192 Anxiety Disorders
dividual’s separation anxiety (e.g., destructio n of the family through fire, murder, or other
catastrophe) (Criterion A7). Physical sympto ms (e.g., headaches, abdominal complaints,
nausea, vomiting) are common in children when separation from major attachment fig-
ures occurs or is anticipated (Criterion A8). Cardiovascular symptoms such as palpitations,
dizziness, and feeling faint are rare in youn ger children but may occur in adolescents and
adults.
The disturbance must last for a period of at least 4 weeks in children and adolescents
younger than 18 years and is typically 6 months or longer in adults (Criterion B). However,
the duration criterion for adults should be used as a general guide, with allowance for
some degree of flexibilit y. The disturbance must cause clinically significant distress or im-
pairment in social, academic, occupational, or  other important areas of functioning (Cri-
terion C). 
Associated Features Supporting Diagnosis
When separated from major attachment figure s, children with separation anxiety disorder
may exhibit social withdrawal, apathy, sadne ss, or difficulty concentrating on work or
play. Depending on their age, individuals may have fears of animals, monsters, the dark,
muggers, burglars, kidnappers, car accidents, plane travel, and other situations that are
perceived as presenting danger to the family or themselves. So me individuals become
homesick and uncomfortable to the point of misery when away from home. Separation
anxiety disorder in children may lead to school refusal, which in turn may lead to academic
difficulties and social isolation. When extrem ely upset at the prospect of separation, chil-
dren may show anger or occasionally aggres sion toward someone who is forcing separa-