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Separation Anxiety: More than Worry

By October 31, 2017Blogs

As most families are just starting to recover from the back-to-school hangover, there are some families who are still experiencing discomfort that extends beyond worries about going to school because of a test or social conflict. This discomfort is now creeping into other aspects of their lives, such as fears about soccer practice or going to a friend’s house. What this discomfort might be is Separation Anxiety or SAD.

SAD is more than worrying about leaving a loved one, which subsides within minutes. It is also not just about trying to get out of going to school. SAD is a debilitating disorder that wreaks havoc on families and individuals alike, presenting itself in many ways. The common scenario is the child’s perceived inability to transition away from a caregiver. Often, when they do, they are overwhelmed with intrusive thoughts until the caregiver is reintroduced. This can be emotionally painful for all parties involved, as children may be trying to express the fear that something terrible might happen to a parent or to themselves. Here are some ways to help beat this type of worry:

Seek Professional Help:

SAD is intricate and more detailed than simply worrying about leaving a parent. There may be some other causes that are interfering with one’s ability to separate from a loved one such as:
a. Harm OCD: A form of OCD that focuses on intrusive thoughts regarding harm to self or others. This may resemble SAD as children may not want to leave loved ones for fear of something happening to them. However, SAD differentiates here with the lack of compulsions and the alleviation of anxiety when in the presence of a loved one, which is not always the case with Harm OCD.
b. Social Anxiety Disorder: The root of a child not wanting to leave the side of a parent may, in fact, be due to the anxiety surrounding a social situation. Children may attempt to avoid a socially anxious situation by choosing to be by their parents instead. This may also present itself for sleep-overs or after-school activities.
c. Sleep Related Disorders: It is quite uncommon to have an organic sleep-related disorder; rather SAD/GAD is much more common. However, if sleep-separation is an issue, be sure to confirm that there are no other medical issues that may be impacting sleep.


Once SAD has been identified, the first course of action will be education. This entails working with a team who specializes in pediatric anxiety to ensure that the way the family is functioning is, in fact, decreasing anxiety and not increasing anxiety. For example, it is only natural to want to reassure a child when they have a worry. This is normal and part of the parent-child relationship. However, in a child with SAD, these reassurances are only stoking the flames. When a child with SAD is asking if you will be home during the day, they are not just curious, they are seeking reassurance to alleviate their anxiety. A trained clinician can help guide the family to reduce these relief-seeking behaviors.

Exposure and Response Prevention:

ERP is the scientifically backed intervention to address SAD. This intervention focuses on addressing the child’s fear response to separation, helping to tolerate the discomfort, and eventually habituating to the absence of a parent. This process should involve both imaginative exposures and in-vivo exposures. Imaginative exposures entail developing more of a cognitive habituation to thoughts/stories of perceived abandonment. This can be done by creating stories, listening to recorded words/situations that one would traditionally avoid. The purpose of this is to help habituate the fear response from activating during these situations. In-vivo exposures are synthetic situations that aim to evoke similar discomfort of transitioning from a parent. The purpose of any type of exposure is habituation to the situation that was causing the initial fear response.

This is simply an introduction to SAD and a quick guide of what to look for as you begin the process of seeking help. It is important to remember that this is not simply a parenting issue or a school issue; rather it is a struggle with anxiety. It most likely won’t be fixed by waiting it out. The interventions for SAD, although challenging, are quite effective.