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Separation Anxiety

Michael S. Jellinek MD1
M. Elyce Kearns MD, MPH2
 1 Chief, Child Psychiatry Service, Massachusetts General Hospital; Associate Professor of Psychiatry (Pediatrics), Harvard Medical School, Boston, MA.
2 Director, Child Psychiatry Clinic, Massachusetts General Hospital; Instructor in Psychiatry, Harvard Medical School, Boston, MA.

Fear in reaction to danger potentially leads to life-saving "fight or flight." Anxiety is intrinsic to fear, and the young infant experiences anxiety during the earliest inevitable separations from caretakers. Over time, a child learns to experience anxiety in anticipation of fear, whether this fear is based on a true impending danger or a separation (eg, being left to fall asleep at bedtime).

Bowlby, recognizing the infant's life and death dependency on a caretaker, defined separation as the "basic anxiety of infancy." The mother's leaving is so potentially dangerous that the infant responds with a piercing cry that reflects both protest and anxiety while calling forth the mother's return. This cry is a paradigm for what we all face when we experience the inevitable losses of loved ones or even our own hopes.

Anxiety secondary to separation can continue beyond the expected age and interfere with a child's ability to function. Separation anxiety disorder may prevent a child from achieving critical developmental milestones, such as leaving his or her parent to play with friends or go to school. The early recognition of unwarranted or excessive separation anxiety may help limit potentially serious dysfunction.

Separation anxiety can be expected to begin to ease for most children at 18 months of age with the cognitive mastery of object permanence and the growing security of consistent caretaking.




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Separation Anxiety Disorder: Planning Treatment
Pediatr. Rev., July 1, 2000; 21(7): 248 - 248.
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