194 Anxiety Disorders
difficulty sleeping alone; in adol escents, not going away to coll ege; in adults, not leaving the
parental home, not tr aveling, not working outside the home). 
Differential Diagnosis
Generalized anxiety disorder. Separation anxiety disorder is distinguished from gener-
alized anxiety disorder in that  the anxiety predominantly concerns separation from attach-
ment figures, and if other wo rries occur, they do not pred ominate the clinical picture. 
Panic disorder. Threats of separation may lead to extreme anxiety and even a panic at-
tack. In separation anxiety disorder, in contr ast to panic disorder, the anxiety concerns the
possibility of being away from attachment figures and worry about untoward events be-
falling them, rather than being incapacitated by an unexpected panic attack. 
Agoraphobia. Unlike individuals with agoraphobia, those with separation anxiety dis-
order are not anxious about being trapped or incapacitated in situations from which es-
cape is perceived as difficult in the event of panic-like sy mptoms or other incapacitating
symptoms.
Conduct disorder. School avoidance (truancy) is common in conduct disorder, but anx-
iety about separation is not responsible for school absences, and the child or adolescent
usually stays away from, rather  than returns to, the home. 
Social anxiety disorder. School refusal may be due to soci al anxiety disorder (social pho-
bia). In such instances, the school avoidance is due to fear of being judged negatively by oth-
ers rather than to worries about being separated from the attachment figures. 
Posttraumatic stress disorder. Fear of separation from loved ones is common after trau-
matic events such as a disasters, particularly when periods of separation from loved ones