Separation Anxiety Disorder

Separation Anxiety Disorder is persistent, excessive fear or anxiety about being apart from an attachment figure. The child may worry that a parent will be injured, become ill, or disappear; fear that an event will prevent reunion; refuse school or activities away from home; resist sleeping alone; have separation-related nightmares; or report headaches, nausea, or abdominal pain when separation is expected. Some separation distress is developmentally expected. The clinical pattern becomes concerning when the fear is out of proportion to the child’s developmental level, persists, and disrupts ordinary functioning. In children, the diagnosis requires at least three of the specified DSM-5 symptoms for a minimum of four weeks. The symptoms may be obvious at the doorway or bedtime, but anticipatory anxiety often begins hours earlier. The mechanism that matters most for nursing care is the avoidance cycle. Separation triggers a threat response; refusing school or calling the parent produces immediate relief. That relief reinforces avoidance, so the next separation feels even more dangerous. Repeated reassurance and allowing the child to escape every feared situation can unintentionally strengthen the cycle. This...