Childhood Disorders 673
Distinguishing Between Separation Anxiety Disorder
and Other Disorders
As they did for JC, the symptoms of separation anxiety disorder can overlap with
those of generalized anxiety disorder and social phobia. Both separation anxiety
disorder and generalized anxiety disorder involve worries that are diffi cult to con-
trol, such as a fear that family members may be harmed. With separation anxiety
disorder, however, the worries are restricted to separation from the parent; with gen-
eralized anxiety disorder, the worries involve a variety of topics, most of which are
unrelated to separation issues. Similarly, although both social phobia and separation
anxiety disorder may involve a reluctance to leave the house (and attend school),
with social phobia, the fear is about performing or being evaluated by others.
When separated from the parent, children with separation anxiety disordermay exhibit symptoms of various other disorders. For instance, a child or adoles-
cent with separation anxiety disorder may, on occasion, have panic attacks when
forced to separate from the parent; however, the attacks do not indicate panic dis-
order unless the child or adolescent comes to fear having additional panic attacks.
In addition, such children may appear depressed—seeming sad, apathetic and
withdrawn—and have diffi culty concentrating. In fact, some may become clinically
depressed. Children with this disorder worry about death and may have persistent
fears of monsters, kidnappers, or other harmful fi gures or acts, particularly when
alone. They may even report that no one loves them—perhaps because their parents
do not allow them to sleep in the parents’ bed or because the parents force them to
attend school. When forced to separate from the parent, children with separation
anxiety disorder may get angry and hit other people. Parents, siblings, teachers, and
others may report that a child with separation anxiety disorder is particularly needy
Prevalence- About 4% of adults experienced separation anxiety disorder in childhood (Shear et al., 2006).
- Separation anxiety disorder is the most prevalent anxiety disorder among children.
Onset - As required by DSM-IV-TR, the disorder must emerge before an individual is 18 years old,
although it can begin as early as the preschool years. - Separation anxiety disorder may emerge after some type of stressful event, such as a move,
the death of a pet, or the illness of a relative.
Comorbidity - Children with separation anxiety disorder are more likely to experience other anxiety disorders
than are children in the general population (Brückl et al., 2006; Verduin & Kendall, 2003).
Course - Symptoms often wax and wane.
- As the child gets older, symptoms tend to lessen; at some point before adulthood, most individu-
als no longer meet the criteria for the disorder (Foley, Pickles et al., 2004; Shear et al., 2006).
Gender Differences - In the general population, more females than males have this disorder; however, comparable
numbers of males and females with this disorder are treated as outpatients.
Cultural Differences - Different ethnic groups and cultures have different norms about what constitutes appropriate
responses to separation in children, which can affect parents’ inclination to perceive a separa-
tion problem and create different thresholds for diagnosis across cultures.
Source: Unless otherwise noted, the source for information is American Psychiatric Association, 2000.Table 14.17 • Separation Anxiety Disorder Facts at a Glance