We all come into the world as vulnerable beings, as we require up to a year of brain maturation to take our first hesitant steps, or even to communicate our will through the spoken word.

That is why relations with figures of attachment are fundamental, because from them the foundation of autonomy and the safe exploration of the natural environment in a moment of extreme lack of protection is built.

In this sense, it is essential to progressively encourage the child’s independence so that he or she can be prepared to take on the challenges inherent in this stage of their life and those to come (such as school or relationships with peers).

Separation anxiety disorder involves the emergence of profound distress during this natural process of transition, and is undoubtedly one of the most common psychological problems in childhood.

What is separation anxiety disorder in children?

Separation anxiety disorder is present in 4% of children and 1.6% of adolescents. It involves a fear of separation from the figures of attachment , which translates into discomfort when these figures leave their side. Very often it is a matter of some imaginary distance, without objective support, with which the child projects his uncertainty or his anguish towards the future.

In the following, we will describe its nuclear symptoms, the reasons why they can occur and the therapeutic approach currently available.

1. Emotional discomfort in anticipation of a separation from attachment figures

Children with a separation anxiety disorder are sensitive to any cues that might suggest withdrawal from their attachment figures (especially their parents). For this reason, they are very attentive not only to the events that occur in front of them and that they think might suggest it, but also to those that might occur in the future, anticipating “threats” that will most likely never come.

In this sense, it is important to consider that, in the first years of life, the projection on the future can be conditioned by a magical thought: children would formulate hypotheses on reality devoid of adult logic, but to which they would give total credibility within the framework of their personal experiences and expectations, turning improbable events (kidnapping, abandonment, etc.) into real and tangible risks . Time, therefore, becomes an enemy and a source of stress.

As the anticipated day approaches, the children see increased emotional pain and worry. A worsening of the behavioural aspects of the problem can also be seen frequently . Thus, it is not strange that they express their fears through tantrums and explosions of bad temper, which suppose a conflict for the parents and other care figures (relatives, teachers, etc.).

2. Excessive and persistent concern about losing one of the attachment figures or suffering damage

Children suffering from generalised anxiety disorder are concerned about the health and well-being of their attachment figures , living in fear of misfortune or illness. This is why they develop reinsurance behaviours, which consist of investigating the state of their parents by asking questions about the probability of their dying or suffering some kind of damage (which is experienced with surprise by those mentioned).

This fear is heightened during periods when one of the attachment figures develops a common or more serious illness. In the latter case, the family’s attempts to hide the situation may precipitate an attitude of suspicion in the child, which would end up adding uncertainty to his experience of anxiety. In the case of minor pathologies, such as colds or other transitory processes, an attitude of concern and excessive anxiety may be shown in the face of harmless symptoms (fever, cough, etc.).

3. Fear of an event that could lead to the separation of the attachment figure

One of the most common phenomena in the context of this disorder is the appearance of thoughts about imaginary events that could precipitate an abrupt separation from parents. These include the likelihood of being lost or abducted, or of a third party gaining access to the privacy of the home and causing harm to family members.

This fear coexists with normal fears for the age period , such as those related to monsters or fantasy beings, and even merges with them in some way (developing fear of Santa Claus at the possibility that he has evil intentions, for example).

It is also common for the child to experience intense distress at the scene of family friction. In this way, he may refer to discomfort during discussions between the parents themselves (daily quarrels over ordinary matters) or in the event that either of them shows signs of anger or disagreement with regard to his behaviour. The latter can trigger the belief that one is worthy of punishment or that one is “bad”, which can be deeply rooted in self-esteem and can cause fear of abandonment .

4. Persistent refusal to leave home

In children with separation anxiety disorder, the home may be perceived as the main space of safety, so when they leave it, they experience overwhelming distress. This fact becomes more acute during moves, when moving to a new school (or institute) and when the summer holidays arrive. This fear can lead to a complete refusal to participate in any school trip or excursion, especially when it involves spending the night away from home.

Fear of withdrawal may persist into adolescence , although there is evidence that separation anxiety disorder tends to decrease in prevalence as time passes. In this case, the emotion that overwhelms the person may hinder the development of dyadic relationships (friendship, camaraderie, etc.) at a time in life when the first bonds are usually forged outside the family framework.

5. Concern about loneliness

Concern about being alone is common in this disorder, as it is a time when the child perceives an increased likelihood of being abducted or lost , two of the most feared situations. This is why the distance of the attachment figures leads to an inhibition of play and other behaviours of exploration of the environment, recovering only at the moment when their presence is restored.

This fear is particularly prevalent at bedtime, and is intensified when parents decide to place their child’s bedroom in a separate space.

During this transition period, the child expresses the desire to be accompanied, or slips into a trusted person’s bed in the middle of the night. Sometimes he may develop a problem with sleeping , expectant of the sounds that may arise in the silence of the house while feeding his fears with his vivid imagination.

6. Recurring nightmares about the separation of attachment figures

Nightmares involving harm to either parent are common in this disorder, and one reason they may reject the idea of sleeping alone. This is a more frequent phenomenon in younger children, since there is a period in which the fear of separation from parents becomes normal and adaptive . In this case, however, the nightmares provoke a profound deterioration in the life of the child and that of his or her family (interfering excessively with areas of functioning).

The content of the nightmares, which the child is capable of evoking at the moment when the parents inquire about the subject (which sometimes happens in the middle of the night), is usually about divorce or the outbreak of some tragic event (murder, accidents, etc.). In this case, the child may wake up agitated, shouting and/or sobbing.

In the event that you go back to sleep immediately, and also do not remember anything that happened the next morning, it could be a night terror (a parasomnia whose intensity increases during periods of stress).

7. Recurring physical complaints during separation of attachment figures or when this is anticipated

Many children experience physical discomfort as a result of separation. The most frequent symptoms are headache, abdominal pain, dizziness, nausea, cramps, palpitations and chest pain ; occurring alone or in combination. In addition, they manifest themselves in the hours prior to going to school or other activities (during which a temporary distancing from people with whom an attachment has been forged is anticipated).

This eventuality is often of great concern to parents and motivates visits to the paediatrician, whose examinations find no organic cause for such a flowery clinic. Likewise, causes constant school absenteeism , which conditions the acquisition of knowledge foreseen in the child’s curriculum and warrants the adoption of extraordinary measures (repetition of school year, for example). When the symptoms persist in school, it is possible that they are associated with that space, producing explicit refusal to attend school.

Causes

The scientific literature on this issue has tried to determine what the risk factors are for this anxiety disorder, with causes being found in the environment and in parenting styles. The most important one refers to the formation of some insecure attachment in any of its three subtypes: worried (feeling that he/she will not have help in case he/she needs it), fearful (rejection by parents of the attempts of approach) and disorganized (experience of explicit abuse or hostility).

Abrupt changes in everyday life can also contribute to this problem (moving, enrolling in a new school or college, etc.), since predictable environments are essential for children’s emotional development.

Stress due to family situations (divorces, death of a loved one, birth of a new sibling, etc.), and the experience of rejection at school, can also be related to this problem.

In turn, there is evidence that adults who had this anxiety disorder as children are more likely to have panic attacks (episodes of acute anxiety).

Finally, an overprotective parenting style may also be related to this anxiety disorder, since it would deprive the child of safe exploration of his or her environment and severely reduce his or her autonomy. This is why loneliness is experienced as an unbearable helplessness , as the child believes he has no tools to manage it without help.

The search for a balance between freedom and protection is key to the care of a child, since it is on this that he or she will forge the first tools with which to build their autonomy.

What is your treatment?

There is an effective psychological treatment for this mental health problem, which involves both a cognitive and behavioral approach, as well as the articulation of a plan aimed at promoting habits that facilitate coexistence at home. In the first place, a psychoeducational treatment of the problem is necessary (together with a functional analysis), so that the parents understand what the most concrete causes of the problem are and can tackle them from their origin.

It is advisable to talk to the child about his feelings in an active way , without avoiding or minimizing them. It is also interesting to support him to get involved in shared activities with his peer group, and to reinforce the progress made towards the development of independence. It is also essential to face the situation of separation naturally, and to be accessible at times when the child may need closeness or support.

Bibliographic references:

  • Ehrenreich, J.T., Santucci, L.C. and Weiner, C.L. (2008). Separation Anxiety Disorder in Youth: Phenomenology, Assessment and Treatment. Behavioral Psychology, 16(3), 389-412.
  • Silove, D., Manicavasagar, V. and Pini, S. (2016). Can Separation Anxiety Disorder Escape its Attachment to Childhood? World Psychiatry, 15(2), 113-115.