What it is
Separation Anxiety Disorder (SAD) is intense, developmentally inappropriate fear or distress about being away from home or key attachment figures. It’s most common in children but can affect teens and adults. The anxiety is persistent (typically 4+ weeks in youth, 6+ months in adults) and interferes with school, work, or relationships. It is treatable.
Normal separation worry in toddlers is expected; the disorder is about severity, persistence, and impairment.
Common signs and symptoms
- Excessive distress before or during separations; worry about harm befalling loved ones
- Reluctance/refusal to go to school, work, sleepovers, or be alone in another room
- Nightmares about separation; physical symptoms (stomachaches, headaches) at separation times
- Repeated calls/texts for reassurance; difficulty sleeping alone
- In adults: difficulty traveling without partner, intense worry if a loved one is late or unreachable
Why it happens
- Temperament (behavioral inhibition), family anxiety patterns, stressful events or losses
- Overestimation of danger and underestimation of coping abilities
- Avoidance and reassurance cycles maintain anxiety
What helps
- Cognitive Behavioral Therapy (CBT) with exposure
- Gradual “brave practices” that stepwise increase time and distance apart
- Coping skills: realistic thinking, calm-breathing, independent routines
- Parent coaching to reduce excessive reassurance and support brave steps
- School/work collaboration
- Return-to-school plans with gradual attendance and supports
- Predictable drop-off routines; attendance goals tracked positively
- Family strategies
- Consistent schedules; brief, confident goodbyes; reward bravery
- Practice independence in small ways (playing in another room, short errands)
- Medications
- For moderate to severe cases or co-occurring anxiety/depression: SSRIs may help, alongside therapy
Early, structured exposure is key; avoidance grows anxiety.
When to seek help now
- School refusal or work avoidance lasting days to weeks
- Panic symptoms or physical complaints around separations
- Thoughts of self-harm or not wanting to live (urgent help)
How to talk to a clinician or school
- “Separation triggers intense distress and school/work avoidance. We’d like CBT with gradual exposure, parent coaching, and a return-to-school plan.”
Outlook
With CBT and coordinated supports, most children and adults improve within weeks to months, regaining independence and confidence.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline; Crisis Text Line text HOME to 741741
- Find care: Psychology Today (filter for child/adolescent CBT or adult anxiety); FindTreatment.gov; NAMI HelpLine (nami.org/help)
- School supports: 504/IEP accommodations for anxiety-related attendance; school counseling
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Verify in-network CBT, family therapy, telehealth; copay/coinsurance, deductible, out-of-pocket max
- Urgent options besides ER: Mobile Crisis for youth via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.