Separation Anxiety Disorder: DSM-5 Criteria, PDF Worksheet, Tools and Exercises

Separation anxiety disorder is one of the most under-identified presentations in adult outpatient practice. The DSM-5 dropped the childhood-onset criterion in 2013, yet many patients still arrive after years of being formulated as generalised anxiety, relationship dependency, or health anxiety, simply because no one mapped the attachment-specific structure of their worry. This PDF worksheet gives you a concrete visual support to do exactly that, in session, without a lengthy detour through the diagnostic manual.

Why Separation Anxiety Is So Often Missed in Consultation

The central clinical difficulty is not the severity of the presentation, it is its apparent shapeshifness. A patient who texts their partner obsessively, cannot sleep when alone, and cancels professional travel looks, on the surface, like someone with avoidance patterns, attachment insecurity, or an abandonment schema. The discriminating feature, that distress is anchored to one specific person, not to places, social evaluation, or somatic symptoms, is easy to miss at oral anamnèse, especially when the patient themselves cannot name it.

The four differential confusions in the fiche capture the exact distinctions that trip up assessment. Separation anxiety is not generalised anxiety (the worry is glued to one theme), not social anxiety (the patient wants their person there, not to escape being judged), not agoraphobia (it is who is missing that triggers the fear, not the place itself), and not health anxiety (the feared illness belongs to the other person, not the self). Hearing this distinction once, aloud, rarely produces genuine clarity. Seeing it laid out on a single page does.

What the Fiche Contains: A Visual Support for DSM-5 Mapping

The worksheet is structured across five numbered sections, designed to be worked through collaboratively rather than handed to the patient to read alone.

• Section 1 lists the eight DSM-5 signs, from anticipatory dread and worry that "something will separate you" to somatic complaints and recurring loss-themed nightmares, with the explicit note that at least three must be present. The numbered format makes the clustering criterion tangible and reduces the risk of over-diagnosing on one or two prominent features.
• Section 2 presents the duration thresholds side by side: four weeks for children and adolescents, six months for adults. The adult threshold is explained directly on the fiche ("so a real-life reaction isn't mistaken for the disorder"), which pre-empts a common patient objection.
• Section 3 offers four brief clinical vignettes, the school-gate child, the teenager who refuses sleepovers, the adult who cannot stop texting, the parent calling several times daily, spanning the full age range. These ground the abstract criteria in recognisable behaviour without requiring you to generate examples on the spot.
• Section 4 presents the differential confusions as parallel statements, one concept per line. Visually scanning the column makes the principle of one fear, one figure immediately apparent.
• Section 5 maps the accommodation loop as a three-node cycle: distress at parting → others soothe → fear stays untested. This is the section most worth dwelling on; it externalises the systemic maintenance mechanism that families and partners rarely recognise as a problem until you show it to them.

> Key point: the fiche is a visual support that facilitates psychoeducation in session, not a questionnaire the patient completes alone. Its function is to give you a shared language and a concrete diagram to reference when naming the accommodation cycle or grounding the differential.

When and How to Introduce the Fiche

Consider bringing it out from the second or third session onward, once the anamnèse has surfaced a pattern of distress organised around one attachment figure. It is particularly useful with adult patients who arrive describing "relationship anxiety" or "needing constant contact", presentations that risk being attributed entirely to early maladaptive schemas or enmeshment dynamics without the separation-anxiety structure being named.

A low-threshold introduction: "I'd like to look at something with you that might put a clearer frame on what we've been describing." Work through sections 1 and 2 together first, letting the patient self-identify the signs. Then move to section 5 and ask specifically who in their life adjusts their behaviour to manage the distress, this often opens the accommodation conversation for the first time.

For younger patients or adolescent work, the parent psychoeducation program on child and adolescent anxiety pairs well with this fiche, helping parents understand the accommodation loop from their own side. For the exposure planning that follows diagnostic clarity, building a graded exposure hierarchy is the logical next tool. The Remember panel at the bottom of the fiche carries one line worth reading aloud at the close: "It treats well." Brief, but useful for patients who have spent years being told their distress is simply a personality trait.

One limit to flag: the fiche maps DSM-5 criteria and is most useful early in the formulation phase. It does not replace a full longitudinal case formulation, and with patients whose attachment history is dense, developmental trauma, complex PTSD, early loss, the diagnostic frame will need to sit inside a broader clinical picture before treatment planning begins.

Sources

• American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Publishing.
• Merck Manuals (2025). Separation Anxiety Disorder. Merck Manual Professional Edition.