Separation Anxiety Disorder

Separation anxiety disorder is characterized by recurrent excessive distress at separation from major attachment figures or home, persistent worry about losing them through illness or harm, fear of getting lost or kidnapped, school or work refusal, fear of being alone, nightmares about separation, and physical complaints (headaches, stomachaches) when separation occurs. Symptoms persist at least four weeks in children and six months in adults.

Pediatric prevalence is 4 percent, peaking at age 7 to 9, with 36 percent persisting into adulthood. Adult separation anxiety affects up to 7 percent of populations, often with onset in adulthood and high comorbidity with panic disorder, social anxiety, and depression. Risk factors include parental anxiety, overprotective parenting, traumatic separation events, and behavioral inhibition.

Cognitive behavioral therapy is the first-line treatment, including psychoeducation, gradual exposure to separation situations, cognitive restructuring of catastrophic thoughts, parent training on differential reinforcement, and relaxation techniques. School refusal requires coordinated school-based intervention. Selective serotonin reuptake inhibitors (sertraline, fluoxetine) treat moderate to severe cases, especially with comorbid depression. Family involvement enhances treatment outcomes.