Heritability was estimated at 73% in a community sample of 6-year-old twins, with higher rates in girls. Children with separation anxiety disorder display particularly enhanced sensitivity to respiratory stimulation using COz-enriched air.
There are cultural variations in the degree to which it is considered desirable to tolerate separation, so that demands and opportunities for separation between parents and chil- dren are avoided in some cultures. For example, there is wide variation across countries and cultures with respect to the age at which it is expected that offspring should leave the parental home. It is important to differentiate separation anxiety disorder from the high value some cultures place on strong interdependence among family members.
Girls manifest greater reluctance to attend or avoidance of school than boys. Indirect ex- pression of fear of separation may be more common in males than in females, for example, by limited independent activity, reluctance to be away from home alone, or distress when spouse or offspring do things independently or when contact with spouse or offspring is not possible.
Separation anxiety disorder in children may be associated with an increased risk for sui- cide. In a community sample, the presence of mood disorders, anxiety disorders, or sub- stance use has been associated with suicidal ideation and attempts. However, this association is not specific to separation anxiety disorder and is found in several anxiety disorders.
Functional Consequences of Separatlon Anxiety Disorder
Individuals with separation anxiety disorder often limit independent activities away from home or attachment figures (e.g., in children, avoiding school, not going to camp, having difficulty sleeping alone; in adolescents, not going away to college; in adults, not leaving the parental home, not traveling, not working outside the home).
Generalized anxiety disorder. Separation anxiety disorder is distinguished from gener- alized anxiety disorder in that the anxiety predominantly concerns separation from attach- ment figures, and if other worries occur, they do not predominate the clinical picture.
Panic disorder. Threats of separation may lead to extreme anxiety and even a panic at- tack. In separation anxiety disorder, in contrast to panic disorder, the anxiety concerns the possibility of being away from attachment figures and worry about untoward events be- falling them, rather than being incapacitated by an unexpected panic attack.
Agoraphobia. Unlike individuals with agoraphobia, those with separation anxiety dis- order are not anxious about being trapped or incapacitated in situations from which es- cape is perceived as difficult in the event of panic-like symptoms or other incapacitating symptoms.
Conduct disorder. School avoidance (truancy) is common in conduct disorder, but anx- iety about separation is not responsible for school absences, and the child or adolescent usually stays away from, rather than returns to, the home.
Social anxiety disorder. School refusal may be due to social anxiety disorder (social pho- bia). In such instances, the school avoidance is due to fear of being judged negatively by oth- ers rather than to worries about being separated from the attachment figures.
Posttraumatic stress disorder. Fear of separation from loved ones is common after trau- matic events such as a disasters, particularly when periods of separation from loved ones were experienced during the traumatic event. In posttraumatic stress disorder (PTSD), the central symptoms concern intrusions about, and avoidance of, memories associated with the traumatic event itself, whereas in separation anxiety disorder, the worries and avoid- ance concern the well-being of attachment figures and separation from them.
Illness anxiety disorder. Individuals with illness anxiety disorder worry about specific illnesses they may have, but the main concern is about the medical diagnosis itself, not about being separated from attachment figures.
Bereavement. Intense yearning or longing for the deceased, intense sorrow and emo- tional pain, and preoccupation with the deceased or the circumstances of the death are ex- pected responses occurring in bereavement, whereas fear of separation from other attachment figures is central in separation anxiety disorder.