How Separation Anxiety Is Diagnosed

People with separation anxiety disorder feel intense fear and anxiety about being parted from the people that they are closely emotionally attached to, such as a parent or loved one, or from their home. They often worry that something bad will happen to their loved ones if they are apart from them.

It's typical for young children to feel some distress when they are separated from their parents or caregivers. Separation anxiety disorder was previously thought to only develop in childhood or adolescence, but it is now understood that it can occur in adults as well.

A person is diagnosed with separation anxiety disorder when their symptoms are excessive for their developmental age and cause significant distress in their daily life. For example, they avoid being separated from their attachment figures and avoid being alone. They may also experience physical symptoms when separation occurs or is anticipated.

A mental health practitioner will make a diagnosis of separation anxiety disorder using specific criteria that are found in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM–5).

Here's what you need to know about how separation anxiety disorder is diagnosed.

Professional Screenings

A person's primary care doctor can often do the initial screening for separation anxiety disorder, but they will need to be referred to a mental health professional for an official diagnosis.

A diagnosis of separation anxiety disorder is made using a clinical assessment that follows the American Psychiatric Association's (APA) diagnostic criteria listed in the DSM-5.

Assessment: Interviews and Questions

The assessment may include self-reporting rating scales and structured interviews. The questions asked will depend on whether an adult or child is being evaluated. For example, the Children’s Separation Anxiety Scale (CSAS) lists child-accessible questions such as, “Does your belly hurt when you have to leave your mom or dad?” and "Do you worry about your mom or dad getting sick?"

If a child is being assessed, parents or caregivers may play a big part in the interview. The mental healthcare professional will likely ask the adult to describe what they have observed in the child's behavior, as well as ask questions about the family's medical history.

DSM-5 Criteria

According to the DSM-5, the following criteria must be met for a diagnosis of separation anxiety disorder to be made.

• Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
• Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
• Persistent and excessive worry about experiencing events that cause separation from a major attachment figure, e.g., getting lost, being kidnapped, having an accident, or becoming ill
• Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
• Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
• Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure

According to the DSM-5, fear, anxiety, or avoidance must be persistent—meaning that it lasts at least four weeks in children and adolescents, and typically six months or longer in adults. The symptoms must also cause clinically significant distress and/or harm a person's development socially, at school, or at work.

Onset

Separation anxiety disorder used to only be diagnosed in children and adolescents. However, the latest update to the DSM in 2013 changed the diagnostic guidelines to reflect findings from studies that found that the disorder could develop in adulthood.

Research has shown that separation anxiety disorder has the earliest age of onset of all anxiety disorders. According to a 2017 meta-analysis of studies carried out up to and including 2014, the average age of onset is 10.6 years old, with 95% of people developing the disorder between the ages of 6 and 14.

However, with the recent recognition that the disorder has been under-diagnosed in adults, the real average age of onset might be higher.

Causes

It is not known exactly what causes separation anxiety disorder, however, its onset is thought to be connected to a combination of factors.

Factors that are believed to contribute to separation anxiety disorder include:

• Childhood family adversities. Such as parental mental illness, substance misuse, criminal behavior, domestic violence; child physical abuse; sexual abuse; and neglect.
• Exposure to traumatic life events. Examples include experiencing natural disasters, war, sexual violence, and the death of a loved one.

Differential Diagnosis

One of the most important steps in diagnosing separation anxiety is establishing whether the symptoms a person is experiencing are better explained by another disorder.

There are several phobias and phobia-related disorders, including separation anxiety disorder, specific phobias, social anxiety disorder, and agoraphobia.

During the diagnostic process, a mental health professional needs to establish that the symptoms a person is experiencing are not better explained by something else. The interview may also involve identifying other disorders that a person has.

The DSM-5 lists several other mental health conditions that should be ruled out before a person is diagnosed with separation anxiety disorder.

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.

According to the DSM-5, if a person's persistent refusal to leave home is connected to excessive resistance to change, their symptoms might be better explained by ASD than separation anxiety disorder.

Psychotic Disorders

Psychotic disorders, such as schizophrenia, are characterized by an impaired relationship with reality, usually with associated behavioral changes.

According to the DSM-5, if there are delusions or hallucinations concerning separation, a person's symptoms might be better explained by a psychotic disorder than separation anxiety disorder.

Agoraphobia

Agoraphobia is characterized by a marked fear or anxiety about situations such as using public transportation, standing in line or being in a crowd, being outside the home, and being in open spaces or enclosed spaces such as shops, theaters, and cinemas.

According to the DSM-5, if a person refuses to go outside without a trusted companion, their symptoms might be related to agoraphobia rather than separation anxiety.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by excessive worry and anxiety that is hard to control.

According to the DSM-5, worries about ill health or other harm befalling significant others may mean that a person has GAD, not separation anxiety disorder.

Illness Anxiety Disorder

Illness anxiety disorder (IAD) (previously called hypochondriasis or hypochondria) is a mental health condition that causes a person to strongly believe that they have or will develop a serious or life-threatening illness even though they show little to no symptoms. 

According to the DSM-5, if a person has concerns about having an illness, their symptoms might be better explained by illness anxiety disorder than separation anxiety disorder.

Labs and Tests

Lab tests cannot be used to make a diagnosis of separation anxiety disorder. The only way to diagnose the condition or any specific phobia is through careful evaluation by a mental health professional using the criteria set out in the DSM-5.

Self or At-Home Testing

It is not unusual for young children to experience some difficulty separating from their parents or caregivers, but it can be challenging to cope with. However, when a child has a hard time being away from parents and caregivers, it does not always mean that they have separation anxiety disorder.

If a child's difficulty being separated from a parent, another attachment figure, or their home is disproportionate to their age, it might be a sign that they have separation anxiety disorder.

There are also other signs of separation anxiety disorder in children and adolescents that adults should be aware of.

A child or teen with separation anxiety disorder may:

• Follow their parent(s) or attachment figure(s) around the house
• Insist on sleeping with their parent(s) or attachment figure(s)
• Refuse to go to school, sleepovers, or other situations where they are separated from their parent(s) or attachment figure(s)
• Repeatedly call their parent(s) or attachment figure(s) to “check-in" when they are away from them

A Word From Verywell

Separation anxiety disorder was once believed to only occur in children and teens, but it is now understood that it can also develop in adulthood. While some difficulty separating from parents or caregivers is common in children, if the symptoms are disproportionate to a person's age, it might be a sign that they have separation anxiety disorder.

Only a qualified mental health professional can diagnose separation anxiety disorder, which is done through careful evaluation using the criteria set out in the DSM-5. Before the diagnosis can be made, a clinician needs to rule out other mental health conditions, such as specific phobias, that might better explain a person's symptoms.

If you are concerned that you or your child might have separation anxiety disorder, the first step to getting an evaluation is to talk to your primary care provider. They can refer you to a mental health professional for screening.