inhibitors (SSRIs). On the flip side, treatment of separation anxiety disorder in adults may include dialectical behavior therapy, family therapy, and group therapy.

What is separation anxiety disorder?

Separation anxiety disorder (SAD) is an intense fear of being separated from a loved one or caregiver. It is an exaggeration of otherwise developmentally normal anxiety indicated by excessive concern, dread, or worry of a real or anticipated separation from another person, a post on the National Library of Medicine explains. In babies and children, separation anxiety is normal, but teenagers and adults can develop it as well.

Babies usually develop separation anxiety at eight months of age. Around eight months, babies tend to be scared of new people. They feel safe when their parents are around and unsafe when their parents are absent. Around two years of age, toddlers start to understand their parents will return. However, it’s possible for a child to continue experiencing separation anxiety beyond the age of two.

In order to understand SAD, it is important to understand it’s not the same as separation anxiety. Separation anxiety is a regular part of a child’s development whereas SAD is a mental illness and extreme fear or worry related to potential separation from an attachment figure. Not every child with separation anxiety will develop SAD.

The primary difference between separation anxiety disorder in children and adults is the type of love or attachment figure involved. For children that attachment figure is a parent or caregiver. On the flip side, for adults, the attachment figure is a child or a romantic partner.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, separation anxiety disorder is classified as one of the types of anxiety disorders. The origin of SAD, however, is associated with the attachment theory of the father of psychoanalysis Sigmund Freud, and a British psychologist John Bowlby.

According to Freud, the emotional bond between a child and mother develops due to the infant’s attachment to the mother as a provider of food. Freud theorized that infants have instinctual impulses that traumatize them when they go unnoticed. The infant learns that they will experience a lack of gratification in absence of their mother. The mother’s absence becomes a continued stimulus that triggers anxiety. With time, the child develops a fear of situations that include being apart from their parent or caregiver.

Bowlby believed that the earliest bonds developed by children with their parents or caregivers have a notable influence that continues throughout their life. According to Bowlby, attachment keeps the infant close to the mother and improves their chances of survival. To Bowlby, attachment is a result of an evolutionary process as children come into this world with an innate drive to develop attachments with their parents or caregivers. He suggested that the trauma of maternal deprivation is responsible for many forms of psychoneurosis and character disorders, according to a paper by Dr. Michael Kirsch from University Hospital Essen and Michael B. Buchholz from the International Psychoanalytic University Berlin in the February 2020 issue of Frontiers in Psychology. Bowlby made a significant contribution to the development of attachment theory by describing four main attachment styles: secure attachment, anxious-avoidant attachment, disorganized attachment, and anxious-ambivalent attachment. The latter, anxious-ambivalent attachment, is the most important here because its description is similar to separation anxiety disorder. In children this attachment style results from inconsistent parental availability, which leaves a child insecure and feeling like they can’t depend on the primary caregiver to be there for them.

One of the most significant breakthroughs in the history of separation anxiety disorder is its description in DSM-5. Earlier editions included SAD, but only as a disorder that affects children. For example, in DSM-4-TR separation anxiety disorder, unlike other anxiety disorders, was considered a mainly child-related condition that could only be diagnosed if a person developed symptoms before 18 years of age. Separation anxiety disorder was categorized under Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence in DSM-4-TR, which changed with the release of DSM-5. In DSM-5, the age-related criterion is removed and SAD was described as a condition that may span the entire life and begin at any age.

How common is separation anxiety disorder?

Estimates show that the prevalence of childhood separation anxiety disorder (CSAD) is 4% in population-based studies, with an increase to 7.6% of pediatric patients in a clinical setting, and about half of referrals for pediatric mental health treatment for anxiety disorders, according to a post, last updated in February 2023, by J. Feriante et al. on the website of National Library of Medicine.

The same article also suggests that the lifetime prevalence of adult separation anxiety disorder (ASAD) in the general U.S. population is 6.6%. Of these, 77.5% of patients report that the initial onset of SAD was in adulthood.

A cross-sectional analytical study by M.R. Mohammadi et al. in the May 2020 issue of the journal Psychiatric Quarterly, which included 29,699 children and adolescents, found that the prevalence of SAD was 5.3%. The comorbidity rate between SAD and other psychiatric disorders was 65.3%, with oppositional defiant disorder and specific phobias being the most common comorbidities.

Separation anxiety disorder affects 4% to 10% of children and is equally present in boys and girls, according to a chapter Childhood Mental Disorders in Encyclopedia of Human Behavior (Second Edition) from 2012 by A. Scarpa and L. Wilson.

A paper by D.M. Silove et al. in the March 2010 issue of BMC Psychiatry involved a review of present data on the prevalence of ASAD and it showed that this mental illness accounts for 23% of all diagnoses in an adult anxiety clinic.

Discrepancies in the prevalence rates are largely due to the studied samples and diagnostic criteria. It is also important to keep in mind that adult separation anxiety disorder has been identified only recently.

Comorbidities are common in ASAD as well. A paper titled Separation Anxiety Disorder in the DSM-5 Era by C. Carmassi et al. in the Journal of Psychopathology reported that adult separation anxiety disorder was first explored in a clinical setting and the prevalence rate was 20% to 40%. In people with panic disorder or generalized anxiety disorder, the prevalence of SAD was 46%. The same paper also reported the findings of the study which included 508 outpatients with anxiety and mood disorders revealing that the prevalence of SAD was 42.4%. About 50% of these cases reported the disorder started in adulthood. A different report found the prevalence of SAD in anxiety patients was 23%. In the abovementioned paper, SAD was strongly associated with being female thus suggesting there could be a difference in gender prevalence, which requires further research.

A comparative study by D. Silove et al. in the July 2015 issue of the American Journal of Psychiatry revealed lifetime SAD prevalence across countries was 4.8% with 43.1% lifetime onsets occurring after the age of 18 years.

What are the causes of separation anxiety disorder?

The causes of separation anxiety disorder are major life stress that triggers the onset of symptoms. Genetics may also play a role in the development of SAD, Mayo Clinic explained. Environmental factors may contribute to a person’s susceptibility to developing separation anxiety disorder, as well. A separation anxiety disorder may be associated with underlying mental health conditions including autism. This subject requires further research to elucidate all the mechanisms that contribute to the onset of this mental illness, but the most significant causes of separation anxiety disorder are listed below:

• Family history of anxiety or depression
• Shy, timid personalities
• Low socioeconomic status
• Overprotective parents
• Lack of appropriate parental interaction
• Problems dealing with kids their own age
• Moving to a new home
• Switching schools
• Divorce
• The death of a close family member

1. Family history of anxiety or depression

Family history of anxiety or depression refers to the presence of anxiety disorders and major depressive disorder in a person’s family, mainly their parents, and siblings. The role of family history in the development of mental health problems is scientifically confirmed. For example, a paper published in July 2014 in journal Translational Psychiatry suggested that familial factors may underpin both cognitive ability and the risk of psychiatric disorders.

A family history of anxiety or depression is a cause of separation anxiety disorder because people may pass on genes and genetic mutations to their children. One of the older studies on this subject, published by D. Silove et al. in the July 1995 issue of Acta Psychiatrica Scandinavica, suggested there is a significant genetic contribution to the development of SAD. The relationship between genes and SAD was observed in females, not males. The same study also confirmed that environmental influences still play a major role as well. Speaking of genetics, it is noteworthy to mention a paper Genetics of Anxiety Disorders from the March 2019 issue of Current Psychiatry Reports which showed that anxiety disorders are highly complex and polygenic. The term polygenic means multiple genes are involved in the development of these disorders.

A family history of anxiety or depression causes SAD because people can inherit specific genes, but also because they can learn anxiety. A child can learn excessive fear or worry from other family members who may struggle with anxiety disorder. In this case, SAD is a learned behavior.

2. Shy, timid personalities

Shy, timid personalities are personalities that experience discomfort in social situations and often feel awkward or worried about what other people will think of them. They often have low self-esteem. Although people may not think about it this way, personality has a major impact on mental health and even social support, a paper by Dr. Karen D. Lincoln from the University of South California in the June 2008 issue of The Social Service Review suggested.

Shy, timid personalities cause separation anxiety disorder because people with these characteristics tend to worry a lot about the opinions and attitudes of other individuals in their life. They also tend to have low self-esteem, which contributes to and worsens symptoms of anxiety. A study by J. Dong et al. in the September 2022 issue of the journal Brain Sciences found that increased concentration of excitatory neurotransmitter glutamate in the dorsal lateral prefrontal cortex (DLPFC) is negatively linked to the anxiety state, which may be a mechanism of action connecting this personality type to anxiety traits. The brain region DLPFC is involved in executive functions including selective attention and working memory.

A shy, timid personality is a cause of SAD because it makes a person feel insecure or uncomfortable around other people. They may cling to the attachment person even more and feel unsafe when that person isn’t around or if they anticipate their absence. While shyness can contribute to the development of separation anxiety disorder, not every shy individual will have SAD. A combination of causes is involved in the onset of this mental illness.

3. Low socioeconomic status

Low socioeconomic status refers to individuals with low educational achievement and/or low household income. A person’s socioeconomic status plays a major role in their mental health. The American Psychological Association reported findings of the study, which found that the poorer socioeconomic conditions are, the higher the risk of mental disability and psychiatric hospitalization.

Low socioeconomic status causes separation anxiety disorder due to increased parental anxiety. A paper, by Y. Zhu et al. in the May 2019 issue of Psychoneuroendocrinology, reported that children from low socioeconomic status families have elevated levels of anxiety, which is mediated by increased anxiety in parents. An article by G. Masi et al. in the August 2012 issue of CNS Drugs reported that 50% to 75% of children with SAD come from homes of low socioeconomic status. Low socioeconomic status is associated with higher levels of stress and anxiety, which can affect children and parents alike. Plus, people of low socioeconomic status don’t have the same quality of resources such as educational and medical care. Access to services like those is necessary for both physical and mental health and well-being.

Low socioeconomic status causes SAD because it may lead to a greater degree of separation between parents doing low-paid long-hour jobs and their children. The exact mechanisms of action between low socioeconomic status and SAD require more research, but a higher level of psychological distress is the major culprit.

4. Overprotective parents

Overprotective parents are parents who exhibit guarding behavior that is excessive considering the developmental stage of a child and the actual risk level in their environment. An overprotective parent is only focused on keeping their child physically and emotionally safe. However, their behavior becomes obsessive and out of proportion to the risks involved. Parental overprotection has been implicated in the development and maintenance of anxiety disorders in children, according to a paper by K. Clarke et al. in the November 2013 issue of Journal of Affective Disorders.

Overprotective parents cause separation anxiety disorder because the children are deprived of the chance to explore the world around them. Lack of opportunity to explore the world i.e. surroundings properly limits the chance of facing novel situations. Their world becomes limited to parents primarily. At the same time, a child’s confidence suffers and it may also contribute to the development of SAD. A study by S. Mofrad et al. in the November 2009 issue of Asian Social Science confirmed the strong association between parental overprotection and SAD meaning children with this mental illness perceived their mothers as overprotective.

Overprotective parenting is a cause of SAD because this parenting style creates a dependent child. By preventing a child from showing autonomy and taking responsibility, overprotective parenting makes children less independent and self-reliant. Overprotective parenting requires a parent to be hyper-sensitive to everything going on with their child. A child picks up on that behavior and becomes oversensitive in adulthood. Even from young years, a person learns that the world is a dangerous or unsafe place where the parent is the only source of security. This paves the way for the development of separation anxiety disorder.

5. Lack of appropriate parental interaction

Lack of appropriate parental interaction refers to the absence of psychological presence or emotional availability in a parent’s response or interaction with their child. Low-quality parental interaction can jeopardize a child’s development and potentially lead to behavioral problems, according to a study that A. Stuart et al. published in the October 2021 issue of Children (Basel).

Lack of appropriate parental interaction causes SAD because low parental warmth and parental rejection influence the development of attribution styles in children. More precisely, the frequent negative feedback promotes a perception of a hostile and threatening world that diminishes a child’s self-concept. This increases the child’s perceptions and expectations of negative consequences, which results in anxiety, according to a paper that Dr. Yosi Yaffe from Tel-Hai Academic College in Israel published in the September 2021 issue of International Journal of Adolescence and Youth. Further research on this subject is necessary mainly because lack of parental worth is discussed in the context of social phobia in most studies.

Lack of appropriate parental interaction is a cause of SAD because high levels of negative talk and criticism on the parent’s side lower a child’s confidence and predispose them to anxiety. A child becomes conditioned to seek approval and praise, but they expect criticism from parents and other people in their life as well. This leads to the development of anxiety in the absence of an attachment figure.

6. Problems dealing with kids their own age

Problems dealing with kids their own age refer to a child’s difficulty forming friendships or functioning with their peers. How children get along with their peers can provide a deeper insight into their mental status. Oftentimes these problems are just a phase that a child grows out of and learns to function with kids their own age. In other cases, it may lead to the presence of a mental illness such as SAD.

Problems dealing with kids their own age causes separation anxiety disorder because a child feels insecure, which deepens their attachment to the parent or caregiver. In a paper from the September 2020 issue of Child Abuse and Neglect, M.M. Husky et al. used data from 5183 children and identified 14.3% of children as bullies, 18.2% as victims, and 19.0% as both bullies and victims. The bully-victim status was strongly associated with the presence of mental disorders such as phobia and separation anxiety disorder.

Problems dealing with kids their own age are a cause of SAD because difficult relationships with colleagues and peers affect a child’s mental health and may impair their confidence and self-esteem. As the relationship with peers is dysfunctional, a child clings to the attachment figure which provides a sense of security.

7. Moving to a new home

Moving to a new home is defined as relocating to a new location such as changing a neighborhood or moving away to a different city or state. Changing a place of living is a major life event and it can have a big impact on a child’s mental health and well-being. In one longitudinal analysis from the July 2017 issue of Health and Place, T. Morris et al. found that moving in childhood is associated with poor mental health.

Moving to a new home causes separation anxiety disorder because a child may struggle to adapt to the whole new environment. It can be overwhelming to move from one home to another mainly because it’s not just about a physical location such as a house or bedroom. Moving to a new home also implies changing people in the surrounding. Friendships and close bonds are left behind. All this can be difficult for a child to process, which increases the level of anxiety and may pave the way to the development of separation anxiety too.

Moving to a new home is a cause of SAD because, in the process of closing one chapter and starting the other, a person (usually a child) may cling to what they have from the life they left behind. In this case, they may cling to the attachment figure because they don’t want to feel the same way they felt already.

8. Switching schools

Switching schools refers to transferring to one school from another, usually when moving to a new home. For children, moving schools is a major life stressor and it can be as traumatic as having a parent hospitalized for a serious medical illness. Children with a history of mental illness are particularly vulnerable to the psychological consequences of switching schools, according to Very Well Mind.

Switching schools causes separation anxiety disorder because it’s a major life stressor that triggers the symptoms of anxiety. For a child or adolescent, going to a new school can be a traumatic experience. They leave their friends behind and change the whole environment. In a new school, they may not know anyone, which raises concerns about fitting in or finding friends. Since a child or adolescent doesn’t want to go through that experience again, it may trigger the development of separation anxiety.

Switching schools is a cause of SAD because a child or adolescent doesn’t cope with the new situation in a healthy manner. The need to change the entire life, which is implied when starting a new school at a different location, acts as a shock to a child’s mental well-being.

9. Divorce

Divorce is a legal dissolution of marriage. It can be both a physically and emotionally draining experience that affects everyone involved.

Divorce causes separation anxiety disorder because it is a major life stressor that results in a child “losing” a parent by being separated from them. Children tend to perceive divorce as a breakage of trust. They expect their family to last forever and it can be overwhelming to learn that is not going to happen. Adults can also experience anxiety due to emotional turmoil caused by divorce, Psychology Today explained. A paper by M.O. Amoros et al. in the August 2008 issue of the Spanish journal Psicothema found that children of divorced parents present higher levels of separation anxiety compared to their counterparts whose parents are together.

Divorce is a cause of separation anxiety disorder because, as an overwhelming experience, it involves facing the situation wherein a child is being separated from their parent. A child may not be able to cope with the new development properly, which causes anxiety. They may develop an irrational thinking pattern that paves the way to separation anxiety disorder later.

10. The death of a close family member

The death of a close family member refers to a loss of a loved one due to an illness, an accident, or any other reason. Losing a family member takes its toll on mental health in adults and children alike.

The death of a close family member becomes a cause of separation anxiety disorder because it is major life stress that results in separation from that specific person. The child may develop separation anxiety disorder after the loss of a parent, sibling, or another beloved family member such as a grandparent. For children, it can be difficult to process grief caused by this specific type of separation. But adults are also prone to separation anxiety. According to Anxiety.org, adults experiencing complicated grief are highly likely to develop separation anxiety because humans have an innate motivation to develop and maintain close emotional bonds. The loss of a loved one causes acute grief that disrupts our attachment system, especially because a person doesn’t fully process or accept the death of that person.

The death of a close family member causes separation anxiety disorder due to intense emotions that arise from separation. A person may feel lost and abandoned or refuse to accept reality because it is an overwhelming experience.

What are the symptoms of separation anxiety disorder?

Symptoms of separation anxiety disorder are intense worry, fear, and distress before and during a separation or when an adult or child with SAD anticipates it. The symptoms of this mental illness can significantly affect a person’s functioning and include changes in behavior as well as physical reactions. The most common physical reactions in SAD include headache, stomachache, dizziness, nausea and/or vomiting, chest pain, diarrhea, and trouble breathing. The most significant symptoms of separation anxiety disorder are listed below:

• Holding onto parents
• Intense and excessive crying
• Unwillingness to engage in actions that call for separation
• Bodily ailment, such as migraines or nausea
• Furious, emotional fit of rage
• Refusing to attend school
• Low academic performance
• Failing to interact with children in a healthy way
• Refusal to sleep alone
• Nightmares

1. Holding onto parents

Holding onto parents is a type of behavior indicated by a strong emotional or behavioral reaction to being separated from a parent. Children can exhibit this kind of behavior at any stage up to late primary school. Children with a separation anxiety disorder may continue to hold onto their parents beyond the stage when other kids grow out of it.

Holding onto parents becomes a symptom of separation anxiety disorder because separation (or its anticipation) from a parent or caregiver causes significant distress and triggers anxiety symptoms in children with this disorder. A child may not be comfortable around other people and they only feel safe when their parent or caregiver is around. While it’s natural for a child to experience separation anxiety that goes away once they learn to cope with it, a child with SAD doesn’t develop proper coping mechanisms that allow them to overcome separation anxiety.

Clinging onto parents is a symptom of SAD because it is a natural reaction to possible separation. Even the idea of being without a parent around can cause symptoms of anxiety, which makes a child hold onto their parents even more.

As a symptom of SAD, holding onto parents is identified by staying close to them at all times and showing strong emotional reactions when a parent is away.

2. Intense and excessive crying

Intense and excessive crying is defined as crying that is extreme and severe even when there is no apparent reason such as hunger or illness. All infants cry and it’s usually because they are hungry, their diaper needs changing, or they are ill. As they’re growing, babies overcome excessive crying. However, in cases of separation anxiety disorder children may exhibit extreme crying and full-blown temper tantrums.

Intense and excessive crying becomes a symptom of separation anxiety disorder because a child is genuinely afraid of being separated or losing their parent or caregiver. Children look to their parents for safety and reassurance. When they’re separated from them, children with SAD feel unsafe and distressed.

Intense and excessive crying is a symptom of SAD because it is a reaction to the separation that is beyond a child’s control. Being separated or anticipating separation from a parent triggers anxiety symptoms including excessive crying. A child is unable to stop it because they haven’t developed coping mechanisms to handle a parent’s absence.

Excessive crying as a symptom of separation anxiety disorder is identified as intense tearfulness accompanied by yelling or tantrums when a parent is absent or they are preparing to leave e.g. to work.

3. Unwillingness to engage in actions that call for separation

Unwillingness to engage in actions that call for separation refers to refusing to do anything that requires being away from a parent or caregiver. A lack of willingness to do anything without a parent deepens a child’s insecurities and confidence.

Refusing to do activities that require separation becomes a symptom of separation anxiety disorder because a child feels unsafe and naturally wants to avoid such a situation. Since a parent or caregiver is the only source of safety or security for that child, any activity that requires their absence can trigger symptoms of anxiety.

Unwillingness to engage in actions that involve separation is a symptom of SAD because a child doesn’t know how to cope with situations when their parents aren’t around. A child can’t handle the separation like their counterpart without SAD would.

As a symptom of SAD, unwillingness to engage in actions that call for separation is identified as refusal to participate in activities such as play dates, camping, and practicing hobbies and sports if that means the parent or caregiver isn’t around all the time. Adults with SAD may also avoid activities that involve being separated from their attachment person. For example, they may refuse to go on a business trip or attend a specific event without the person to whom they are attached.

4. Bodily ailments, such as migraines or nausea

Bodily ailment such as migraines or nausea refers to physical reactions to anxiety. The triggers of anxiety lead to changes in behavior and physical reactions.

Bodily ailments are a symptom of separation anxiety disorder because being anxious induces underlying mechanisms associated with the fight-or-flight response. A good example is a headache or migraine. When a person is anxious, the body responds to deal with the source of extreme fear or worry. In people with long-term anxiety, the body remains in a state of increased alert. Muscles remain tense, instead of relaxing after the threat subsides. As a result, headaches occur according to Healthline. Fluctuating serotonin levels may also contribute to headaches and migraines in people with anxiety. According to a paper by M.F. Prieto Peres et al. in the March 2017 issue of the Journal of Headache and Pain, the biggest reason behind migraines in people with anxiety is the lack of ability to properly control worrying and to relax.

Nausea and vomiting are common physical reactions in separation anxiety disorder. They happen because neurotransmitters released during the fight-or-flight response reach the digestive tract and upset the balance of the gut microbiome. In turn, a person experiences stomach symptoms including nausea and vomiting. The latter generally occurs in people with extreme anxiety.

Bodily ailments are a symptom of separation anxiety disorder due to the natural reaction called the fight-or-flight response. When this defense mechanism is activated, a person may feel physical reactions such as a faster heartbeat, headache, or nausea. In people with long-term anxiety, the body is constantly in the state of anticipating danger or threat, which makes these effects more pronounced.

As a symptom of separation anxiety disorder, bodily ailments are identified as aches and pains that occur after anxiety triggers such as separation from an attachment person (or anticipating it). A person may exhibit problems such as headache or migraine, nausea, and vomiting, and digestive issues such as diarrhea, and chest pain.

5. Furious, emotional fit of rage

The furious, emotional fit of rage refers to violent temper tantrums, which can also be described as meltdowns. Although temper tantrums are often considered a normal part of childhood, excessive displays of such a behavior point to the presence of serious problems. The January 2008 issue of The Journal of Pediatrics published a study by A.C. Belden et al, which found that excessive temper tantrums in preschoolers can indicate serious mental health issues.

An emotional or violent fit of rage becomes a symptom of separation anxiety disorder because it is the reaction that a child can’t control when they are separated from a parent or caregiver. Separation is stressful and overwhelming for a child who doesn’t know how to cope with it in a healthier fashion.

The furious, emotional fit of rage is a symptom of SAD because a child is terrified their parent or caregiver will leave them in an environment where all other people make them feel unsafe and insecure.

A temper tantrum as a symptom of SAD is identified by severe crying, yelling, and begging a parent or caregiver not to leave the room or home. It becomes even worse when a parent leaves.

6. Refusing to attend school

Refusing to attend school refers to a child being reluctant to attend classes regularly. According to the Child Mind Institute, school refusal is associated with disorders such as depression, separation anxiety, and panic disorder. Most children are reluctant to go to school from time to time, but in cases of children with mental illnesses, this problem is persistent.

Refusal to attend school becomes a symptom of separation anxiety disorder because avoidance is one of the most significant aspects of this disorder. One example of avoidance is a refusal to go to school. In school, a child is separated from their parent or caregiver. They feel unsafe and insecure. As a result, this separation triggers anxiety symptoms. A child refuses to attend school because they don’t want to deal with separation on a daily basis.

Refusing to attend school is a symptom of SAD because a child is unable to cope with separation from a parent or loved one, even if it means spending a few hours in school. In patients with anxiety disorders such as SAD, avoidance of triggering situations is a common display of behavior.

As a symptom of SAD, refusal to attend school is identified by pretending to be sick, making up excuses not to go to school, and emotional outbursts when a parent refuses to indulge in a child’s pleas.

7. Low academic performance

Low academic performance refers to failing to attain a set standard of performance in a given evaluation exercises such as a test or examination. Poor school performance is associated with the presence of mental health problems in children, according to a paper by S. Agnafors et al. in the May 2021 issue of Social Psychiatry and Psychiatric Epidemiology. Keep in mind that not all children with low academic performance have mental illnesses. However, children who do have a mental disorder tend to exhibit poorer performance in school.

Low academic performance becomes a symptom of separation anxiety disorder because intense worry and fear of separation may interfere with concentration and productivity. In its December 2007 issue, the journal BMC Public Health published a study by L. Mazzone et al, which suggested that the relationship between anxiety and poor school performance is complex and involves multiple factors including familiar influences, socioeconomic status, and individual affective and cognitive profile. High levels of anxiety may affect a child or adolescent’s functioning in school.

Poor school performance is a symptom of SAD because anxiety makes a child preoccupied with their fear and worry while their focus on school assignments decreases. Symptoms of anxiety and the level of fear caused by separation can be so overwhelming that a child can’t dedicate enough effort to solving their academic tasks.

As a symptom of SAD, low academic performance is identified by the inability to solve tasks in school, failing to do homework, getting bad grades, and poor concentration during classes.

8. Failing to interact with children in a healthy way

Failing to interact with children in a healthy way refers to a child’s inability to establish proper communication or relationship with other children such as their peers, class colleagues, or cousins. There are many reasons a child can’t interact properly with other children. For example, they may not be used to sharing things or spending time with other children. Another explanation would be that an underlying mental health disorder prevents a child from interacting with other kids properly.

Failing to interact with children in a healthy way becomes a symptom of SAD because a child may feel insecure in that situation. They may feel scared and unsafe with other children when their parent or caregiver is not around. As mentioned above, to a child with SAD a parent/caregiver is the only source of safety and security.

Failing to interact with children in a healthy way is a symptom of separation anxiety disorder because intense symptoms of anxiety prevent a child from developing friendships in an environment where they don’t feel safe. Since a child with SAD wants to spend their time with a parent or caregiver only, they fail to learn how to function with their peers.

As a symptom of SAD, failure to interact with children in a healthy way is identified by a lack of interest to play, refusal to share stuff, and frequent arguments with kids.

9. Refusal to sleep alone

Refusal to sleep alone refers to a child being reluctant to sleep in their own bed or bedroom. Every child is afraid to sleep alone sometimes. For example, a child may refuse to sleep alone after having nightmares or due to strong winds and thunderstorms outside. Children with mental health problems such as anxiety disorders may also refuse to sleep alone.

Refusal to sleep alone becomes a symptom of SAD because a child is scared of being alone. A child may also have nightmares about separation. Their anxiety may worsen once they wake up all alone.

Refusal to sleep alone is a symptom of SAD because separation from a parent or caregiver causes a great deal of distress. Distress can affect sleep patterns and make a child feel unsafe without a parent next to them. It is a type of avoidance behavior i.e. sleeping in their own bed is an activity that a child may refuse to do because it involves separation.

As a symptom of SAD, refusal to sleep alone is identified by the constant need to sleep in the same bed with parents and making emotional tantrums if they insist a child should sleep in their own bed. A child may go to their own bed and end up moving into the parent’s bed during the night.

10. Nightmares

Nightmares are disturbing dreams linked to negative feelings such as fears that awaken a person. Everyone has nightmares as they can affect people of all ages. They occur in times of high stress or emotional turmoil, but also as a consequence of a mental health problem such as separation anxiety disorder.

Nightmares become a symptom of SAD because the intense fear of separation can lead to a child dreaming about this theme. A study by V. Simard et al. in the September 2021 issue of the journal Current Psychology found that separation anxiety disorder predicted frequent nightmares and bad dreams, dreaming of the parent’s death, or any separation theme.

Nightmares are a symptom of SAD because they could be a result of unprocessed negative stimuli the brain is trying to process through sleep. In this case, the brain is trying to process a theme of separation, which may lead to bad dreams.

As a symptom of SAD, nightmares are identified as bad dreams about being separated from a parent or loved one, waking up frequently during the night, and feeling stressed out upon wakening.

What can I expect from separation anxiety disorder?

Patients with a separation anxiety disorder may experience recurrent and excessive distress about being away from home or loved ones. Anticipation of being separated induces distress as well. They may worry excessively about losing their parents and loved ones to an illness or disaster. Additionally, a person with SAD is constantly worried something bad might happen and separate them from their loved ones. They may even miss out on opportunities that involve being away from home due to refusal to leave an attachment person.

Children and adults with SAD are reluctant to be home alone or sleep away from home because these actions involve being separated from a loved one. The constant worry and fear may lead to nightmares about separation and unpleasant symptoms when a person is separated from an attachment person or anticipates it. These symptoms may include headaches and pain in the abdominal area.

When left unmanaged, a separation anxiety disorder can cause complications such as problems functioning at home, work, and in social situations. A patient with SAD may develop other mental illnesses including depression, obsessive-compulsive disorder, panic attacks, generalized anxiety disorder, phobias, and social anxiety disorder.

Who is at risk for separation anxiety disorder?

Children are at risk of separation anxiety disorder, but adolescents and adults can develop it too. Experiencing a major life stress or a loss that results in separation from a loved one is a major trigger for the onset of SAD. Examples include losing an attachment person to an illness, but besides the death of a beloved person other major stresses that may increase the risk of SAD include the death of a pet, changing a place of living, and parents getting a divorce.

People who experience a disaster that may involve separation, e.g. war or natural disasters, are more likely to develop this disorder. Like other mental illnesses and anxiety disorders such as generalized anxiety disorder, SAD tends to affect people whose family members have problems with anxiety.

Parental absence, alcoholism, and foster care/adoption may also predispose an individual to develop a separation anxiety disorder, Cleveland Clinic explained.

In a study published by D. Silove et al. in the July 2015 issue of the American Journal of Psychiatry predictors for the development of separation anxiety disorder include female gender, negative events in childhood, and lifetime traumatic events. Low education and maladaptive family functioning in childhood were also described as risk factors for separation anxiety disorder.

How is separation anxiety disorder diagnosed in children?

The physician may assess a child who is experiencing physical complaints to determine whether their symptoms have a physical cause. Separation anxiety disorder in children is diagnosed after evaluation by a child psychiatrist or other mental health expert, Stanford Medicine Children’s Health reported.

During the evaluation, a psychiatrist will ask about the child’s history, the symptoms, and their duration, and may observe the child at the scene of separation. The goal of the evaluation is to determine whether a child is going through a normal stage of development or they have a mental disorder.

The only diagnostic tool specifically designed to help in the specific diagnosis of SAD is called The Separation Anxiety Avoidance Inventory (SAAI). It has a child and parent version. Evidence, such as a paper by T. In-Albon et al. in the December 2013 issue of Child Psychiatry and Human Development, shows SAAI has good internal consistency, and high reliability, and can be used in clinical and research settings.

In order for a child to be diagnosed with SAD, the symptoms must be present for at least four weeks. The symptoms must be severe enough to produce significant impairment to the normal functioning of the child.

How is separation anxiety disorder diagnosed in adults?

The healthcare provider may ask questions about personal medical history and symptoms that an adult patient experiences. They may also ask permission to interview close family members or friends to help them gain more understanding of how symptoms affect a patient’s quality of life and daily functioning. During this process, a psychiatrist doesn’t disclose any information that a patient had shared. Several sessions with a therapist may be necessary before receiving a diagnosis.

The healthcare professional uses DSM-5 to determine whether a patient meets the diagnostic criteria for separation anxiety disorder. A patient needs to exhibit at least three out of eight symptoms that significantly disrupt academic, social, or occupational functioning. Separation anxiety disorder is diagnosed when a patient experiences the symptoms for at least six months and they can’t be explained by a different diagnosis.

After diagnosing the disorder, a psychiatrist may proceed to determine the severity of SAD. They may rely on the questionnaire to get a close insight into a patient’s symptoms and emotions or behaviors. One such questionnaire is Severity Measure for Separation Anxiety Disorder – Adult, created by the American Psychiatric Association. It is a 10-item questionnaire that evaluates the severity of symptoms of separation anxiety disorder. The questionnaire was specifically created for individuals upon receiving a separation anxiety disorder diagnosis.

What are the available treatments for separation anxiety disorder in children?

Available treatments for separation anxiety disorder in children depend on the severity of symptoms, age, and a child’s general health. The healthcare professional recommends the most suitable approach for a child’s specific needs and it includes a combination of two different options. The available treatments for separation anxiety disorder in children are listed below:

• Cognitive behavioral therapy
• Selective serotonin reuptake inhibitors (SSRIs)

1. Cognitive behavioral therapy

Cognitive-behavioral therapy (CBT) is a type of talk therapy that helps patients learn how to identify and change destructive thought patterns that negatively affect their emotions and behaviors. It combines cognitive therapy with behavior therapy to help manage problems by changing the way a patient thinks and behaves.

In the treatment of separation anxiety disorder, cognitive behavioral therapy helps by working with the child to better understand their condition. The more a child learns about SAD, the easier it becomes for them to control and manage it. Children with separation anxiety disorder learn how SAD affects them, their thoughts, and their behaviors. They learn to identify irrational thoughts about separation from their parents and caregivers and how to replace them with more rational thinking patterns.

During CBT sessions, children begin to think about separation differently and examine their fears in a rational fashion. The therapist also empowers a child to cope with separations, which is achieved by changing their thinking and replacing negative with more positive self-talk. With time, children learn how changing their thoughts or behaviors and doing things they may want to avoid can reduce their anxiety.

Cognitive-behavioral therapy is one of the best treatment options for children with SAD because it can include parents as well. With the help of a therapist, parents learn how to reduce the unhelpful reassurance and help their children gain more control over their fears and insecurities. Additionally, CBT is a goal-oriented and patient-centric therapy that focuses on the specific needs of each patient. A child gets to learn skills that improve their daily functioning. The therapist assigns homework that includes practicing skills and strategies learned during the session until the next appointment.

The effectiveness of CBT is scientifically confirmed; a good example is a randomized controlled trial that S. Schneider et al. published in the April 2011 issue of Psychotherapy and Psychosomatics. The study included 43 children (5-7 years) with SAD and their parents. The participants were divided into two groups. One group involved disorder-specific treatment that included 16 sessions of CBT and parent training and the other was a 12-week waiting list group. Results showed that 76.19% of children from the treatment group no longer met the criteria for SAD at follow-up. Parents reported improvements in their children’s functioning and quality of life. Scientists concluded the study suggesting that CBT programs work for young children.

A paper that S. Pegg et al. published in the December 2022 issue of Current Psychiatry Reports confirmed the effectiveness of CBT in treating anxiety disorders in youth and lowering the recurrence rates.

The specific number of CBT sessions for children with separation anxiety disorder depends on the severity of the condition. On average significant progress is observed after 12 to 15 sessions. The sessions are scheduled weekly and last 45 to 60 minutes. The duration of CBT sessions can be shorter for younger children.

2. Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are also prescribed to treat other mental illnesses such as anxiety disorders. According to Mayo Clinic, SSRIs can ease symptoms of mild to moderate depression and cause fewer side effects than other antidepressants.

Selective serotonin reuptake inhibitors help treat SAD by increasing levels of serotonin in the brain. Serotonin is a neurotransmitter that takes part in regulating mood, sleep, thinking, memory, and digestion. It is one of the feel-good chemicals in the brain.

Nerve cells produce serotonin naturally. The neurotransmitter releases into the synaptic cleft i.e. the space between two nerve cells. From there, serotonin binds to the second nerve cell i.e. post-synaptic neuron, which allows the signal to be received. Otherwise, serotonin can be reabsorbed or recycled back into the nerve cell that released it (presynaptic neuron), thus making it inactive. The whole process is well-balanced in healthy people. As a result, their mood is stable.

However, people with anxiety disorders such as SAD tend to have lower levels of serotonin or its functioning is abnormal. The role of SSRIs is to prevent the reabsorption (reuptake) of serotonin into the presynaptic nerve cells by inhibiting the transporter that reabsorbs it. As a result, serotonin is released. Serotonin levels increase and the neurotransmitter remains active so it can bind to the postsynaptic cell and send more signals that help regulate mood. Considering that SSRIs are selective, they don’t affect the levels and functioning of other neurotransmitters in the brain.

Selective serotonin reuptake inhibitors are among the best treatments for children with SAD because they can help in cases when symptoms are severe. They also work well in combination with CBT, Medical News Today explained.

The use of SSRIs in the treatment of anxiety disorders in children is effective, according to a paper by T.K. Murphy et al. in the August 2000 issue of International Clinical Psychopharmacology. A review published by G.C. Dieleman and R.F. Ferdinand from Erasmus Medisch Centrum from the Netherlands in the January 2008 issue of Dutch journal Tijdschrift voor Psychiatrie reported that SSRI medications are the first-choice pharmacotherapy for the treatment of social phobias, separation anxiety disorder, and generalized anxiety disorder in children and adolescents. The researchers concluded their review by confirming that SSRIs are effective for the management of anxiety disorders in younger patients.

Selective serotonin reuptake inhibitors take two to four weeks to exhibit their full effects. That is when a patient experiences noticeable benefits. For the treatment of SAD, children, and adolescents may need to take SSRIs for six to nine months, according to a paper by E.E. Hathaway et al. in the February 2018 issue of Current Problems in Pediatric and Adolescent Health Care. The duration of SSRI treatment depends on the severity of symptoms and how a patient responds to the medication. The healthcare professionals determine the dosages and length of treatment.

What are the available treatments for separation anxiety disorder in adults?

Available treatments for separation anxiety disorder in adults are mainly focused on therapy, but a doctor may prescribe medications if necessary. The medications may include SSRIs or anti-anxiety medications. The exact treatment approach depends on how severe the symptoms are and their effects on a person’s daily functioning. The available treatments for separation anxiety disorder in adults are listed below:

• Dialectical behavioral therapy (DBT)
• Family therapy
• Group therapy

1. Dialectical behavioral therapy (DBT)

Dialectical behavior therapy (DBT) is a type of talk therapy based on CBT. It is specifically created for people who feel their emotions intensely. Originally, DBT was intended for patients with borderline personality disorder, but it has been adapted to treat other mental health conditions including anxiety disorders. The main goal of dialectical behavioral therapy is to help a patient understand and accept their difficult feelings and learn skills to manage them.

Dialectical behavior therapy helps treat SAD by focusing on changing negative behavior patterns instead of talking a patient through their anxious thoughts. The term dialectical means combining two opposite ideas. This type of therapy doesn’t urge a patient to change their irrational thoughts or behaviors but to accept their reality while learning to adopt healthier habits and behavior patterns. The balance between acceptance (validation) of who a patient is and the challenges and benefits of the change is the cornerstone of DBT. During a DBT session, the therapist teaches a patient to learn new skills to improve emotion regulation.

The exact structure of DBT may vary, but it usually involves DBT pre-assessment, individual therapy, skills training in groups, and telephone crisis coaching. With DBT, patients with anxiety disorders learn to tolerate intense feelings, modify ineffective behaviors, and decrease anxiety symptoms. In order to make that happen, DBT consists of four modules such as mindfulness (learning to be truly present), emotion regulation (learning to manage/change/accept emotions), distress tolerance (learning to tolerate painful emotions/situations), and interpersonal effectiveness (learning to communicate with others in respectful ways).

Dialectical behavior therapy is one of the best treatments for adults with SAD because it helps them better understand their emotions and thoughts while improving their relationships with others. Patients resolve “all or nothing” thinking and gain strategies to maintain positive thoughts and behavior.

The effectiveness of DBT for separation anxiety disorder in adults requires further research. Studies on this subject are scarce, but current evidence shows it is an effective therapy. For instance, a randomized controlled trial that B. Afshari et al. published in the August 2022 issue of Trends in Psychiatry and Psychotherapy compared the effects of CBT and DBT in patients with generalized anxiety disorder. The results showed that DBT was more beneficial in improving the executive function of participants. A randomized controlled trial by L. Liang et al, from the October 2021 issue of Annals of Palliative Medicine, suggested that DBT was effective at treating depression and anxiety.

Dialectical behavior therapy consists of weekly individual therapy sessions and the treatment typically lasts 12 to 18 months. Each session lasts 45 to 60 minutes. When it comes to DBT, it’s important to remember the rule that if a patient misses four consecutive individual therapy sessions, four consecutive DBT skills group sessions, or five sessions (individual + group) altogether during a 24-week period, they will be discharged from the program.

2. Family therapy

Family therapy is a type of psychotherapy that helps family members improve communication and resolve conflicts. It may include all members of the family or just those who are able to participate.

Family therapy helps treat separation anxiety disorder in adults by helping family members understand the loved one’s anxiety. It also helps them learn ways to interact without reinforcing anxious habits. Negative experiences in childhood, especially with parents, contribute to the development of separation anxiety disorder. Family therapy can help by repairing the relationship between the patient and their family in order to reduce the severity of SAD symptoms.

Family therapy is among the best treatments for SAD in adults because it helps repair family dynamics and enables a patient to form healthier relationships in adulthood. It also allows a patient to address the root cause of their separation anxiety disorder.

Effectiveness of family therapy for the treatment of SAD in adults calls for further research. Current evidence supports this approach. In its January 2022 issue the Journal of Marital and Family Therapy published a review titled Family-Based Treatment of Anxiety Disorders: a Review of the Literature (2010-2019) that suggested that family-based treatments are a good alternative to anxiety treatment. According to a paper that Dr. Alan Carr from the University College and Clanwilliam Institute in Dublin, Ireland published in the April 2016 issue of the Australian and New Zealand Journal of Family Therapy, family therapy could be useful in treating adult-focused problems.

Family therapy is a short-term approach that usually requires 12 sessions, according to Mayo Clinic. The frequency of sessions and length of treatment depends on the specific situation and dynamics between a patient and their family. Each session lasts 50 to 60 minutes.

3. Group therapy

Group therapy is a type of psychotherapy where one or more therapists work with several people at the same time. While group therapy can be used alone, it is usually integrated into a comprehensive treatment plan that includes individual therapy sessions as well. There are different types of group therapy based on the mental health condition that is to be treated. They include cognitive behavioral groups, interpersonal groups, psychoeducational groups, skills development groups, and support groups.

Group therapy helps treat separation anxiety disorder in adults because patients have the opportunity to discuss their feelings, and experiences, and find solutions with a licensed professional and people who are in the same situation. The main focus of group therapy is to allow people to share their experiences and talk about challenges and how they overcome them. These stories serve as both education and motivation to people in the group. With group therapy, people with SAD understand they’re not alone and many men and women deal with this mental illness or manage it effectively.

Group therapy is among the best treatment options for adults with SAD because it allows each person in the group to learn more about oneself and helps them find new ways to relieve the severity of their symptoms.

The effectiveness of group therapy has been confirmed by studies such as a paper titled Cognitive Behavioral Group Therapy for Anxiety: Recent Developments from the September 2015 issue of Dialogues in Clinical Neuroscience. The paper suggested that group therapy is usually CBT-based and takes an important role in the prevention and treatment of anxiety. A meta-analysis by S. Barkowski et al. published in the November 2020 issue of Psychotherapy Research reported that group psychotherapy is effective for the treatment of anxiety disorders. Interestingly, mixed-diagnosed groups are equally effective as diagnosis-specific groups.

Group therapy sessions may last from a couple of months up to a year. The duration of a treatment program with group therapy is eight to 10 weeks. Most therapists hold one to two sessions a week and the duration of each session is 90 to 120 minutes.

What are the complications of separation anxiety disorder treatment?

Complications of separation anxiety disorder treatment are listed below:

• Insomnia
• Changes in appetite
• Vomiting
• Tiredness
• Thoughts of suicide

1. Insomnia

Insomnia is a sleep disorder wherein a person experiences difficulties falling and/or staying asleep. The condition can be acute (short-term) or long-lasting (chronic).

Insomnia becomes a complication of separation anxiety disorder treatment because it is a side effect of medications such as SSRIs. While antidepressants may help people with insomnia, there are situations when they do the opposite and cause sleep disturbances. A review from the journal Drugs suggested that antidepressants that enhance serotonin function by blocking reuptake have the greatest effects on rapid eye movement (REM) sleep. They can reduce the amount of REM sleep, particularly in the treatment.

Insomnia is one of the complications of SAD treatment because it may take a while for the body to adjust to the medication. This complication is short-term and resolves once the body adapts to the treatment or when a patient starts taking medications in the morning. However, changing the dosage or time when it’s taken should be performed only when a healthcare professional approves.

Insomnia as a complication of SAD treatment is identified by the appearance of sleep difficulties that a patient hasn’t experienced before. For example, they may struggle to fall asleep, wake up often during the night, or wake up too early after they have started taking medications.

2. Changes in appetite

Changes in appetite are defined as an increase or decrease in appetite compared to the usual food intake. Illnesses such as diabetes, hyperthyroidism, and hypothyroidism can cause changes in appetite. They can also occur due to a complication or adverse reactions to treatments and medications.

Changes in appetite become a complication of separation anxiety disorder treatment because they can occur as a side effect of medications such as SSRIs. Antidepressants such as SSRIs may temporarily suppress appetite, make a person eat less, and even lead to weight loss. Neurotransmitters such as serotonin may also be involved in this process. However, after taking them for more than six months weight gain may occur, Psych Central explained.

Changes in appetite are a complication of treatment for SAD because therapy sessions can be emotionally tense and challenging. A person may feel physically drained afterward, which can affect their appetite.

As a complication of SAD treatment, changes in appetite are identified as a higher or lower food intake that occurs right after initiation of the treatment. It may last until the body adapts to the medication.

3. Vomiting

Vomiting is an involuntary, forceful expulsion of the stomach contents. It can be a one-time event due to food that doesn’t settle right in the stomach, or it can be recurrent and associated with underlying medical conditions. Vomiting can occur as a complication of treatment with medications such as SSRIs.

Vomiting becomes a complication of separation anxiety disorder treatment because SSRIs stimulate the effects of serotonin. As levels of this neurotransmitter go up, they stimulate serotonin receptors in the gastrointestinal (GI) tract and the brain’s central nervous system (CNS). The stimulatory effect of these medications on GI and CNS can trigger vomiting, nausea, and even reduce appetite. Abrupt cessation of antidepressant use can cause vomiting as well.

Vomiting is a complication of the treatment of SAD because medications may cause a chain of reactions that make a person nauseated with the urge to vomit. Like other complications on this list, such as insomnia, this complication may resolve once the body adapts to the treatment.

As a complication of treatment for separation anxiety disorder, vomiting is identified as nausea, a strong urge to vomit, and involuntary stomach reflexes that occur after a person has started treatment.

4. Tiredness

Tiredness or fatigue is the feeling of weariness or lack of energy that doesn’t go away even after getting rest. While not a disease itself, tiredness occurs as a symptom of both physical and psychological conditions alike. It can also occur as a complication of the treatment, such as for anxiety disorders like SAD.

Tiredness becomes a complication of SAD treatment because it may be a side effect of SSRI. Selective serotonin reuptake inhibitors increase serotonin levels in the brain, and although the medication itself doesn’t work on other neurotransmitters, a higher concentration of serotonin can disrupt dopamine and norepinephrine activity. As these neurotransmitters have a strong influence on energy levels, SSRIs may cause tiredness.

Tiredness is a complication of SAD treatment because therapy sessions can be overwhelming. Therapy requires digging deep into one’s emotions and unpacking and analyzing thought patterns, and it can make a person emotionally vulnerable. This can lead to physical exhaustion and tiredness too.

As a complication of SAD treatment, tiredness is identified as a lack of energy and loss of motivation after the person has started with medications or completed a therapy session. A person may be moody and irritable as well. They may also have slow reflexes or become sedentary i.e. claim they have no energy for physical activity. It is important to consult a doctor about SSRIs. They may adjust the dosage if necessary. This complication may go away on its own as a person adapts to the effects of medications or as they’re making progress with therapy sessions.

5. Thoughts of suicide

Thoughts of suicide are defined as thoughts that a person has about ending their life. Suicidal thoughts are also known as suicidal ideation, which is a broad term that describes a range of contemplations, wishes, and preoccupations with death and suicide.

Suicidal thoughts become a complication of separation anxiety disorder treatment because they are a side effect of medications such as SSRIs. The risk of suicidal behavior is the highest for young adults (18 to 24 years) who are taking these antidepressants. Since SSRIs increase serotonin levels in the brain, people may experience intense mood swings, which can worsen their depression and anxiety, Drug Watch explained.

Thoughts of suicide are a complication of SAD treatment because SSRIs may cause mania and violent behaviors, which can lead to suicidal thoughts. It is important to mention that not all patients who are taking SSRIs will experience this complication.

As a complication of SAD treatment, thoughts of suicide are identified as constantly thinking about suicide, ways to perform it, and exploring the subject online. Suicidal thoughts may occur after a person has started taking their medications. They may also talk a lot about death and suicide.

How to reduce separation anxiety disorder?

Besides adhering to doctor-recommended treatment, there’s a lot that patients and their loved ones can do to manage their condition. Tips on how to reduce separation anxiety disorder are listed below:

• Learn as much as possible about SAD (whether you’re a parent or an adult with SAD)
• Identify triggers of anxiety and find a way to reduce exposure to them or how to handle them in a healthier manner
• Manage stress
• Focus on self-care and a healthy lifestyle
• Join a support group
• Be consistent
• Avoid having long goodbyes when leaving to work or trip

Is separation anxiety disorder a mental illness?

Yes, separation anxiety disorder is a mental illness and it is categorized as a type of anxiety disorder. While separation anxiety is a normal part of a child’s development, SAD is a serious mental health disorder because the symptoms, such as fear and worry, are excessive and intense. Adolescents and adults can develop separation anxiety disorder as well. Even though fear and worry about losing a loved one affect every individual, in people with SAD, these feelings are so intense they affect their functioning and quality of life.