Separation anxiety in teens: What to know

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Separation anxiety occurs when a person develops a fear-based reaction to leaving a loved one or the thought of doing so.

When do doctors diagnose it as a disorder?

According to a 2023 article, infants ages 6 to 12 months experience separation anxiety as a typical developmental stage. It usually starts to become less intense or go away by the time a child is 3 years old.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5-TR) does not classify separation anxiety as a diagnosable disorder when it occurs in young children. However, it does classify this form of anxiety as a disorder in older children, teens, and adults.

In older children and teens

The article cites clinical data suggesting that around 4.1% of children exhibit clinical levels of separation anxiety. The average age of onset is 6 years old.

Children and teens living with separation anxiety often display signs of fear due to being separated from a parent or caregiver or just the thought of separation. This stress can lead them to miss school or activities that require being away from their parents or caregivers.

In adults

According to the 2023 article, approximately one-third of children with separation anxiety experience symptoms that continue into adulthood.

People can also develop separation anxiety for the first time as adults. The lifetime prevalence of adult separation anxiety disorder is around 6.6%. Of that percentage, 77.5% report first developing symptoms in adulthood.

Adults with separation anxiety may develop an intense fear of losing their children or other loved ones.

Read more about separation anxiety in adults and infants.

Separation anxiety in teens can present differently from person to person.

The DSM-5-TR states that a teenager must experience at least three of the following symptoms for at least 4 weeks to receive a diagnosis of separation anxiety disorder:

• persistent, pervasive worry about losing one or more attachment figures, such as a parent
• fear of possible harm, such as injury or illness, to an attachment figure
• reluctance or refusal to be alone at school, at home, or in other settings
• reluctance or refusal to leave the home because of a fear of separation
• recurrent excessive distress with actual or anticipated separation from the home or attachment figures
• repeated nightmares about separation
• refusal to sleep without being near the attachment figure
• persistent, pervasive worry that a future event will cause prolonged or permanent separation
• physical anxiety symptoms, such as:
  • headache
  • nausea
  • vomiting

These symptoms must be severe enough to disrupt daily life for a clinical diagnosis.

For example, they may cause a teen to avoid school, activities, or work, leading them to fall behind academically or be unable to maintain their part-time job.

The exact cause of separation anxiety is not fully understood. Older research suggests both biological and environmental factors may play a role.

Biological factors

Experts suggest that people with separation anxiety often experience changes in their brains that cause emotional dysregulation and cognitive dysfunction. For example, a person may develop an exaggerated sympathetic fight-or-flight reaction, leading to anxiety.

Environmental factors

Environmental risk factors for anxiety development can include:

• exposure to stressful life events or trauma
• shyness or feeling distress in new situations in childhood
• a personal or family history of mental health disorders

Some possible reasons a teen may develop separation anxiety can include:

• a loved one dying or having a severe illness
• living with a chronic illness
• parental separation or divorce
• moving homes or switching schools
• the death of a pet

In addition to seeking professional help from a mental health professional, parents and caregivers can take an active role in helping reassure a teen experiencing separation anxiety.

Some steps to consider include:

• normalizing separation anxiety and assuring them that treatments are available
• discussing and labeling symptoms they experience due to separation anxiety
• acknowledging and respecting their fears and worries, even if they do not make sense to the parent or caregiver
• providing reassurance about their or other people’s safety
• creating additional nurturing opportunities
• helping them establish a healthy view of themselves
• establishing a consistent routine

Parental education can play an important role in the treatment and management of separation anxiety in teens. A mental health professional will likely want to work with parents or caregivers to help them develop skills for helping a teen manage and cope with the condition.

If a parent or caregiver does not know where to start, discussing steps they can take at home with a mental health professional can help.

Treatment for separation anxiety typically involves psychotherapy. Severe cases of the condition may require medication.

The current first-line therapy involves cognitive behavior therapy (CBT), in which a mental health professional helps people reframe thinking patterns, allowing them to adjust how their brain processes situations.

If CBT or other forms of psychotherapy do not help, a person may benefit from antidepressant medications.

The medications a mental health or healthcare professional is most likely to recommend are selective serotonin reuptake inhibitors (SSRIs). However, no medication has explicit approval for use in separation anxiety disorder or much clinical evidence to verify its effectiveness.

Combination therapy using both SSRIs and CBT or other psychotherapy may be more effective in cases where medication is necessary.

With treatment, a person can typically recover from separation anxiety. However, they have a higher chance of developing anxiety again in the future. The risk of recurrence increases without treatment.

Read more about treatment for anxiety.

At what age does separation anxiety peak?

Typically, separation anxiety peaks when an infant is 9 to 18 months old. It has usually faded by the time a child is about 2.5 years old. Doctors do not consider it a disorder when it occurs at this developmentally appropriate stage.

Doctors may diagnose separation anxiety disorder if an older child or teen develops several symptoms of the condition that last at least 4 weeks. These symptoms also need to be severe enough to cause the child or teen to miss school or other activities that take them away from an attachment figure, such as a parent.

What is the coping mechanism for separation anxiety?

There is no single coping mechanism that works for everyone with separation anxiety. However, it may help if parents or caregivers of teens with separation anxiety try acknowledging and validating the teen’s fears, establishing consistent routines, and providing additional nurturing.

Separation anxiety is a typical part of development in children that usually goes away in the early years of childhood. Older children, teens, and adults can also develop separation anxiety due to genetic and environmental factors.

When this anxiety causes an older child or teen to miss school or other activities due to symptoms that last for 4 weeks or more, mental health workers may diagnose separation anxiety disorder.

Treatment often involves psychotherapy but may also include antidepressant medications. Treatment is often effective. However, a person will have an increased risk of developing anxiety again in the future.