The DSM-5 has very specific criteria for this diagnosis.
The criteria for a diagnosis of separation and anxiety disorder include the following:
- Developing inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:
- 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 an untoward event (eg. Getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
- Persistent reluctance or refusal to go out, be away from home, go to school, go to work, or elsewhere because of fear of separation.
- Persistent and excessive fear 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.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (eg.headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.
- The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.
- The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning.
For my son, this anxiety is greater than any other he experiences. It is a constant, perceived threat that haunts him every single day.
I think I am beginning to understand a bit.
Because he struggles with maintaining control of himself, including his own mind at times, it is terrifying to think of being left alone.
What if I feel like I want to kill myself? I need you here, Momma.
I can’t do it by myself. I get too frustrated and I might destroy something.
My brain doesn’t always let me be calm. What if I start panicking and you are gone?
My sweet boy is aware enough of his challenges to know he needs help. And help comes in the form of his primary caregiver – me.
I am the one who knows what to do if he has a panic attack.
am the one who knows how to help him in a fit of mania.
I am the one who directs him to breathe deeply, sip water and pet his dog.
Of course, he wants to ensure I am around. When I look at it from his perspective, it actually makes sense.
As we treat his other disorders, we are also increasingly able to help him learn how to separate appropriately. As his anxiety decreases, his mania subsides and his body feels like his own again, he is more willing to take risks like falling asleep alone, toileting independently, and saying goodbye without terror when I leave for the grocery store.
It is not easy.
It is not easy for either one of us.
I am sharing this today because I have not found a resource for older children and separation anxiety.
I don’t have a list of things that make a difference. This isn’t a Top 5 Things To Do To Help kind of post. We are just trying to figure this out, one day at a time.
I am sharing this because it’s exhausting to feel ashamed about your 11 year old’s need to have you in the public restroom with him. It’s discouraging to feel like you have somehow caused and enabled this level of anxiety.
Separation anxiety in older children is a real thing.
It’s rooted in clinical anxiety disorder and is just as real as any other diagnosis or challenge.
Your child is not the only one. My child is not the only one.
We are not alone.
Somehow, this feels like enough for now.
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This article originally appeared at Not the Former Things.
