When separated from major attachment figures, children with separation anxiety disorder may exhibit social withdrawal, apathy, sadness, or difficulty concentrating on work or play. Depending on their age, individuals may have fears of animals, monsters, the dark, muggers, burglars, kidnappers, car accidents, plane travel, and other situations that are perceived as presenting danger to the family or themselves. Some individuals become homesick and uncomfortable to the point of misery when away from home. Separation anxiety disorder in children may lead to school refusal, which in turn may lead to academic difficulties and social isolation. When extremely upset at the prospect of separation, chil- dren may show anger or occasionally aggression toward someone who is forcing separa- tion. When alone, especially in the evening or the dark, young children may report unusual perceptual experiences (e.g., seeing people peering into their room, frightening creatures reaching for them, feeling eyes staring at them). Children with this disorder may be de- scribed as demanding, intrusive, and in need of constant attention, and, as adults, may ap- pear dependent and overprotective. The individual’s excessive demands often become a source of frustration for family members, leading to resentment and conﬂict in the family.
The 12-month prevalence of separation anxiety disorder among adults in the United States is 0.9%—1.9%. In children, 6- to 12-month prevalence is estimated to be approximately 4%.
In adolescents in the United States, the 12-month prevalence is 1.6%. Separation anxiety is the most prevalent anxiety disorder in children younger than 12 years. In clinical sam- ples of children, the disorder is equally common in males and females. In the community, the disorder is more frequent in females.
Periods of heightened separation anxiety from attachment figures are part of normal early development and may indicate the development of secure attachment relationships (e.g., around 1 year of age, when infants may suffer from stranger anxiety). Onset of separation anxiety disorder may be as early as preschool age and may occur at any time during child- hood and more rarely in adolescence. Typically there are periods of exacerbation and re- mission. In some cases, both the anxiety about possible separation and the avoidance of situations involving separation from the home or nuclear family (e.g., going away to col- lege, moving away from attachment figures) may persist through adulthood. However, the majority of children with separation anxiety disorder are free of impairing anxiety dis- orders over their lifetimes. Many adults with separation anxiety disorder do not recall a childhood onset of separation anxiety disorder, although they may recall symptoms.
The manifestations of separation anxiety disorder vary with age. Younger children are more reluctant to go to school or may avoid school altogether. Younger children may not express worries or specific fears of definite threats to parents, home, or themselves, and the anxiety is manifested only when separation is experienced. As children age, worries emerge; these are often worries about specific dangers (e.g., accidents, kidnapping, mug- ging, death) or vague concerns about not being reunited with attachment figures. In adults, separation anxiety disorder may limit their ability to cope with changes in circumstances (e.g., moving, getting married). Adults with the disorder are typically overconcemed about their offspring and spouses and experience marked discomfort when separated from them.
They may also experience significant disruption in work or social experiences because of needing to continuously check on the whereabouts of a significant other.
Environmental. Separation anxiety disorder often develops after life stress, especially a loss (e.g., the death of a relative or pet; an illness of the individual or a relative; a change of schools;parenta1 divorce; a move to a new neighborhood; immigration; a disaster that in- volved periods of separation from attachment figures). In young adults, other examples of life stress include leaving the parental home, entering into a romantic relationship, and be- coming a parent. Parental overprotection and intrusiveness may be associated with sepa- ration anxiety disorder.
Genetic and physiological. Separation anxiety disorder in children may be heritable.