Florida Anxiety Clinic: Cognitive-Behavioral Treatment for Anxiety Disorders: Separation Anxiety Self-Test.

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SEPARATION ANXIETY SELF-TEST

To see if you or your child meet the diagnostic criteria for Separation Anxiety Disorder, please complete the following self-test by clicking the "yes" or "no" boxes next to each question,

PART A: Are you, or your child, troubled by:

Recurrent, excessive distress when separation from home or the major attachment figure (e.g., parent) occurs or is anticipated?

Yes No

Persistent, excessive worry about losing, or harm befalling, the major attachment figure?

Yes No

Persistent, excessive worry that an event, such as getting lost or kidnapped, will lead to separation from the attachment figure?

Yes No

Persistent reluctance or refusal to go to school (or elsewhere) because of fearing separation?

Yes No

Fear being alone or without major attachment figure (or other significant adults)?

Yes No

Persistent reluctance or refusal to go to sleep without being near the major attachment figure, or to sleep away from home?

Yes No

Repeated nightmares involving the theme of separation?

Yes No

Repeated complaints of physical symptoms, such as headaches, stomachaches, or nausea, when separation from the attachment figure occurs or is anticipated?

Yes No

PART B: The problems listed in Part A:

Have occurred for at least 4 weeks?

Yes No

Started before age 18 years?

Yes No

Cause significant distress or impairment in social, academic, occupational, or other areas of functioning?

Yes No

PART C: Are the problems:

Unrelated to another disorder, such as Panic Disorder or Agoraphobia?	Yes No
Unrelated to the course of Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder?	Yes No

SCORING: You or your child may have Separation Anxiety Disorder if:

Part A: You answered "Yes" to at least three items, and

Part B: You answered "Yes" to all items, and

Part C: You answered "Yes" to all items.

This test is meant to be informative and is not designed to provide a formal diagnosis.

To determine if you have Social Anxiety Disorder (Social Phobia), please contact one of our psychologists at the Florida Anxiety Clinic.

These criteria were extracted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 1994.

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