How are parents supposed to respond when what first seemed like developmentally appropriate separation anxiety never goes away?

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Most parents know the pain of having to leave a crying child with a babysitter, day care worker, or even a family member they haven’t seen in a while.

According to the American Academy of Pediatrics (AAP), separation anxiety is a standard developmental milestone between 6 and 18 months of age. It happens when a baby’s growing attachment to you faces off against their still budding understanding of object permanence.

It isn’t fun, but it helps to know most parents go through it — and it especially helps to know it will eventually end.

But what happens when it doesn’t actually end? How are parents supposed to respond when their child’s separation anxiety either never goes away or becomes a new concern after a traumatic event in their child’s life?

And what about the adults still dealing with separation anxiety themselves?

The American Psychological Association (APA) defines separation anxiety disorder as an anxiety disorder that typically occurs in childhood or adolescence.

This isn’t the same as the separation anxiety most babies and toddlers experience.

While separation anxiety disorder may look similar — in that it involves a fear of separation from one’s home or family — it differs from developmentally appropriate separation anxiety. This is because it occurs outside that expected time period and is both excessive and persistent in nature.

Separation anxiety disorder may involve:

  • mounting anxiety purely over the anticipation of potential separation
  • ongoing fears and concerns surrounding the presumed terrible things that might happen if that separation occurs
  • ongoing fears and concerns about the types of events that may lead to separation
  • refusing to go to school
  • not being able to sleep outside the home or when their main attachment figures are absent
  • nightmares
  • physical symptoms like headaches, nausea, or vomiting

While most commonly seen in children and adolescents, the current Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes that adults can also experience separation anxiety disorder.

In fact, research from 2008 indicates that approximately 4.1% of children will deal with separation anxiety disorder — and 36.1% of them will continue living with the condition into adulthood if it’s left untreated.

Only in the last decade or so has separation anxiety disorder been recognized in adults, according to a 2010 study. And even still, it’s diagnosed only when symptoms fail to meet the criteria for other panic and anxiety disorders.

For the most part, childhood separation anxiety disorder and adult separation anxiety disorder appear very similar, with just a few minor exceptions.

Adults with separation anxiety disorder experience extreme anxiety and fear when it comes to being separated from major attachment figures, just as children do. They worry about being separated and avoid being alone.

The main differences in presentation seem to have more to do with maturity than anything else. For instance, adults may be better at recognizing and articulating their anxiety for what it is, and they may be less likely to outwardly display their symptoms.

While separation anxiety disorder can develop in adulthood, the researchers in the 2010 study believe it’s more likely for childhood separation anxiety to persist into adulthood. This means that most adults with separation anxiety disorder have likely been living with the condition for much of their lives.

Separation anxiety disorder in adults or children is marked by fears and concerns about:

  • being separated from an attachment figure
  • losing a major attachment figure to illness, injury, or death
  • experiencing unexpected events that may result in separation from a major attachment figure
  • being away from home
  • being alone

Other symptoms include an inability to sleep without a major attachment figure nearby and nightmares about being separated from a major attachment figure.

While many kids may experiences some of the above from time to time, the DSM-5 explains that in order to qualify for a diagnosis of separation anxiety disorder, these symptoms must be:

  • persistent
  • excessive to the point of impairing social or academic functioning
  • not developmentally appropriate

In children, the symptoms must last for at least 4 weeks, while the timeline is 6 months or more for adults.

There’s no one known cause for the development of separation anxiety disorder, but several factors appear to increase a child’s risk of developing the disorder.

Research from 2009 suggested possible genetic components in the development of separation anxiety disorder.

In other words, some people may be predisposed to higher levels of anxiety and fear surrounding separation from major attachment figures. If a child has a family history of anxiety or depression, they may be at greater risk.

That said, research from 2008 concluded that separation anxiety disorder is more influenced by environmental factors than many other childhood anxiety disorders.

Some of those environmental risk factors include:

  • low levels of parental warmth
  • overprotective and over-involved parenting behaviors
  • parental intrusiveness in emotional regulation and behavior

Traumatic or stressful life events are also thought to increase the risk of separation anxiety disorder in children. These may include:

  • the absence or death of a major attachment figure
  • domestic violence in the home
  • parental divorce
  • recurrent moves that impact the development of social connections

For adults, the main risk factor for separation anxiety disorder is having untreated separation anxiety disorder in childhood.

One of the main parts of diagnosing separation anxiety disorder is first ruling out other potential mental health conditions, including:

From there, it’s a matter of meeting the diagnostic criteria, including fears about a major attachment figure that are:

  • persistent
  • excessive to the point of impairing social or academic functioning
  • not developmentally appropriate

If symptoms meet the diagnostic criteria and a trained medical or mental health professional has ruled out other mental health conditions, they can make a diagnosis of separation anxiety disorder.

For a parent wondering if they should take their child for evaluation, the answer is simple: If your child’s anxiety is impacting their day-to-day life (or yours), an evaluation is warranted.

Most mental health professionals will spend time talking with a child’s about what they’ve witnessed in their child. Then, they’ll talk with the child about how they experience their anxiety. It may take only one session for a diagnosis — but that’s when the real work begins.

As mentioned, the main risk factor for adult separation anxiety disorder is untreated childhood separation anxiety disorder.

That’s just one more reason to commit to treatment for your child once a mental health professional makes a diagnosis of separation anxiety disorder.

The good news is several treatment options are available, and many have proven successful in the treatment of separation anxiety disorder.

The treatment option with the most research behind it is cognitive behavior therapy (CBT). Plus, research from 2018 indicates that this form of therapy may be effective long term.

The goal of CBT is to challenge thought distortions and teach the person undergoing therapy better coping strategies.

For children and adults living with separation anxiety disorder, this may involve talking about the fears they’re experiencing and exploring how realistic those fears may be.

Continuing treatment adds in an exposure component. This is when the child or adult goes through imagined or real-life anxiety-provoking situations while applying the coping skills learned previously.

Another potential treatment option is parent-child interaction therapy (PCIT), which focuses on improving the parent-child relationship and allows parents to learn how to interact with their children in a healthier manner.

For children with separation anxiety disorder, one of the key components of success, regardless of the type of treatment being pursued, is parental involvement. It may be best to think of this as family treatment, as opposed to treatment for just the individual child.

Having a child with separation anxiety disorder can be isolating and exhausting for both caregiver and child. Being an adult with separation anxiety disorder is perhaps even more exhausting.

That’s why it’s so important to remember you’re not alone. This diagnosis exists because others like you are dealing with the same thing.

In fact, there are quite a few support groups specifically for parents of children with anxiety disorders, including:

It’s also important to remember that treatment can help, particularly when the whole family is involved. Children and adults living with separation anxiety disorder can find relief from their symptoms.

The first step is often as simple as picking up the phone and asking for help.