What is Separation Anxiety Disorder?

Separation Anxiety Disorder is characterised by developmentally inappropriate and excessive anxiety concerning separation from home or attachment figures. In children it commonly appears around school entry; in adults it presents with debilitating worry about losing or being separated from close relationships.

Causes & risk factors

• Temperamental factors: behavioural inhibition, high trait anxiety.
• Family factors: parental anxiety, overprotection, family stressors (divorce, bereavement).
• Life events: trauma, prolonged separation, school transitions, or medical illness.
• Genetic & neurobiological vulnerability interacting with environmental stressors.

Symptoms (children & adolescents)

• Excessive distress when anticipating or experiencing separation (crying, tantrums, refusal to go to school).
• Persistent worry about harm befalling attachment figures or about experiencing an event that leads to separation (abduction, illness).
• Somatic complaints (stomachache, headache) on separation, nightmares about separation, reluctance to sleep away from home.
• Duration: typically ≥4 weeks in children/adolescents and causing functional impairment.

Symptoms (adults)

• Excessive worry about losing major attachment figures, persistent fear of being alone, reluctance to be away from partner/family, and avoidance of work or social activities that require separation.
• Symptoms last ≥6 months and cause significant distress or impairment.

Assessment checklist

1. Gather developmental history, onset relative to life events, family history of anxiety, and current functioning (school, work, relationships).
2. Use standardised measures where available (e.g., Separation Anxiety Symptom Inventory for adults; SCARED, RCADS for children).
3. Assess comorbidity: other anxiety disorders, depression, health anxiety, and trauma‑related disorders.
4. Observe parent–child interactions and obtain teacher reports for school attendance and behaviour.

Treatment approaches

• Cognitive‑Behavioural Therapy (CBT): core treatment—includes psychoeducation, graded separation exercises, cognitive restructuring of catastrophic beliefs and skills training.
• Family‑based interventions: parent coaching to reduce accommodating behaviours, increase graded separations and provide consistent routines.
• School liaison: collaborative plans to support gradual school attendance, accommodations and brief exposure tasks at school.
• Medication: SSRIs can be considered for moderate–severe cases or comorbid conditions, usually alongside CBT and specialist oversight.

Practical treatment steps (children)

1. Collaboratively create a separation hierarchy (e.g., stand at the gate → short time in class → staying for lunch).
2. Use behavioural activation and graduated exposure with rewards for successful separations.
3. Coach parents to avoid excessive reassurance and to reinforce child’s coping; plan brief, predictable goodbye routines.
4. Coordinate with school for phased return, buddy systems and teacher prompts to support participation.

Key takeaways

• Recognise SAD early—assess family and school context; use graded exposure and parent coaching for children.
• For adults, CBT targeting catastrophic separation beliefs and behavioural activation is effective; consider SSRIs when needed.
• Coordinate with schools and social supports; escalate for severe functional decline, safety concerns or suicidality.

Common anxiety disorder categories

• Generalised Anxiety Disorder (GAD)
• Panic Disorder & Agoraphobia
• Social Anxiety Disorder (Social Phobia)
• Specific Phobias
• Separation Anxiety Disorder
• Obsessive‑Compulsive Disorder (OCD) and related disorders
• Post‑Traumatic Stress Disorder (PTSD) — trauma‑related anxiety

Core assessment principles

• Comprehensive history: onset, course, triggers, functional impact, substance use, medical history and family context.
• Use validated scales (PHQ‑9, GAD‑7, LSAS, PDSS, SPIN) and behavioural observations.
• Screen for medical mimics and comorbidities (thyroid disease, cardiac, respiratory conditions, substance use).
• Assess risk: suicidality, severe avoidance, substance misuse and safety concerns.

Evidence‑based treatments

• Psychological therapies: CBT (including exposure, cognitive restructuring, behavioural activation), ACT, and trauma‑focused therapies where relevant.
• Pharmacotherapy: SSRIs/SNRIs are first‑line medications across many anxiety disorders; benzodiazepines for short‑term severe symptoms when necessary but avoid long‑term use.
• Stepped care: low‑intensity interventions (guided self‑help, digital CBT) for mild cases; high‑intensity individual or group CBT, pharmacotherapy and specialist referral for moderate–severe cases.
• Adjunctive supports: sleep, exercise, substance reduction, psychoeducation, family involvement and workplace/school accommodations.

Transdiagnostic approaches

Transdiagnostic CBT and emotion‑regulation approaches target shared mechanisms (avoidance, cognitive fusion, intolerance of uncertainty) and can be efficient for comorbid anxiety presentations.

Practical clinic tips

• Set collaborative goals and use outcome measures to monitor progress (ROM) regularly.
• Address safety behaviours and avoidance in treatment planning; design exposures with measurable steps and homework.
• Coordinate with primary care for medical reviews and medication monitoring; involve families and employers/schools when appropriate.

Key takeaways

• Anxiety disorders are common, treatable conditions—identify type, assess severity and comorbidity, and offer evidence‑based CBT and/or pharmacotherapy.
• Use stepped care models, monitor outcomes, and coordinate with other services for comprehensive care.
• Address lifestyle factors, provide psychoeducation and involve families/schools/employers to support recovery.