Everything you need to know about Separation Anxiety in Adults

There is not a clear estimate of the prevalence of separation anxiety in adults in the UK. However, anxiety disorders in general are fairly common among the UK adult population. According to a survey by the Mental Health Foundation, 31% of adults in the UK reported experiencing anxiety at some stage in their lives with 19% reporting having experienced it within the last 12 months.

Having said this, separation anxiety in adults is less often diagnosed than other anxiety disorders such as generalised anxiety disorder or panic disorder. However, it still has a profound impact on a person’s well-being and quality of life.

What is separation anxiety?

Separation anxiety is more often than not associated with children, but it can also affect adults. Separation anxiety in adults is a psychological condition where a person experiences intense distress and anxiety when they are separated from a person or a place on which there are dependent or are deeply connected. Separation anxiety is typically disruptive to a person’s life and impacts their ability to engage in their daily activities, including socialising and work.

Separation anxiety is persistent and excessive distress or fear. The person or place they are separated from provides a sense of security and offers the individual comfort. In children, separation anxiety is a common part of development and results in crying, clinginess to caregivers and refusal to attend childcare or school. For adults, it often manifests in different ways such as avoidance of social situations, difficulty in forming close relationships, the fear of being alone or the fear of losing a loved one.

What causes separation anxiety in adults?

The causes of separation anxiety in adults are not yet fully understood. Several factors are thought to contribute to its development.

These include:

• Childhood trauma such as frequent house or school moves during childhood, parental divorce and family breakdown, or the loss of a loved one.
• Genetics. It is thought that our genetics predispose us to the development of anxiety disorders and therefore separation anxiety may have some genetic link.
• Neurochemistry. Some studies have suggested that imbalances in some of the chemicals in the brain such as dopamine and serotonin may contribute to the development of anxiety disorders such as separation anxiety.
• Significant life stressors and change. This can include the loss of a loved one, a relationship breakdown and job changes. It is said that major life changes can trigger or exacerbate separation anxiety.
• Attachment style. Our attachment style is typically determined in infancy. It is thought that people who have insecure attachment styles are more likely to develop separation anxiety either as a child or later as an adult.

Each person with separation anxiety will likely have had a unique set of circumstances that has led to the development of the condition and, for many people, it is not necessarily easy to work out an exact cause.

Working with a mental health professional may help someone who is experiencing separation anxiety determine some of the likely causal factors of their condition, which may make it easier to treat and resolve.

What are the symptoms of separation anxiety in adults?

Separation anxiety experienced as an adult is often thought of as being on a scale whereby some people only experience mild symptoms and others have extreme, severe symptoms. These symptoms may be both physical and psychological.

Psychological symptoms

Separation anxiety is essentially a psychological condition. The symptoms of separation anxiety in adults include feelings of fear, unease and discomfort when separated from their object or person of attachment. They may experience emotional distress including panic, panic attacks and crying fits.

Additionally, some people suffer from obsessive thoughts and/or compulsive behaviours (obsessive-compulsive disorder – OCD) or experience excessive worry about their object of attachment. They may believe that if they are not with their loved one, something bad will happen to either the loved one or themselves. This worry in individuals with separation anxiety is unrealistic, excessive and persistent.

Many adults with separation anxiety avoid being alone as this is when their worries, fear and panic tend to escalate. As such, they may avoid any situations where they will have periods of time on their own and may always wish to be in the company of others. What is more, the psychological symptoms often give rise to associated physical symptoms.

Physical symptoms

The physical symptoms of separation anxiety include sweating, nausea, vomiting, shortness of breath and a rapid heartbeat. Trembling and shaking are also common.

Those with the condition may also have insomnia or restless sleep and they often find it difficult to concentrate during the day, either as a direct result of their anxiety or due to the lack of sleep the anxiety has brought on. These physical symptoms, whilst real symptoms of the condition, stem from the psychological symptoms.

Behavioural symptoms

Aside from the psychological and physical symptoms associated with separation anxiety in adults, there are also associated behavioural symptoms too.

These behaviours are often more subtle than the physical or psychological symptoms listed above and include:

• Extreme jealousy
  Adults with separation anxiety may show signs of jealousy in their relationships. The fear of being abandoned often drives adults with separation anxiety to feel jealous. This includes irrational feelings surrounding a partner’s fidelity or not wanting a partner to spend time without them.
• Super strict parenting
  Anxious parents are more often than not strict parents. This is sometimes called ‘reverse separation anxiety’ because the parents are so concerned about their child’s well-being that they simply will not allow themselves to be away from them. When the children grow older, this often manifests itself as control, where parents try to control almost every aspect of their children’s life.
• Remaining in unhealthy relationships
  Whether the relationship is familial, friend or romantic, adults with separation anxiety will cling to unhealthy, toxic or abusive relationships due to the fear of being alone. They may stay in the relationship at a great personal cost. Additionally, it’s worth noting that sometimes separation anxiety is triggered by being in an abusive and controlling relationship but this still does not always push a person to leave the relationship.
• Outstaying one’s welcome
  Most of us have experienced this at some stage in our lives. You invite a friend round for a drink or a coffee and they just won’t leave. You’ve even dropped hints! Quite often, adults who do this are experiencing separation anxiety and are avoiding leaving for fear of being alone.

Who is at risk of separation anxiety?

As mentioned, separation anxiety is common in children but can occur in people of all ages. Also mentioned in the causes of separation anxiety above, many factors contribute to the development of the condition. This, in turn, means that some people are at an increased risk of experiencing separation anxiety.

Aside from children and teenagers for whom separation anxiety can be a common developmental stage, certain predisposing factors make the development of the condition more likely.

These include:

• A family history of mental health disorders such as anxiety.
• Traumatic or stressful experiences such as a death in the family or divorce.
• Those with an insecure attachment style which is often the result of inconsistent caregiving during early childhood.
• Having experienced major life events such as job changes or moving home.
• Certain medical conditions such as Parkinson’s disease.
• Other mental health conditions such as depression,  post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).

What are the differences between separation anxiety in adults and children?

Separation anxiety is very common in children. Typically young children around the age of eight to nine months begin to realise that they are a separate being from their main caregiver, and this is when their separation anxiety kicks in. Babies of this age with separation anxiety will tend to cry when their caregiver leaves the room or drops them at childcare so they can go to work.

Normally, this separation anxiety eases naturally in children, and by the time they are in pre-school, most children have resolved their separation anxiety and understand that their caregiver will return soon.

On the contrary, in adults, there is no typical age when separation anxiety tends to strike. It is more likely to occur in response to a significant life event or experience. As such, the triggers for adults are slightly different. They may not be triggered by their loved one leaving but may be affected by being in unfamiliar surroundings, by being alone for long periods or by going through a life change.

The symptoms experienced in children and adults with separation anxiety can be somewhat different too. Children tend to cry, throw a ‘tantrum’, or refuse to go to childcare or school. For adults, the symptoms may be more internalised, including excessive worry or obsessive thoughts. They are also more likely to experience physical symptoms such as sweating, trembling or panic attacks.

Children tend to cope with separation anxiety by sticking to familiar routines or by being comforted by their favourite things such as a soft toy, comforter or blanket. Adults tend to cope with their feelings by distracting themselves with tasks and activities or by frequently texting and calling a loved one.

The treatments for separation anxiety in children and adults differ too. Essentially, this is because separation anxiety in children is common and is nearly always a developmental stage. For excessive separation anxiety in children, and separation anxiety that does not relent after the typical age, play therapy or parent-child interaction therapy is often a typical treatment. In adults, treatment often involves cognitive behavioural therapy and sometimes medication for the underlying anxiety.

It’s important to remember that the experience of separation anxiety, whether adult or child, can vary widely, and so what works for one individual may not always be best for another.

Diagnosis of separation anxiety in adults

It is typical for adults to be diagnosed with separation anxiety by a mental health professional such as a psychologist or psychiatrist. Often separation anxiety is a subsidiary of generalised anxiety disorder and, as such, adults do not often get a separate diagnosis of the condition.

Normally, the diagnosis comes after a thorough assessment of the individual’s medical history and symptoms, as well as looking at any current triggers or stressors. The combination of the symptoms presented, the information gathered in the clinical interview and any observation opportunities would be what is needed to assess and subsequently diagnose separation anxiety in adults.

During the diagnostic process, the mental health professional will ask detailed questions regarding the individual’s past medical history as well as their current symptoms. They may use assessment tools and standardised questionnaires such as the GAD-7, the Generalised Anxiety Disorder Assessment.

The DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) lists the diagnostic criteria for Separation Anxiety Disorder and the mental health professional will decide whether or not the individual meets these criteria.

At least three of the following criteria must be met:

• Recurrent excessive distress when anticipating or experiencing separation from major attachment figures or from home.
• Persistent and excessive worry about possible harm to major attachment figures or losing them including injury, illness, disasters or death.
• Persistent and excessive worry about experiencing a problematic event such as being kidnapped, getting lost, becoming ill, or having an accident that would cause separation from their major attachment figure.
• Persistent reluctance or refusal to leave their home, go to school, work or anywhere else.
• Persistent and excessive reluctance or fear about being alone without their major attachment figure present.
• Persistent refusal or reluctance to sleep anywhere other than home or sleep without being near their major attachment figure.
• Regular nightmares with separation as a theme.
• Repeated complaints of physical symptoms including headaches, nausea, stomach aches and vomiting when separation from a major attachment figure is anticipated or occurs.

The following criteria must also be met:

• The anxiety, fear and avoidance are persistent and have lasted for at least six months in adults.
• The disturbance is causing clinically significant impairment and distress in occupational, social and other important areas of life.
• The disturbance cannot be otherwise explained by other mental disorders such as refusal to leave home due to autism spectrum disorder, agoraphobia, or delusions or hallucinations caused by other psychiatric conditions.

How to deal with separation anxiety in adults

In adults, separation anxiety is typically dealt with by using a combination of treatments and support.

Treatment often includes:

• Psychotherapy such as cognitive behavioural therapy (CBT). This helps people identify their negative thoughts and behaviours regarding their separation anxiety and challenge them.
• Medication such as anti-anxiety medication or antidepressants to help manage the symptoms.
• Lifestyle changes such as mindfulness, relaxation techniques, eating a healthy diet, doing some exercise and participating in enjoyable activities to help alleviate the symptoms as well as distract the sufferer.

There is also support available through different charities and organisations that can help people cope with their symptoms, and offer advice or help when they are in crisis:

• Anxiety UK.
• No Panic.
• Support Line.
• Mind.

Final thoughts on ‘Separation Anxiety in Adults’

Separation anxiety in adults is not a very well-known condition but it can be a debilitating one that has huge implications for an individual’s day-to-day life. However, with a proper diagnosis and treatment, people can learn to live with the condition as well as improve their outlook in the long term.

If you or someone you know is experiencing symptoms of separation anxiety, it’s important to seek help from a qualified mental health professional.