What are the symptoms and signs of separation anxiety disorder?

Symptoms of separation anxiety disorder may include

• repeated excessive anxiety about something bad happening to loved ones or losing them;
• heightened concern about either getting lost or being kidnapped;
• repeated hesitancy or refusal to go to day care or school or to be alone or without loved ones or other adults who are important to the anxious child;
• persistent reluctance or refusal to go to sleep at nighttime without being physically close to adult loved ones;
• repeated nightmares about being separated from the people who are important to the sufferer;
• and/or recurrent physical complaints, such as headaches or stomachaches, when separation either occurs or is expected.

To qualify for the diagnosis of separation anxiety disorder, a minimum of three of the above symptoms must persist for at least a month and cause significant stressor problems with school, social relationships, or some other area of the sufferer's life. Also, the disorder is not considered to be present if symptoms only take place when the child is suffering from certain other mental-health problems, such as schizophrenia or from a specific kind of developmental disability called pervasive developmental disorder. School refusal, also called school phobia, may be a symptom of separation anxiety disorder, but it can also occur as a symptom of other anxiety disorders and is not a diagnosis by itself.  

Social phobia, also an anxiety disorder, differs from separation anxiety disorder in that social phobia is characterized by severe fear of most, if not all, social situations, not just events that result in separating from primary caregivers. This illness affects about 1% of children and adolescents and up to 5% of adults.

Individuals with social phobia may be children, teenagers, or adults, and the anxiety may interfere with the person's ability to function. Children with this problem may have difficulty with a number of ordinary activities, such as playing with their peers, talking in class, or speaking to adults.

What are causes and risk factors for separation anxiety disorder?

Separation anxiety disorder (as with most mental-health conditions) is likely caused by the combination of genetic and environmental vulnerabilities rather than by any one thing.

In addition to being more common in children with family histories of anxiety, children whose mothers were stressed during pregnancy with them tend to be more at risk for developing this disorder.

A majority of children with separation anxiety disorder have school refusal as a symptom and up to 80% of children who refuse school qualify for the diagnosis of separation anxiety disorder. Approximately 50%-75% of children who suffer from this disorder come from homes of low socioeconomic status.