Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-30T20:12:57.509Z Has data issue: false hasContentIssue false

The separation of adult separation anxiety disorder

Published online by Cambridge University Press:  09 August 2016

David S. Baldwin
Affiliation:
Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Robert Gordon*
Affiliation:
Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
Marianna Abelli
Affiliation:
Department of Psychiatry, University of Pisa, Pisa, Italy
Stefano Pini
Affiliation:
Department of Psychiatry, University of Pisa, Pisa, Italy
*
*Address for correspondence: Robert Gordon, University Department of Psychiatry, University of Southampton, College Keep, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK. (Email: [email protected])

Abstract

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorization of mental disorders places “separation anxiety disorder” within the broad group of anxiety disorders, and its diagnosis no longer rests on establishing an onset during childhood or adolescence. In previous editions of DSM, it was included within the disorders usually first diagnosed in infancy, childhood, or adolescence, with the requirement for an onset of symptoms before the age of 18 years: symptomatic adults could only receive a retrospective diagnosis, based on establishing this early onset. The new position of separation anxiety disorder is based upon the findings of epidemiological studies that revealed the unexpectedly high prevalence of the condition in adults, often in individuals with an onset of symptoms after the teenage years; its prominent place within the DSM-5 group of anxiety disorders should encourage further research into its epidemiology, etiology, and treatment. This review examines the clinical features and boundaries of the condition, and offers guidance on how it can be distinguished from other anxiety disorders and other mental disorders in which “separation anxiety” may be apparent.

Type
Review Articles
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

RG is supported by the NIHR Clinical Academic Fellow training programme and by the Research Management Committee of the Faculty of Medicine at the University of Southampton. Secretarial support was provided by Magda Nowak, herself supported by the European College of Neuropsychopharmacology Network Initiative (ECNP-NI).

References

1. Bögels, SM, Knappe, S, Clark, LA. Adult separation anxiety disorder in DSM-5. Clin Psychol Rev. 2013; 33(5): 663674.CrossRefGoogle ScholarPubMed
2. Manicavasagar, V, Marnane, C, Pini, S, et al. Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep. 2010; 12(4): 290297.CrossRefGoogle ScholarPubMed
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.Google Scholar
4. Silove, DM, Marnane, C. Overlap of symptom domains of separation anxiety disorder in adulthood with panic disorder-agoraphobia. J Anxiety Disord. 2013; 27(1): 9297.CrossRefGoogle ScholarPubMed
5. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. Geneva: World Health Organization; 1993.Google Scholar
6. Pini, S, Abelli, M, Shear, KM, et al. Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Acta Psychiatr Scand. 2010; 122(1): 4046.CrossRefGoogle Scholar
7. Lewinsohn, PM, Holm-Denoma, JM, Small, JW, Seeley, JR, Joiner, TE Jr. Separation anxiety disorder in childhood as a risk fac0tor for future mental illness. J Am Acad Child Adolesc Psychiatry. 2008; 47(5): 548555.CrossRefGoogle ScholarPubMed
8. Silove, D, Alonso, J, Bromet, E, et al. Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey. Am J Psychiatry. 2015; 172(7): 647656.CrossRefGoogle ScholarPubMed
9. Kossowsky, J, Pfaltz, MC, Schneider, S, Taeymans, J, Locher, C, Gaab, J. The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry. 2013; 170(7): 768781.CrossRefGoogle ScholarPubMed
10. Brückl, TM, Wittchen, H-U, Höfler, M, Pfister, H, Scheider, S, Lieb, R. Childhood separation anxiety and the risk of subsequent psychopathology: results from a community study. Psychother Psychosom. 2007; 76(1): 4756.CrossRefGoogle ScholarPubMed
11. Seligman, LD, Wuyek, LA. Correlates of separation anxiety symptoms among first-semester college students: an exploratory study. J Psychol. 2007; 141(2): 135145.CrossRefGoogle ScholarPubMed
12. Wijeratne, C, Manicavasagar, V. Separation anxiety in the elderly. J Anxiety Disord. 2003; 17(6): 695702.CrossRefGoogle ScholarPubMed
13. Eapen, V, Silove, DM, Johnston, D, Apler, A, Rees, S. Adult separation anxiety in pregnancy: how common is it? Int J Women’s Health. 2012; 4: 251256.CrossRefGoogle Scholar
14. Kohlhoff, J, Barnett, B, Eapen, V. Adult separation anxiety and unsettled infant behavior: associations with adverse parenting during childhood and insecure adult attachment. Compr Psychiatry. 2015; 61: 19.CrossRefGoogle ScholarPubMed
15. Shear, K, Jin, R, Ruscio, AM, Walters, EE, Kessler, RC. Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the national comorbidity survey replication. Am J Psychiatry. 2006; 163(6): 10741083.CrossRefGoogle ScholarPubMed
16. Pini, S, Abelli, M, Mauri, M, et al. Clinical correlates and significance of separation anxiety in patients with bipolar disorder. Bipolar Disord. 2005; 7(4): 370376.CrossRefGoogle ScholarPubMed
17. Troisi, A, Massaroni, P, Cuzzolaro, M. Early separation anxiety and adult attachment style in women with eating disorders. Br J Clin Psychol. 2005; 44(Pt 1): 8997.CrossRefGoogle ScholarPubMed
18. Dell’Osso, L, Carmassi, C, Corsi, M, et al. Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms. Ann Gen Psychiatry. 2011; 10: 29.CrossRefGoogle ScholarPubMed
19. Dell’Osso, L, Carmassi, C, Musetti, L, et al. Lifetime mood symptoms and adult separation anxiety in patients with complicated grief and/or post-traumatic stress disorder: a preliminary report. Psychiatry Res. 2012; 198(3): 436440.CrossRefGoogle ScholarPubMed
20. Pini, S, Gesi, C, Abelli, M, et al. The relationship between adult separation anxiety disorder and complicated grief in a cohort of 454 outpatients with mood and anxiety disorders. J Affect Disord. 2012; 143(1–3): 6468.CrossRefGoogle Scholar
21. Boelen, PA. Symptoms of prolonged grief, depression, and adult separation anxiety: distinctiveness and correlates. Psychiatry Res. 2013; 207(1–2): 6872.CrossRefGoogle ScholarPubMed
22. Franz, AP, Rateke, L, Hartmann, T, et al. Separation anxiety disorder in adult patients with obsessive-compulsive disorder: prevalence and clinical correlates. Eur Psychiatry. 2015; 30(1): 145151.CrossRefGoogle ScholarPubMed
23. Mroczkowski, MM, Goes, FS, Riddle, MA, et al. Separation anxiety disorder in OCD. Depress Anxiety. 2011; 28(3): 256262.CrossRefGoogle ScholarPubMed
24. Wiltgen, A, Adler, H, Smith, R, et al. Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness. J Affect Disord. 2015; 174: 411415.CrossRefGoogle ScholarPubMed
25. Silove, DM, Marnane, CL, Wagner, R, Manicavasagar, VL. Associations of personality disorder with early separation anxiety in patients with adult separation anxiety disorder. J Pers Disord. 2010; 25(1): 128133.CrossRefGoogle Scholar
26. Roberson-Nay, R, Klein, DF, Klein, RG, et al. Carbon dioxide hypersensitivity in separation-anxious offspring of parents with panic disorder. Biol Psychiatry. 2010; 67(12): 11711177.CrossRefGoogle ScholarPubMed
27. Roberson-Nay, R, Eaves, LJ, Hettema, JM, Kendler, KS, Silberg, JL. Childhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis. Depress Anxiety. 2012; 29(4): 320327.CrossRefGoogle Scholar
28. Battaglia, M, Pesenti-Gritti, P, Medland, SE, Ogliari, A, Tambs, K, Spatola, CAM. A genetically informed study of the association between childhood separation anxiety, sensitivity to CO2, panic disorder, and the effect of childhood parental loss. Arch Gen Psychiatry. 2009; 66(1): 6471.CrossRefGoogle ScholarPubMed
29. Kirsten, LT, Greyner, BFS, Wagner, R, Manicavasagar, V. Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders. Counselling and Psychotherapy Research. 2008; 8(1): 3642.CrossRefGoogle Scholar
30. Aaronson, CJ, Shear, MK, Goetz, R, et al. Predictors and time course of response among panic disorder patients treated with cognitive-behavioral therapy. J Clin Psychiatry. 2008; 69(3): 418424.CrossRefGoogle ScholarPubMed
31. Manicavasagar, V, Silove, D, Curtis, J. Separation anxiety in adulthood: a phenomenological investigation. Compr Psychiatry. 1997; 38(5): 274282.CrossRefGoogle ScholarPubMed
32. Manicavasagar, V, Silove, D. Is there an adult form of separation anxiety disorder? A brief clinical report. Aust N Z J Psychiatry. 1997; 31(2): 299303.CrossRefGoogle ScholarPubMed
33. Cyranowski, JM, Shear, MK, Rucci, P, et al. Adult separation anxiety: psychometric properties of a new structured clinical interview. J Psychiatr Res. 2002; 36(2): 7786.CrossRefGoogle ScholarPubMed
34. Manicavasagar, V, Silove, D, Wagner, R, Drobny, J. A self-report questionnaire for measuring separation anxiety in adulthood. Compr Psychiatry. 2003; 44(2): 146153.CrossRefGoogle ScholarPubMed
35. Silove, DM, Rees, S. Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis. Asian J Psychiatr. 2014; 11: 98101.CrossRefGoogle ScholarPubMed
36. Masi, G, Mucci, M, Favilla, L, Romano, R, Poli, P. Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents. Compr Psychiatry. 1999; 40(3): 210215.CrossRefGoogle ScholarPubMed
37. Verduin, TL, Kendall, P. Differential occurrence of comorbidity within childhood anxiety disorders. J Clin Child Adolesc Psychol. 2003; 32(2): 290295.CrossRefGoogle ScholarPubMed
38. Bowlby, J. Attachment and Loss. Vol. 2: Separation. New York: Basic Books; 1973.Google Scholar
39. Bowlby, J. Attachment and Loss. Vol. 1. New York: Basic Books; 1969.Google Scholar
40. Shaver, PR, Schachner, DA, Mikulincer, M. Attachment style, excessive reassurance seeking, relationship processes, and depression. Pers Soc Psychol Bull. 2005; 31(3): 343359.CrossRefGoogle ScholarPubMed
41. Bartholomew, K, Horowitz, L. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol. 1991; 61(2): 226244.CrossRefGoogle ScholarPubMed
42. Greenberg, MT. Attachment and psychopathology in childhood. In Cassidy J, Shaver PR, Eds. Handbook of Attachment: Theory, Research, and Clinical Applications. New York: Guilford Press; 1999: 469496.Google Scholar
43. Mikulincer, M, Shaver, P. Attachment, group-related processes, and psychotherapy. Int J Group Psychother. 2007; 57(2): 233245.CrossRefGoogle ScholarPubMed
44. Manicavasagar, V, Silove, D, Marnane, C, Wagner, R. Adult attachment styles in panic disorder with and without comorbid adult separation anxiety disorder. Aust N Z J Psychiatry. 2009; 43(2): 167172.CrossRefGoogle ScholarPubMed
45. Pini, S, Abelli, M, Troisi, A, et al. The relationships among separation anxiety disorder, adult attachment style and agoraphobia in patients with panic disorder. J Anxiety Disord. 2014; 28(8): 741746.CrossRefGoogle ScholarPubMed
46. Mertol, S, Alkin, T. Temperament and character dimensions of patients with adult separation anxiety disorder. J Affect Disord. 2012; 139(2): 199203.CrossRefGoogle ScholarPubMed
47. Boelen, PA, Reijntjes, A, Carleton, RN. Intolerance of uncertainty and adult separation anxiety. Cogn Behav Ther. 2014; 43(2): 133144.CrossRefGoogle ScholarPubMed
48. Scaini, S, Ogliari, A, Eley, TC, Zavos, HMS, Battaglia, M. Genetic and environment contributions to separation anxiety: a meta-analytic approach to twin data. Depress Anxiety. 2012; 29(9): 754761.CrossRefGoogle ScholarPubMed
49. Pini, S, Martini, C, Abelli, M, et al. Peripheral-type benzodiazepine receptor binding sites in platelets of patients with panic disorder associated to separation anxiety symptoms. Psychopharmacology (Berl). 2005; 181(2): 407411.CrossRefGoogle ScholarPubMed
50. Atli, O, Bayin, M, Alkin, T. Hypersensitivity to 35% carbon dioxide in patients with adult separation anxiety disorder. J Affect Disord. 2012; 141(2–3): 315323.CrossRefGoogle ScholarPubMed
51. Milrod, B, Markowitz, JC, Gerber, AJ, et al. Childhood separation anxiety and the pathogenesis and treatment of adult anxiety. Am J Psychiatry. 2014; 171(1): 3443.CrossRefGoogle ScholarPubMed
52. Costa, B, Pini, S, Martini, C, et al. Mutation analysis of oxytocin gene in individuals with adult separation anxiety. Psychiatry Res. 2009; 168(2): 8793.CrossRefGoogle ScholarPubMed
53. Costa, B, Pini, S, Gabelloni, P, et al. Oxytocin receptor polymorphisms and adult attachment style in patients with depression. Psychoneuroendocrinology. 2009; 34(10): 15061514.CrossRefGoogle ScholarPubMed
54. Gordon, I, Zagoory-Sharon, O, Schneiderman, I, Leckman, JF, Weller, A, Feldman, R. Oxytocin and cortisol in romantically unattached young adults: associations with bonding and psychological distress. Psychophysiology. 2008; 45(3): 349352.CrossRefGoogle ScholarPubMed
55. Starcevic, V. Separation anxiety disorder in adults: is the neglect real? Aust N Z J Psychiatry. 2015; 47(2): 188189.CrossRefGoogle Scholar