How is separation anxiety disorder treated?

The hallmark feature of separation anxiety disorder is persistent and intense fear or anxiety about being separated from home or people to whom one feels close.

The condition may be more common among children, but adults may also receive the diagnosis, particularly if the condition has gone undiagnosed in childhood. 

Treatment for separation anxiety is available and effective. CBT, or a combination of CBT and medications, may help both children and adults find relief.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), symptoms of separation anxiety in children and adults may include:

• persistent and intense distress when facing a possible separation from home or significant others
• constant concern about losing loved ones to illness, accidents, or death
• intense preoccupation about being separated from loved ones by a tragic event like kidnapping or getting lost
• difficulty going away from home to school, someone else’s house, public places, or work
• fear of being alone at home or somewhere else
• nightmares about being separated from home or others
• physical symptoms like stomachache and vomiting when separated or about to be separated from a significant other

To receive a diagnosis, at least three of these symptoms must be present for at least 4 weeks in children, and 6 months in adults. Symptoms often impair the ability to function and cause significant emotional, mental, and physical distress.

Psychotherapy for separation anxiety

CBT may help improve separation anxiety symptoms by helping you identify and reframe thoughts and behaviors that reinforce anxiety.

A therapist may focus on exploring the root of the child’s fears and discussing how likely they are to become true. In younger children, therapy may involve game components that represent someone going away and returning home safely, for example.

A 2017 review indicates that CBT is more effective in reducing primary anxiety symptoms in children long term compared to treatment using medications like Prozac. 

In adults, therapy may focus on understanding thoughts and ideas about early childhood experiences and current significant relationships, particularly with those people the person fears separating from.

Gradual exposure to separation scenarios may also be part of therapy at some point, starting with imagining these situations, while in a safe space.

Other psychotherapy options include parent-child interaction therapy (PCIT) and separation anxiety family therapy (SAFT).

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Medications for separation anxiety 

Serotonin and norepinephrine reuptake inhibitor (SNRI) and selective serotonin reuptake inhibitor (SSRI) are first-line pharmaceutical treatments for separation anxiety. Doctors may recommend them if psychotherapy alone does not help or if symptoms are severe. 

Healthcare professionals may prescribe medications to children and adults with separation anxiety disorder, although frequency and dosage may differ significantly.

Currently, the Food and Drug Administration (FDA) has not approved any medications specifically for separation anxiety in adults or children.

Selective serotonin reuptake inhibitors (SSRIs) 

SSRIs are an antidepressant drug class, but medical professionals commonly prescribe them for other conditions, including anxiety.

SSRIs inhibit the reabsorption of the neurotransmitter serotonin, so more of it remains in the brain. Serotonin plays an important role in mood and sleep, among other bodily functions.

Common side effects of SSRIs may include:

• sleep
• weight changes
• gastrointestinal distress
• headaches
• dry mouth

Some examples of SSRIs are: 

• fluoxetine (Prozac)
• sertraline (Zoloft)
• citalopram (Celexa, Lexapro)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) 

SNRIs are also antidepressants often used effectively for anxiety symptoms.

As with SSRIs, SNRIs also reduce neurotransmitter reabsorption. However, in this case, they affect serotonin and norepinephrine. Norepinephrine plays a role in attention, stress response, mood, and memory.

Common side effects of SNRIs include:

• dry mouth
• headaches
• changes in sleep cycles
• high blood pressure
• excessive sweating

Examples of SNRIs include:

• venlafaxine (Effexor)
• duloxetine (Cymbalta)

Benzodiazepines

Benzodiazepines work on receptors of the central nervous system (CNS) resulting in depression of the CNS, which results in mild sedation. 

Doctors commonly prescribe benzodiazepines to adults only, although long-term use is not recommended due to their potential for dependence.

The American Psychiatric Association indicates benzodiazepines may lead to habit forming and are meant for short-term anxiety relief. 

Side effects of benzodiazepines may include:

• drowsiness
• confusion
• respiratory depression (shallow breathing)
• nausea
• tremors

Common benzodiazepines prescribed for anxiety include:

• alprazolam (Xanax)
• lorazepam (Ativan)
• diazepam (Valium)

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Summary

Separation anxiety disorder is more common among children, but adults may also receive the diagnosis. Treatment often starts with psychotherapy, most likely CBT.

For severe symptoms or those that do not respond to psychotherapy only, a healthcare professional may prescribe SSRIs and SNRIs.