Separation anxiety

Separation anxiety is the worry or distress people feel when separated from someone they are attached to. In infancy and early childhood, it is a sign of healthy attachment: babies learn who their caregivers are and protest when they leave.

Separation anxiety disorder is diagnosed when the fear goes beyond what is expected for a person's age, lasts for an extended period and causes significant distress or problems. A child may refuse to go to school, sleep alone or attend activities without a parent. An adult may struggle intensely when a partner, child or parent is away.

The core of separation anxiety disorder is fear that something bad will happen to the loved one or to yourself during separation, such as an accident, illness or getting lost.

Separation anxiety in toddlers is a normal part of development. It often appears in the first year, may peak in the toddler years and usually eases as children learn that caregivers come back. A clingy child at daycare drop-off or bedtime is very common.

In older children, separation anxiety may become a concern when:

• Distress at separation is intense and lasts long after drop-off
• They refuse to go to school, sleepovers or activities
• They worry excessively that something will happen to a parent
• They have frequent nightmares about separation
• They complain of stomachaches or headaches before separations
• They follow a parent from room to room or cannot sleep alone

Changes such as starting school, moving, a new sibling, divorce or illness can trigger or intensify separation anxiety in children.

Separation anxiety in adults is less widely known but very real. Adults may feel intense anxiety when apart from a partner, children or parents, worry constantly about their safety, need frequent contact or avoid traveling or being alone.

Adult separation anxiety may have started in childhood or appear for the first time in adulthood, sometimes after a loss, trauma or a frightening event. It can overlap with other conditions, including panic disorder, generalized anxiety, depression and attachment difficulties.

The impact on relationships can be significant. Partners may feel overwhelmed by the need for reassurance, and the person with separation anxiety may feel ashamed of their fears.

Separation anxiety usually develops from a combination of factors:

• An anxious or sensitive temperament
• Family history of anxiety
• Stressful events or losses, especially involving separation
• Overprotective patterns that limit opportunities to practice independence
• Past trauma or frightening experiences
• Major life changes such as moving or a new school

No single cause explains separation anxiety, and it is not a sign of weakness or poor parenting.

Cognitive behavioral therapy is the main treatment for separation anxiety disorder. For children, it often includes parents and focuses on gradual practice with separations, coping skills and changing anxious thoughts. Parents learn how to respond supportively without accommodating avoidance.

For adults, CBT helps identify fears about separation, reduce reassurance seeking and checking, and gradually tolerate time apart. Attachment-focused approaches and couples or family therapy may also help. A psychiatrist may consider medication when anxiety is severe or accompanied by other conditions.

Child psychologists, clinical psychologists, family therapists and child or adult psychiatrists can help. In a first appointment, you will discuss when the anxiety appears, how it affects daily life and what has been tried.

For parents of a clingy child:

• Keep goodbyes short, warm and predictable.
• Practice short separations and build up gradually.
• Avoid sneaking away, which can increase anxiety.
• Praise brave behavior and keep promises about returning.

For adults:

• Notice reassurance-seeking and try to delay it.
• Build activities and connections of your own.
• Practice tolerating uncertainty in small steps.

Seek help if separation anxiety lasts for weeks, interferes with school, work or relationships, or causes significant distress.