(SAD) is most often an issue suffered by small children. It’s a normal stage of development characterized by symptoms of anxiety and upset when physically separated from a primary caregiver. They may:
- Be frightened by the idea of meeting new people
- Be unhappy about being in unfamiliar situations with new people
- Feel threatened when left alone in a room without a parent or caregiver
- Cry or cling to a parent or caregiver even when being left with known family members and close friends
This is a normal stage of development that usually passes by age two. However, in some cases, separation anxiety disorder can remain an issue or pop up again throughout life. Some children never completely feel safe and at ease in certain situations and carry this issue into adulthood. Others become overwhelmed by separation anxiety in certain situations, and still others find that after experiencing a trauma (e.g., attack, natural disaster, abuse, etc.) or loss of a loved one, separation anxiety becomes an overwhelming issue.
Often, especially when the disorder strikes in the adult years, a common response is substance abuse. Turning to alcohol or other drugs for relief from the symptoms can seem like a natural solution to quell anxiety. Unfortunately, it often not only exacerbates the issue in the short-term but also creates a host of long-term problems that are just as difficult to overcome as the separation anxiety symptoms.
Separation Anxiety Disorder in Adults
A review published in the journal Clinical Psychology Review found that because separation anxiety disorder was long thought to be a disorder relegated to infancy, it has been heavily underdiagnosed in adults. Additionally, most anxiety disorders begin to appear and are recognized medically during childhood, adolescence or the teen years, so when symptoms aren’t apparent until after the age of 18, it is rare for a patient to be diagnosed with separation anxiety disorder.
The review, however, demonstrated that not only is separation anxiety disorder a problem for adults, it is also:
- Relatively widespread
- Often co-occurring with other diagnoses
- Debilitating in nature
In both substance abuse and separation anxiety, codependency is often an issue. Once believed to be a problem only among those who were enabling addicted loved ones, it has been found that addicts and alcoholics in recovery often struggle with the same inability to define positive boundaries within their relationships. In the same way, those who are living with adult separation anxiety disorder find it difficult to function in the world independently without defining their choices based on the actions or needs of another.
Some signs of codependency include:
- Isolating oneself so the primary relationship is the codependent relationship
- Lacking focus on one’s primary needs in order to prioritize the needs or desires of someone else or to be with them
- Feeling concern that doing – or not doing – some small thing will result in the loss of a loved one or a loss of their love or attention
- Feeling anxious when thinking about the relationship
When these issues exist, it is something that should be addressed in treatment. Often, these symptoms can be triggers for anxiety related to the separation anxiety disorder and/or the urge to drink or get high. Thus, learning how to create healthy boundaries in relationships and find one’s own independence is often a part of the healing process.
- High anxiety or distress when without the person they are attached to
- Sleep disruption (e.g., insomnia, difficulty falling asleep or staying asleep especially without the person they are attached to nearby, nightmares, etc.)
- Reluctance to leave the house or go anywhere other than short errands, especially without the person of attachment
- Increase in physical ailments
- Excessive (often unwarranted) concern for the safety and well-being of the person they are attached to
Childhood Separation Anxiety Disorder Is NOT an Indicator of Adult Anxiety Disorder
Though there is some debate about whether or not the issue of separation anxiety disorder in childhood may indicate or trigger an issue with generalized or specific anxiety disorder in adulthood, many studies say this is unlikely.
One study published in the Journal of the American Academy of Child and Adolescent Psychiatry found that childhood SAD is not a risk factor for the development of agoraphobia or panic disorder in adults.
There is an indication, however, as seen in a study published in another issue of the Journal of the American Academy of Child and Adolescent Psychiatry, that the existence of parental panic disorder might increase the chance of development or severity of a child’s separation anxiety issues and other atopic disorders. Therefore, it may be indicated that a parent’s untreated adult separation anxiety disorder may be part of the development of similar issues in their child.
There are a number of studies that support the notion that adult separation anxiety disorder is often a diagnosis that co-occurs with other mental health issues.
For example, a study published in the Journal of Affective Disorders found that complicated grief was diagnosed among more than half of their participants diagnosed with adult separation anxiety disorder. Another study published in the Journal of Traumatic Stress found that adult separation anxiety disorder was associated with post-traumatic stress disorder (PTSD) as well.
Substance abuse, too, is very often a problem for those who struggle with separation anxiety. In order to calm their fears or go to sleep, they may take pills, drink alcohol, smoke marijuana or use drugs like heroin. Unfortunately, this can cause a number of problems including:
- Increasing anxiety while under the influence despite the goal of relaxation
- Causing acute health problems like overdose due to medical emergency
- Causing long-term health problems, including addiction and other issues related to the use of the drug of choice
- The development of an addiction that can further harm the patient’s ability to function in the world and have positive relationships
Dual Diagnosis Treatment
Co-occurring disorders should always be addressed at a Dual Diagnosis rehab facility so the patient can make progress in recovery from both issues at the same time. Especially in the case of a disorder like separation anxiety disorder, where co-occurring disorders are deeply enmeshed in the symptoms and expression of SAD, Dual Diagnosis rehab is highly recommended.
Dual Diagnosis treatment will provide a multilevel approach to address all disorders and symptoms that are stopping the patient from living a life of balance. This is done through a combination of services, applicable as necessary:
- Intensive evaluation. Every patient should begin rehabilitation with an intensive evaluation and diagnostic period. Some issues may be undiagnosed; some may have changed in character due to active drug use or time. It’s important that the medical team have a clear picture of the patient needs in recovery – especially when multiple diagnoses are evident – in order to provide the best possible care.
- Detoxification and stabilization. Whether mental health symptoms have become overwhelming or medical care is necessary due to withdrawal symptoms caused by detox from drugs and alcohol, the patient must be stable physically before they can proceed with therapeutic treatment.
- Medication and medical monitoring. Some individuals will require medication assistance for detox from their drug of choice. Others may need medication to address acute or overwhelming mental health symptoms until they become better managed during treatment.
- Therapeutic program specific to SAD. A number of therapeutic interventions may be directed specifically at helping the patient overcome SAD. Depending upon how the disorder began, this will vary from patient to patient. Coping mechanisms specific to the experience of the patient will be provided.
- Therapeutic program specific to the co-occurring disorder. If, for example, the co-occurring disorder is drug abuse or addiction, then therapeutic measures designed to identify triggers, address inappropriate or incorrect perceptions and thought patterns, and aid in relapse prevention are all necessary.
- Holistic treatment options. For improved outcome on all fronts, it is often recommended that patients opt for a treatment program that provides access to holistic and alternative treatment. These treatments serve to improve overall health and well-being by aiding the patient in learning how to make lifestyle changes that support good nutrition, healthy sleep, lower stress levels and regular exercise. When incorporated with professional and medical help, these can increase the patient’s ability to avoid relapse and get the most out of treatment.
- Aftercare support. No matter the specifics of recovery from separation anxiety disorder or how long a patient remains enrolled in active and intensive treatment, it is important to follow up for a minimum of a year through aftercare support services. This enables the patient to remain supported as they return home and begin to practice their new principles in the community, getting the assistance they need to face challenges as they arise without reverting back to old, destructive behaviors.
You’re Not Alone
The Centers for Disease Control (CDC) reports that anxiety disorders like separation anxiety disorder are the most commonly diagnosed mental health issues in the United States.
Lifetime prevalence of these kinds of disorders is more than 15 percent; past-year prevalence is as high as 10 percent. For the patients struggling as well as their friends and loved ones, this can create difficulties at home and hurt everyone’s ability to live healthfully, thriving at work and in the community.
If someone you love needs treatment for adult separation anxiety disorder alone or in connection with a co-occurring instance of substance abuse or addiction, don’t hesitate to call. We can match your loved one to a treatment program that can help them learn how to move forward safely and effectively and offer you support and assistance along the way. We’re here to help. Contact us at the phone number listed above now.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.