By: Ayesha Tufail

Separation Anxiety Disorder and Epilepsy

What is Separation Anxiety Disorder

Separation anxiety disorder (SAD) is a mental health condition that affects both children and adults. It causes a person to feel excessive fear or anxiety when separated from close attachment figures or anticipating separation. The fear and anxiety are out of proportion to the situation and not developmentally appropriate. A child’s attachment figure is usually a parent but can be anyone they have bonded with, including a grandparent or a caregiver. In adults anxiety usually centers on their child or romantic partner.

(Cleveland Clinic, 2024)

Signs and Symptoms

SAD is diagnosed when an individual experiences symptoms that are significantly beyond what is considered normal for their development stage, to the point where symptoms can lead to a considerable amount of distress and can interfere with their ability to carry out everyday tasks. (Mayo clinic 2024). A person with SAD can have three or more of the following symptoms:

• Feeling distressed when apart from the attachment figure or anticipating separation
• Worrying something bad (injury or death) will happen to an attachment figure
• Worrying something bad will happen to one’s own self (getting lost or kidnapped) that will lead to separation from the attachment figure
• Refuse to leave home or go places due to fear of separation
• Fear of being alone without an attachment figure nearby
• Refuse to go to sleep without an attachment figure
• Having recurring nightmares about separating from attachment figure
• Having physical symptoms like stomachaches, headaches or nausea when apart from an attachment figure or anticipating separation. Adolescents and adults may also have heart palpitations or dizziness

(Cleveland Clinic, 2024) 

Separation anxiety disorder and Epilepsy

Psychiatric comorbidities are present in patients with epilepsy two to three times stronger than the general population. According to one comprehensive Canadian study all mental disorders were found to be 35.5% with a total prevalence of 20.2% of anxiety disorders present in patients with epilepsy according to recent metal-analysis (Aleksandar Gavrilovic et al 2024). A systematic review found that certain anxiety disorders such as generalized anxiety disorder and SAD, are particularly elevated in youth with epilepsy possibly reflecting the unique psychological impact epilepsy has on younger populations. Separation anxiety specifically has received less research attention, but evidence suggests it is more common in both children and adults with epilepsy than in the general population. (Amelia J.Scott et al 2020)

There appears to be a bio-directional relationship between anxiety and epilepsy, involving common underlying mechanisms. Dysfunction of neurotransmitter systems, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, structural changes, or chronic neuroinflammation may be involved in the pathophysiology of both conditions as biological mechanisms.  (Aleksandar Gavrilovic et al 2024)  

Treatment

One treatment paradigm that may be relevant involves understanding the role of the hypothalamic-pituitary-adrenal (HPA) axis. Any medication that reduces sympathetic overactivity may help to reduce stress and, at least intuitively, reduce the seizure threshold. Although potentially effective, the evidence base does not yet support this approach. Another approach involves using treatments that are presumed to target mesial temporal lobe structures involved in anxiety, such as the amygdala. The amygdala is an important component of the neural circuitry related to mood disorders, which phenomenologically overlaps with anxiety to such a degree that similar treatments are often used. 

Ultimately, the most efficient approach may be to take advantage of medications already used in this patient population, namely anticonvulsants, for the treatment of anxiety. Although sound strategies may blend the use of anticonvulsant with other classes of psychiatric medications, modern regimens of anticonvulsant already use multiple agents to synergize differing mechanisms of action; these combinations not only improve seizure outcomes, but they may potentially and efficiently address comorbid conditions.

Nonpharmacological Strategies

Most nonpharmacological strategies involve psychotherapeutic approaches, but additional lifestyle changes may be important. Appropriate diet and activity level, including exercise, will improve wellness and mood. Appropriate sleep will also improve anxiety, as well as increase the threshold for seizures.

Psychotherapy may involve a variety of strategies, but primarily includes talk therapy that is problem focused or insight oriented. More practical strategies include supportive psychotherapy or problem-focused approaches. Patients with epilepsy are good candidates for talk therapy given that they tend to require lifestyle adjustments to address the possibility of seizure activity occurring, and inherent anxiety may be present in attempting to make such accommodations. Additional strategies include the use of relaxation techniques, such as abdominal breathing, progressive muscle relaxation, or imagery, to mitigate anxiety symptoms.

(Jay A.Salpekar et al 2023)

References

What is separation anxiety disorder?. Cleveland Clinic. (2025, November 26).  https://my.clevelandclinic.org/health/diseases/separation-anxiety-disorder

Gavrilovic, A., Gavrilovic, J., Ilic Zivojinovic, J., Jeličić, L., Radovanovic, S., & Vesic, K. (2024a, August 26). Influence of epilepsy characteristics on the anxiety occurrence. Brain sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC11430231/

Mayo Foundation for Medical Education and Research. (2024, June 12). Separation anxiety disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455 

Salpekar, J. A., J, G., Mietchen, J., Mani, J., & Jones, J. E. (2023). Treatment of comorbid anxiety and epilepsy | The Journal of Neuropsychiatry and Clinical Neurosciences. https://psychiatryonline.org/doi/full/10.1176/appi.neuropsych.20220116

Scott, A. J., Gandy, M., Loomes, M., & Sharpe, L. (2020). Systematic Review and meta-analysis of anxiety and depression in youth with epilepsy. Journal of pediatric psychology. https://pubmed.ncbi.nlm.nih.gov/31904859/