Separation Anxiety Disorder

Individuals with separation anxiety disorder experience excessive fear or anxiety when separated from people to whom they feel strongly attached.

In children, this may involve 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. Fear and anxiety is typically persistent for at least four weeks in children and adolescents, and typically six months or more in adults. It causes impairment in social, academic, occupational and other functional areas.

Children may experience significant anxiety and distress when having to separate from caregivers to go to school or to enrichment activities, or when being left in a room by themselves. They may try to avoid situations in which separation may occur.

Adults may find it difficult to go to work, get married or move out of the home to live independently. 

The criteria used to diagnose Separation Anxiety Disorder include:

• Excessive fear or reluctance of being left 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, or 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 or caregivers
• Repeated nightmares about separation from or loss of attachment figures
  
• Repeated complaints of physical symptoms when separated or anticipating separation from attachment figures (e.g. headaches, stomach-aches, dizziness)

Typically, cognitive behavioural therapy is recommended to help the individual to 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 underpin their anxiety.

Therapy may also include exposure exercises in which the individual is gradually exposed to situations or settings that 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.

• Associate Professor John Wong Chee Meng
• Dr Chee Tji Tjian
• Dr Tian Cheong Sing