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Finsaas MC, Klein DN. Is adult separation anxiety associated with offspring risk for internalizing psychiatric problems? Psychol Med 2023; 53:3168-3177. [PMID: 35080196 PMCID: PMC10187056 DOI: 10.1017/s0033291721005249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Awareness of adult separation anxiety (ASA) is growing, but there is a dearth of knowledge about how separation anxiety aggregates in families. We examined the intergenerational associations of separation anxiety and other forms of internalizing problems in an American community sample of 515 predominantly white children and their parents. METHODS Children's separation anxiety (CSA), depression, and other anxiety disorders were modeled as latent factors using diagnoses from interviews and symptom scores from questionnaires completed by mothers, fathers, and children when children were 9 years old and again 3 years later. Parents' separation anxiety was assessed via a questionnaire and parents' other anxiety, depressive, and substance use disorders were assessed with a diagnostic interview when children were nine. Relationships between parents' and children's psychopathology were modeled using s.e.m. RESULTS Mothers' and fathers' ASA were related to all three psychopathology factors in offspring, over and above other parental disorders, in concurrent and prospective analyses. CSA was also related to maternal depression concurrently and prospectively and to maternal anxiety prospectively. Of all paternal psychopathology variables, only ASA was significantly related to children's psychopathology in either model. CONCLUSIONS Results indicate that parental separation anxiety is an important, but non-specific, risk factor for children's psychopathology. The pathway by which this risk is transmitted may be genetic or environmental, and the observed statistical associations likely also encompass child-to-parent effects.
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Affiliation(s)
- Megan C. Finsaas
- Department of Epidemiology, Columbia University, New York, NY, USA and
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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2
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Karakoç H, Kul Uçtu A. The unseen aspect of negative birth experience: Blues of birth. Health Care Women Int 2023; 44:159-174. [PMID: 34534042 DOI: 10.1080/07399332.2021.1961777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period.
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Affiliation(s)
- Hediye Karakoç
- Department of Midwifery, College of Health Science, KTO Karatay University, Konya, Turkey
| | - Arzu Kul Uçtu
- Faculty of Gulhane Health Sciences, Department of Midwifery, Health Sciences University, Ankara, Turkey
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Bahar Ölmez S, Sarıgedik E, Ataoğlu A. The Relationships Between Separation Anxiety Disorder, Childhood Traumas, and Anxiety Sensitivity in a Sample of Medical Students. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Anxiety Sensitivity and Intolerance of Uncertainty as Factors Related to Adult Separation Anxiety Disorder Symptoms. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00114-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elbay RY, Görmez A, Kılıç A, Avcı SH. Separation anxiety disorder among outpatients with major depressive disorder: Prevalence and clinical correlates. Compr Psychiatry 2021; 105:152219. [PMID: 33378709 DOI: 10.1016/j.comppsych.2020.152219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Prior studies have reported that separation anxiety disorder (SEPAD) can continue into or may begin in adulthood. Association of SEPAD with other psychiatric disorders has been frequently examined, and high rates of comorbidities have been found. The aim of this study was to investigate the prevalence and clinical correlation of SEPAD in adult patients undergoing treatment for major depressive disorder (MDD). The study sample was comprised of 100 outpatients. Participants underwent a DSM-5-based comprehensive assessment. Purposefully-designed semi-structured sociodemographic information and illness history forms were filled out by the researchers, and diagnoses of SEPAD were made using the Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory and Adult Separation Anxiety Survey. The frequency of SEPAD was 41% in patients with MDD, three-quarters of whom were adult onset. The use of new-generation antidepressants, adjunctive medications and comorbidity of other anxiety disorders were higher in patients with SEPAD (p < 0.05). SEPAD was highly prevalent, with a majority of cases starting in adulthood among patients with MDD, while SEPAD comorbidity was associated with high levels of anxiety and an increased likelihood of suboptimal response to usual depression treatment. Further studies are required to define the relevance and pathological basis for the comorbidity of SEPAD in people with MDD.
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Affiliation(s)
- Rümeysa Yeni Elbay
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, Turkey.
| | - Aynur Görmez
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, Istanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14, Kadıköy, İstanbul, Turkey
| | - Alperen Kılıç
- Istanbul Medipol University, Faculty of Medicine, Psychiatry Department, TEM Avrupa Otoyolu Göztepe Çıkışı No:1, 34214 Bağcılar, İstanbul, Turkey
| | - Selma Hilal Avcı
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14, Kadıköy, İstanbul, Turkey
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Dogan B, Kocabas O, Sevincok D, Baygin C, Memis CO, Sevincok L. Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia. Psychiatry 2021; 84:68-80. [PMID: 33577430 DOI: 10.1080/00332747.2021.1875730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (β = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (β = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.
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Endler NS, Flett GL, Macrodimitris SD, Corace KM, Kocovski NL. Separation, self‐disclosure, and social evaluation anxiety as facets of trait social anxiety. EUROPEAN JOURNAL OF PERSONALITY 2020. [DOI: 10.1002/per.452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the current article, we propose an expansion of the trait anxiety concept to include interpersonal or social facets of trait anxiety involving separation from significant others and disclosing aspects of the self to others, as a supplement to the existing focus on social evaluation anxiety. Participants in three studies completed a modified version of the Endler Multidimensional Anxiety Scales that included a measure of trait social evaluation anxiety, as well as new measures of trait separation anxiety and trait self‐disclosure anxiety (i.e., three measures of trait social anxiety). Results showed that the social evaluation, separation, and self‐disclosure trait anxiety scales have strong psychometric properties and that they represent distinct but related components of trait anxiety. With respect to validity, the facets of trait social anxiety were predictive of related variables including self‐concealment, anxiety sensitivity, and trait worry. The theoretical and practical implications of a multifaceted approach to trait social anxiety are discussed in terms of an expanded multidimensional interaction model of anxiety. Copyright © 2002 John Wiley & Sons, Ltd.
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Hu Y, Cai Y, Tu D, Guo Y, Liu S. Development of a Computerized Adaptive Test for Separation Anxiety Disorder Among Adolescents. Front Psychol 2020; 11:1077. [PMID: 32625130 PMCID: PMC7315771 DOI: 10.3389/fpsyg.2020.01077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/28/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Separation anxiety disorder (SAD) is one of the most common mental disorders among children and adolescents, and it may seriously affect their growth, daily life, and learning. Self-report scales have been used for diagnosis, which require lengthy testing and personnel. METHODS A total of 1,241 adolescents were recruited from 16 junior- and senior-high schools in China. The initial item bank was selected from classical SAD scales according to the DSM-5. First, the optimal model was selected using item response theory (IRT) according to data fit. Then, per the IRT analysis, items that did not meet the psychometric requirements were deleted (e.g., discriminating values < 0.2). Consequently, a computerized adaptive test (CAT) for SAD was formed (CAT-SAD). RESULTS An average of 17 items per participant was required to achieve and maintain a 0.3 standard error of measurement in the SAD severity estimate. The estimated correlation of the CAT-SAD with the total 68-item test score was 0.955. CAT-SAD scores were strongly related to the probability of a SAD diagnosis with the Separation Anxiety Assessment Scale-Child and Adolescent Version. Therefore, SAD could be accurately predicted by the CAT-SAD. CONCLUSIONS Exploratory factor analyses revealed that SAD was unidimensional. The CAT-SAD, which has good reliability and validity and high sensitivity and specificity, provides an efficient test for adolescents with SAD as compared to standard paper-and-pencil tests. It can be used to diagnose varying degrees of SAD quickly and reliably and ease the burden on adolescents. Potential applications for inexpensive, efficient, and accurate screening of SAD are discussed.
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Affiliation(s)
| | - Yan Cai
- School of Psychology, Jiangxi Normal University, Nanchang, China
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9
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Casale S, Flett GL. Interpersonally-Based Fears During the Covid-19 Pandemic: Reflections on the Fear of Missing Out and the Fear of Not Mattering Constructs. CLINICAL NEUROPSYCHIATRY 2020; 17:88-93. [PMID: 34908975 PMCID: PMC8629079 DOI: 10.36131/cn20200211] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is currently spreading in all the areas of the world. This ongoing pandemic has clear impacts in terms of the relevance of psychological needs. Psychological needs such as self-esteem, self-actualization, and relatedness only become relevant once basic physiological needs and safety and survivor needs have been satisfied. Because psychological constructs are not objectively existing constituents of reality but rather efforts to represent it, they tend to become more or less relevant and salient as a function of prevailing conditions. Starting from this premise, the current paper focuses on the relevance that fears with an interpersonal basis (i.e. the fear of missing out and the fear of not mattering) have during a period in which physical distancing or “social distancing” has been implicated as a crucial important public health intervention that can help stop transmission of the coronavirus. We underscore how the current health crisis impacts the self and identity of people who are confronted with the discrepancy between their usual psychological needs and current realities.
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Affiliation(s)
- Silvia Casale
- Department of Health Sciences, University of Florence (Italy)
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10
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Finsaas MC, Olino TM, Hawes M, Mackin DM, Klein DN. Psychometric analysis of the adult separation anxiety symptom questionnaire: Item functioning and invariance across gender and time. Psychol Assess 2020; 32:582-593. [PMID: 32162945 DOI: 10.1037/pas0000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Adult Separation Anxiety Symptom Questionnaire (ASA-27) is the most widely used self-report assessment of adult separation anxiety (ASA). Despite its widespread use, relatively little is known about its psychometric properties, specifically whether it is unidimensional, its degree of precision (or information) across latent levels of ASA, the functioning of individual items in general and of DSM-derived versus non-DSM-derived items in particular, and whether the measure is invariant across gender and time. We addressed these issues in a sample of 509 adult women and 407 adult men from the local community participating in a longitudinal study of temperament and psychopathology in children. Two items from the ASA-27 were removed so that the measure met the item response theory (IRT) assumption of unidimensionality. Findings from a graded response model for categorical items suggested that the ASA-27 assesses ASA most reliably at moderate to high levels and that the DSM-derived items were more closely related to latent ASA than the non-DSM-derived items. Invariance tests employing single-factor confirmatory factor analysis models suggested that the measure is partially invariant across gender and time at the unique factor level, with fewer than 7% of parameters freed in both cases; this implies that the means and variances of the latent factors and differences in the observed responses are attributable to true differences in ASA. Future work should replicate these findings in a sample that includes individuals with a wider range of ASA severity and may consider removing additional items that provide little or redundant information. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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11
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Avedisova A, A Arkushae I, Akzhigitov R, Anosov Y, Zakharova K. Prevalence of anxiety separation disorder in adult outpatients with non-psychotic mental disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:92-98. [DOI: 10.17116/jnevro202012006192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Avedisova AS, Arkusha IA, Zakharova KV. [Separation anxiety disorder in adults - a new diagnostic category]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:66-75. [PMID: 30499500 DOI: 10.17116/jnevro201811810166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety separation disorder (SAD) became the subject of increased attention of researchers in recent decades. DSM-5 and project of ICD-11 allow us to treat this disorder as an independent nosological unit without attachment to age. The review provides information on the prevalence, clinical manifestations and diagnosis of SAD in adults, summarizes information on the etiopathogenesis, relations to other psychiatric disorders, and highlights the lack of modern therapeutic approaches to SAD. The purpose of this review is to raise the level of knowledge about SAD and its new positioning in classification systems.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - I A Arkusha
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - K V Zakharova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
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Schneier FR, Moskow DM, Choo TH, Galfalvy H, Campeas R, Sanchez-Lacay A. A randomized controlled pilot trial of vilazodone for adult separation anxiety disorder. Depress Anxiety 2017; 34:1085-1095. [PMID: 29071764 DOI: 10.1002/da.22693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Separation anxiety disorder was recently recognized by fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a diagnosis in adults, but no publications to date have characterized a sample of patients seeking treatment for adult separation anxiety disorder (ASAD) or assessed treatment efficacy. We hypothesized that vilazodone, a selective serotonin reuptake inhibitor (SSRI) and serotonin 1a (5HT1a ) receptor partial agonist, would have efficacy in ASAD, because SSRIs have appeared efficacious in children with mixed diagnoses including separation anxiety disorder and in animal models of separation anxiety. METHODS In this pilot study, 24 adults (ages 18-60) with a principal diagnosis of ASAD were randomized to 12 weeks of double-blind treatment with vilazodone (n = 13) or placebo (n = 11). Outcome was assessed by an independent evaluator and self-ratings, and analyzed with mixed effect models. RESULTS This sample was predominantly female (67%), with comorbid psychiatric disorders (58%), and adult onset of separation anxiety disorder (62%). Response rates at week 12 did not differ significantly between groups. Across all time points, the vilazodone group evidenced greater improvement on the Structured Clinical Interview for Separation Anxiety Symptoms (P = .026) and the Quality of Life Enjoyment and Satisfaction Questionnaire (P = .011), and trends toward greater improvement on the Adult Separation Anxiety Questionnaire (P = .054) and the Clinical Global Impression-Change Scale (P = .086), all with large between-group effect sizes. CONCLUSIONS Findings demonstrate feasibility of a clinical trial in ASAD, and they suggest that vilazodone may have efficacy in the treatment of ASAD and warrants further study.
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Affiliation(s)
- Franklin R Schneier
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Danielle M Moskow
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Raphael Campeas
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Arturo Sanchez-Lacay
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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Costa B, Pini S, Baldwin DS, Silove D, Manicavasagar V, Abelli M, Coppedè F, Martini C. Oxytocin receptor and G-protein polymorphisms in patients with depression and separation anxiety. J Affect Disord 2017; 218:365-373. [PMID: 28499211 DOI: 10.1016/j.jad.2017.03.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/16/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The impact of combined variants of Oxytocin Receptor (OXTR) and G protein β3 subunit genes was investigated in relation to retrospective reports of childhood as well as contemporary adult separation anxiety (SA), based on evidence of a β/γ dimer-mediated signaling for OXTR. METHODS A case-control association study (225 healthy adults and 188 outpatients with depression) was performed to establish Risk-Combined Genotype (RCG) of the studied variants (OXTR rs53576 and the functional Gβ3 subunit rs5443). Current SA was evaluated by the ASA-27 and retrospective childhood symptoms by the SASI. GG genotype of OXTR rs53576 combined with T-carrier genotype of Gβ3 rs5443 represented the RCG. RESULTS Compared to non-RCG, those with RCG had significantly higher levels of childhood and adult SA. The RCG was significantly associated with childhood SA threshold score (OR=2.85, 90%CI: 1.08-7.50). Childhood SA was, in turn, strongly associated with a threshold SA score in adulthood (OR=15.58; 95% CI: 4.62-52.59). LIMITATIONS Although the overall sample size is sizable, comparisons among subgroups with specific combination of alleles are based on relatively small numbers. CONCLUSIONS Our study indicates that variations in OXTR and Gβ3 genes are specifically associated with presence and severity of SA in childhood and adulthood, but not with depression or anxiety in general. Because there is increasing interest in oxytocin in social behavior, the gene-SA associations identified have potential translational and clinical relevance.
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Affiliation(s)
- Barbara Costa
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.
| | - David S Baldwin
- Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Marianna Abelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Fabio Coppedè
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Gesi C, Carmassi C, Shear KM, Schwartz T, Ghesquiere A, Khaler J, Dell'Osso L. Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates. Compr Psychiatry 2017; 72:6-12. [PMID: 27683967 DOI: 10.1016/j.comppsych.2016.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Complicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG. METHODS 151 adults with CG, enrolled in a randomized controlled trial comparing the effectiveness of (CG) treatment to that of interpersonal therapy, were assessed by means of the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HAM-D), the Work and Social Adjustment Scale (WSAS), the Adult Separation Anxiety Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Impact of Events Scale (IES). RESULTS 104 (68.9%) individuals with CG were considered to have SEPAD (ASA-27 score ≥22). Individuals with SEPAD were more likely to have reported a CG related to the loss of another close relative or friend (than a parent, spouse/partner or a child) (p=.02), as well as greater scores on the ICG (p=<.001), PDEQ (p=.004), GRAQ (p<.001), intrusion (p<.001) and avoidance (p=<.001) IES subscales, HAM-D (p<.001) and WSAS (p=.006). ASA-27 total scores correlated with ICG (p<.0001), PDEQ (p<.001) GRAQ (p<.0001) scores and both the IES intrusion (p<.0001) and IES avoidance (p<.0001) subscale scores. People with SEPAD had higher rates of lifetime post-traumatic stress disorder (PTSD) (p=.04) and panic disorder (PD) (p=.01). CONCLUSIONS SEPAD is highly prevalent among patients with CG and is associated with greater symptom severity and impairment and greater comorbidity with PTSD and PD. Further studies will help to confirm and generalize our results and to determine whether adult SEPAD responds to CG treatment and/or moderates CG treatment response.
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Affiliation(s)
- Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | | | | | - Julie Khaler
- Columbia University School of Social Work, NY, U.S.A
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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16
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Silove DM, Tay AK, Tol WA, Tam N, Dos Reis N, da Costa Z, Soares C, Rees S. Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence. J Affect Disord 2016; 205:292-300. [PMID: 27552593 DOI: 10.1016/j.jad.2016.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 06/19/2016] [Accepted: 07/09/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors. METHODS In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors. RESULTS LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors. LIMITATIONS The study is cross-sectional, cautioning against inferring causal inferences. CONCLUSIONS The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.
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Affiliation(s)
- D M Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - A K Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - W A Tol
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - N Tam
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | | | | | - C Soares
- Alola Women's Foundation, Timor-Leste
| | - S Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
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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.
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Manicavasagar V, Silove D. Why are we still missing adult separation anxiety disorder in clinical practice? Aust N Z J Psychiatry 2016; 50:807-8. [PMID: 27343899 DOI: 10.1177/0004867416655875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Vijaya Manicavasagar
- Black Dog Institute, School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Liverpool Hospital, Liverpool, NSW, Australia
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Separation anxiety disorder from the perspective of DSM-5: clinical investigation among subjects with panic disorder and associations with mood disorders spectrum. CNS Spectr 2016; 21:70-5. [PMID: 25704393 DOI: 10.1017/s1092852914000807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/INTRODUCTION High levels of comorbidity between separation anxiety disorder (SEPAD) and panic disorder (PD) have been found in clinical settings. In addition, there is some evidence for a relationship involving bipolar disorder (BD) and combined PD and SEPAD. We aim to investigate the prevalence and correlates of SEPAD among patients with PD and whether the presence of SEPAD is associated with frank diagnoses of mood disorders or with mood spectrum symptoms. METHODS Adult outpatients (235) with PD were assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Panic Disorder Severity Scale (PDSS), the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and the Mood Spectrum Self-Report Instrument (MOODS-SR, lifetime version). RESULTS Of ther 235 subjects, 125 (53.2%) were categorized as having SEPAD and 110 (46.8%) as not. Groups did not differ regarding onset of PD, lifetime prevalence of obsessive compulsive disorder (OCD), social phobia, simple phobia, BD I and II, or major depressive disorder (MDD). SEPAD subjects were more likely to be female and younger; they showed higher rates of childhood SEPAD, higher PDSS scores, and higher MOODS-SR total and manic component scores than subjects without SEPAD. Discussion SEPAD is highly prevalent among PD subjects. Patients with both PD and SEPAD show higher lifetime mood spectrum symptoms than patients with PD alone. Specifically, SEPAD is correlated with the manic/hypomanic spectrum component. CONCLUSION Our data confirm the high prevalence of SEPAD in clinical settings. Moreover, our findings corroborate a relationship between mood disorders and SEPAD, highlighting a relationship between lifetime mood spectrum symptoms and SEPAD.
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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; 61:1-9. [PMID: 26094158 DOI: 10.1016/j.comppsych.2015.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study examined the prevalence and correlates of Adult Separation Anxiety Disorder (ASAD) and Adult Separation Anxiety (ASA) symptoms in a sample of first-time mothers with an unsettled infant during the first postpartum year. METHODS Eighty-three primiparous women admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis and questionnaires assessing ASA symptoms, adult attachment and childhood parenting experiences. Nurses recorded infant behavior using 24-hour charts. RESULTS The prevalence of ASAD in this sample was 19.3% and women with ASAD were, on average, more likely to be diagnosed with depression and anxiety disorders, report aversive parenting experiences during childhood and show adult attachment style insecurity. Both ASAD and ASA symptoms were predicted by adult attachment anxiety, and ASAD was associated with unsettled infant behavior. Attachment anxiety and attachment avoidance mediated relations between parental over-control and ASAD diagnosis, and between parental abuse and ASAD diagnosis. Attachment anxiety mediated the relation between parental over-control and ASA symptoms, and attachment avoidance mediated the relations of parental over-control and parental abuse with ASA symptoms. CONCLUSIONS This study highlights the prevalence of ASAD among first time mothers experiencing early parenting difficulties and the roles of childhood parenting experiences and adult attachment style in the development of the disorder. This points to the importance of introducing universal screening for ASAD in postnatal settings, and for the development of targeted interventions.
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Affiliation(s)
- Jane Kohlhoff
- Karitane, PO Box 241, Villawood, NSW, 2163, Australia.
| | - Bryanne Barnett
- St John of God Raphael Services, 36-38 First Avenue, Blacktown, NSW, 2148, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District, Mental Health Centre, L1 Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia; School of Psychiatry & Ingham Institute, University of New South Wales
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21
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Pini S, Abelli M, Troisi A, Siracusano A, Cassano GB, Shear KM, Baldwin D. The relationships among separation anxiety disorder, adult attachment style and agoraphobia in patients with panic disorder. J Anxiety Disord 2014; 28:741-6. [PMID: 25218272 DOI: 10.1016/j.janxdis.2014.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Revised: 06/20/2014] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
Abstract
Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.
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Affiliation(s)
- Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy.
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy
| | - Alfonso Troisi
- Department of Neurosciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Alberto Siracusano
- Department of Neurosciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giovanni B Cassano
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy
| | - Katherine M Shear
- Columbia University, Department of Social Work, School of Social Work, Columbia University, New York, NY, USA
| | - David Baldwin
- Department of Psychiatry, University of Southampton, Faculty of Medicine, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom
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Redlich R, Grotegerd D, Opel N, Kaufmann C, Zwitserlood P, Kugel H, Heindel W, Donges US, Suslow T, Arolt V, Dannlowski U. Are you gonna leave me? Separation anxiety is associated with increased amygdala responsiveness and volume. Soc Cogn Affect Neurosci 2014; 10:278-84. [PMID: 24752071 DOI: 10.1093/scan/nsu055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The core feature of separation anxiety is excessive distress when faced with actual or perceived separation from people to whom the individual has a strong emotional attachment. So far little is known about the neurobiological underpinnings of separation anxiety. Therefore, we investigated functional (amygdala responsiveness and functional connectivity during threat-related emotion processing) and structural (grey matter volume) imaging markers associated with separation anxiety as measured with the Relationship Scale Questionnaire in a large sample of healthy adults from the Münster Neuroimaging Cohort (N = 320). We used a robust emotional face-matching task and acquired high-resolution structural images for morphometric analyses using voxel-based morphometry. The main results were positive associations of separation anxiety scores with amygdala reactivity to emotional faces as well as increased amygdala grey matter volumes. A functional connectivity analysis revealed positive associations between separation anxiety and functional coupling of the amygdala with areas involved in visual processes and attention, including several occipital and somatosensory areas. Taken together, the results suggest a higher emotional involvement in subjects with separation anxiety while watching negative facial expressions, and potentially secondary neuro-structural adaptive processes. These results could help to understand and treat (adult) separation anxiety.
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Affiliation(s)
- Ronny Redlich
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Dominik Grotegerd
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Nils Opel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Carolin Kaufmann
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Pienie Zwitserlood
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Harald Kugel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Walter Heindel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Uta-Susan Donges
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Thomas Suslow
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
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23
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Bögels SM, Knappe S, Clark LA. Adult separation anxiety disorder in DSM-5. Clin Psychol Rev 2013; 33:663-74. [DOI: 10.1016/j.cpr.2013.03.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/27/2022]
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Affiliation(s)
- Claire Marnane
- School of Psychiatry, University of New South Wales, Randwick, Australia.
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25
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Silove D, Marnane C. Overlap of symptom domains of separation anxiety disorder in adulthood with panic disorder-agoraphobia. J Anxiety Disord 2013; 27:92-7. [PMID: 23247205 DOI: 10.1016/j.janxdis.2012.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 09/26/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
There is a need to explain the high level of comorbidity between separation anxiety disorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, Randwick, Australia.
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26
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Pini S, Gesi C, Abelli M, Muti M, Lari L, Cardini A, Manicavasagar V, Mauri M, Cassano GB, Shear KM. 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; 143:64-8. [PMID: 22832169 DOI: 10.1016/j.jad.2012.05.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. Data from literature suggest that Adult Separation Anxiety Disorder (ASAD) may develop after a bereavement or threat of loss. Research has demonstrated that bereaved persons may present a clinically significant grief reaction, defined as Complicated Grief (CG) that causes a severe impairment in the quality of life. The aim of this study was to evaluate the relationship between ASAD and CG in a large cohort of outpatients with mood and anxiety disorders. METHODS Study participants comprised 454 adult psychiatric outpatients with DSM-IV mood or anxiety disorders diagnoses. Diagnostic assessments were performed using the SCID-I; ASAD was assessed using an adapted version of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS-adult). Complicated grief symptoms were assessed by the Inventory of Complicated Grief (ICG). Social and work impairments were evaluated using the Sheehan Disability Scale (SDS). Adult attachment styles were assessed by the Relationship Questionnaire (RQ). RESULTS The overall frequency of ASAD in our sample was 43% and that of CG was 23%. Individuals with CG had a greater frequency of ASAD (56%) with respect to those without CG (40%). Subjects with CG plus ASAD reported higher scores on ICG and greater impairment on quality of life, as measured with SDS, than CG patients without ASAD. CONCLUSIONS Adult separation anxiety disorder occurs in a high proportion of adult psychiatric outpatients with complicated grief. The association between these two conditions should be further investigated in light of their clinical implications.
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Affiliation(s)
- Stefano Pini
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, via Roma 65, I-56100 Pisa, Italy.
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Hypersensitivity to 35% carbon dioxide in patients with adult separation anxiety disorder. J Affect Disord 2012; 141:315-23. [PMID: 22542862 DOI: 10.1016/j.jad.2012.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adults with panic disorder (PD) and children with separation anxiety disorder (CSAD) show higher reactivity to CO(2). Our hypothesis was patients with adult separation anxiety disorder (ASAD) would show similar hypersensitivity to CO(2). In the present study, we determined whether sensitivity to CO(2) was enhanced in adult patients with separation anxiety disorder with no history of panic attacks. METHODS Patients with PD (n=38), adult separation anxiety disorder (ASAD) patients with no history of panic attacks (n=31), and healthy subjects (n=40) underwent a 35% CO(2) inhalation challenge procedure. Baseline and post-inhalation anxiety were assessed with the Acute Panic Inventory, Visual Analog Scale, and Anxiety Sensitivity Index-3 (ASI-3). RESULTS As hypothesized the rate of CO(2)-induced panic attacks was significantly greater in PD and ASAD patient groups (55.3% and 51.6% respectively) than healthy comparison group (17.5%). Nine (69.2%) of 13 patients in PD group who have ASAD concurrent with PD had a CO(2)-induced panic attack. ASI-3 total scores were not different between PD and ASAD groups and both were significantly higher than controls. However, anxiety sensitivity did not predict the occurrence of panic attacks. LIMITATIONS The researchers were not blind to the diagnosis and there was no placebo arm for comparison. Besides, parameters of respiratory physiology were not evaluated. CONCLUSION ASAD was associated with CO(2) hypersensitivity quite similar to PD. This finding partly unfolds the complex relationship of 'CSAD, PD, and CO(2) hypersensitivity' and indicates that CO(2) hypersensitivity and separation anxiety extend together beyond childhood.
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Mertol S, Alkın T. Temperament and character dimensions of patients with adult separation anxiety disorder. J Affect Disord 2012; 139:199-203. [PMID: 22440427 DOI: 10.1016/j.jad.2012.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is growing evidence suggesting that separation anxiety can occur in adults. We aimed to determine temperament and character dimensions in patients with adult separation anxiety disorder (ASAD) compared to patients with panic disorder (PD) and healthy subjects. METHODS The study sample included 77 outpatients with ASAD, 44 outpatients with a PD with or without agoraphobia diagnosis, and 35 healthy subjects. ASAD diagnoses were confirmed with Structured Clinical Interview for Separation Anxiety Symptoms. Other measures included Adulthood Separation Anxiety Checklist, Separation Anxiety Symptom Inventory, and Temperament and Character Inventory (TCI). Group comparisons according to presence or absence of PD comorbidity in ASAD were also done. RESULTS Patients with ASAD scored higher in harm avoidance (HA) and scored lower in self-directedness (SD) compared to PD and control groups. Moreover, both PD patients and ASAD patients scored higher in RD, and self-transcendence dimensions than control subjects. All subscales of HA (anticipatory worry, fear of uncertainty, shyness, and fatigability) were significantly higher than controls. While HA scores were not different between ASAD and 'ASAD+PD' patients, HA levels of both groups were higher than PD alone and control groups. SD scores of patients with ASAD were lower than PD and control groups. LIMITATIONS Cross-sectional design and ASAD group have other anxiety disorders comorbidity which might affect the results. CONCLUSION Similar to PD and other anxiety disorders HA and RD was higher, and SD was lower in patients with ASAD compared to healthy subjects. Observed TCI profile is related to the ASAD itself since depression comorbidity was controlled.
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Eapen V, Silove DM, Johnston D, Apler A, Rees S. Adult separation anxiety in pregnancy: how common is it? Int J Womens Health 2012; 4:251-6. [PMID: 22723732 PMCID: PMC3379859 DOI: 10.2147/ijwh.s30981] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The present study, the first to examine adult separation anxiety (ASA) in the context of pregnancy, found that ASA is a common yet unrecognized condition. Women attending an antenatal clinic were evaluated for the presence of ASA. A quarter of the women reached an established symptom threshold for ASA, with significantly more primigravida women (P = 0.003) identified as having the problem. There were no significant differences in the sociodemographic characteristics between those with and without ASA. Around one-third acknowledged that ASA was causing significant impairment in day-to-day functioning, suggesting the clinical importance of the pattern. Further research is indicated to explore this clinical entity and its impact on maternal and infant psychosocial wellbeing.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney
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Silove D, Marnane C, Wagner R, Manicavasagar V. Brief report--associations of personality disorder with early separation anxiety in patients with adult separation anxiety disorder. J Pers Disord 2011; 25:128-33. [PMID: 21309628 DOI: 10.1521/pedi.2011.25.1.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A recent study has suggested a link between early separation anxiety and personality disorder. It is possible that this relationship is mediated or confounded by the presence of adult separation anxiety disorder (ASAD). In a clinic study of 397 anxiety patients, we found that ASAD patients with heightened early separation anxiety had higher rates of any Cluster C personality disorder compared to ASAD patients without elevated early separation anxiety, and higher rates of any Cluster B or C personality disorder compared to anxiety patients with low early separation anxiety and no ASAD. Although cross-sectional in design, the study supports a direct link between early separation anxiety and some adult personality disorders, irrespective of the type of adult anxiety disorder present, including ASAD.
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Affiliation(s)
- Derrick Silove
- Centre for Mental Health Research, The Liverpool Hospital, Liverpool NSW 2170, Australia.
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Évaluer l’anxiété de séparation de l’adolescent avec le Separation Anxiety Symptom Inventory (SASI). Adaptation et validation française. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.neurenf.2010.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Manicavasagar V, Marnane C, Pini S, Abelli M, Rees S, Eapen V, Silove D. Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep 2010; 12:290-7. [PMID: 20552302 DOI: 10.1007/s11920-010-0131-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article explores accruing evidence supporting the occurrence of an adult form of separation anxiety disorder (ASAD), a category yet to be recognized by international classification systems. ASAD can have its first onset in adulthood, although in a portion of cases, it represents a persistence or recurrence of the childhood-onset type. Recent large-scale clinic studies have suggested that ASAD is associated with high levels of disability. In addition, the presence of ASAD in individuals with anxiety disorders seems to signal a poor outcome to cognitive-behavioral therapy. The existing evidence suggests possible grounds for removing the childhood-onset requirement for the category of separation anxiety disorder, thereby allowing for first onset in adulthood. There is a pressing need to design and test appropriate treatments for ASAD and to educate clinicians to identify and manage the condition.
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Affiliation(s)
- Vijaya Manicavasagar
- School of Psychiatry, Prince of Wales Hospital, University of New South Wales and Black Dog Institute, Randwick, New South Wales 2031, Australia.
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Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Acta Psychiatr Scand 2010; 122:40-6. [PMID: 19824987 DOI: 10.1111/j.1600-0447.2009.01480.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the frequency and clinical correlates of adult separation anxiety disorder in a large cohort of patients with mood and anxiety disorders. METHOD Overall, 508 outpatients with anxiety and mood disorders were assessed by the structured clinical interview for diagnostic and statistical manual (IV edition) axis I disorders for principal diagnosis and comorbidity and by other appropriate instruments for separation anxiety into adulthood or childhood. RESULTS Overall, 105 subjects (20.7%) were assessed as having adult separation anxiety disorder without a history of childhood separation anxiety and 110 (21.7%) had adult separation anxiety disorder with a history of childhood separation anxiety. Adult separation anxiety was associated with severe role impairment in work and social relationships after controlling for potential confounding effect of anxiety comorbidity. CONCLUSION Adult separation anxiety disorder is likely to be much more common in adults than previously recognized. Research is needed to better understand the relationships of this condition with other co-occurring affective disorders.
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Silove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S. The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC Psychiatry 2010; 10:21. [PMID: 20219138 PMCID: PMC2846894 DOI: 10.1186/1471-244x-10-21] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 03/10/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adult separation anxiety disorder (ASAD) has been identified recently, but there is a paucity of data about its prevalence and associated characteristics amongst anxiety patients. This study assessed the prevalence and risk factor profile associated with ASAD in an anxiety clinic. METHODS Clinical psychologists assigned 520 consecutive patients to DSM-IV adult anxiety subcategories using the SCID. We also measured demographic factors and reports of early separation anxiety (the Separation Anxiety Symptom Inventory and a retrospective diagnosis of childhood separation anxiety disorder). Other self-report measures included the Adult Separation Anxiety Symptom Questionnaire (ASA-27), the Depression, Anxiety, Stress Scales (DASS-21), personality traits measured by the NEO PI-R and the Work and Social Adjustment Scale. These measures were included in three models examining for overall differences and then by gender: Model 1 compared the conventional SCID anxiety subtypes (excluding PTSD and OCD because of insufficient numbers); Model 2 divided the sample into those with and without ASAD; Model 3 compared those with ASAD with the individual anxiety subtypes in the residual group. RESULTS Patients with ASAD had elevated early separation anxiety scores but this association was unique in females only. Except for social phobia in relation to some comparisons, those with ASAD recorded more severe symptoms of depression, anxiety and stress, higher neuroticism scores, and greater levels of disability. CONCLUSIONS Patients with ASAD attending an anxiety clinic are highly symptomatic and disabled. The findings have implications for the classification, clinical identification and treatment of adult anxiety disorders.
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Affiliation(s)
- Derrick M Silove
- Centre for Population Mental Health Research, Psychiatry Research and Teaching Unit, Level 1 Mental Health Centre, Liverpool Hospital, corner Forbes and Campbell St, Liverpool NSW 2170, Australia.
| | - Claire L Marnane
- School of Psychiatry, University of New South Wales, Randwick NSW 2031, Australia
| | - Renate Wagner
- School of Psychiatry, University of New South Wales, Randwick NSW 2031, Australia,Clinic for Anxiety and Traumatic Stress, Bankstown Hospital, Bankstown NSW 2200, Australia
| | - Vijaya L Manicavasagar
- School of Psychiatry, University of New South Wales, Randwick NSW 2031, Australia,Black Dog Institute, Prince of Wales Hospital, Randwick NSW 2031, Australia
| | - Susan Rees
- Centre for Population Mental Health Research, Psychiatry Research and Teaching Unit, Level 1 Mental Health Centre, Liverpool Hospital, corner Forbes and Campbell St, Liverpool NSW 2170, Australia,School of Psychiatry, University of New South Wales, Randwick NSW 2031, Australia
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Silove D, Momartin S, Marnane C, Steel Z, Manicavasagar V. Adult separation anxiety disorder among war-affected Bosnian refugees: comorbidity with PTSD and associations with dimensions of trauma. J Trauma Stress 2010; 23:169-72. [PMID: 20135680 DOI: 10.1002/jts.20490] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although separation anxiety disorder appears to be common among children exposed to disasters, there are no data focusing on the impact of trauma on adult separation anxiety disorder. The present exploratory study examined the relationship of adult separation anxiety disorder with other psychological reactions (posttraumatic stress disorder [PTSD], complicated grief, depression) and dimensions of trauma among 126 war-affected Bosnian refugees resettled in Australia. Adult separation anxiety disorder was associated with PTSD, but not with complicated grief or depression. Although adult separation anxiety disorder was weakly linked with traumatic losses, this association was nonspecific. Further research is needed to clarify the pathogenic pathways leading to the comorbid PTSD-adult separation anxiety disorder pattern and its clinical implications.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales and Centre for Population Mental Health Research, Sydney South West Area Health Service, Liverpool, Australia.
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36
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Dudaee-Faass S, Marnane C, Wagner R. Ambiguity in the manifestation of adult separation anxiety disorder occurring in complex anxiety presentations: Two clinical case reports. CLIN PSYCHOL-UK 2009. [DOI: 10.1080/13284200903283774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Claire Marnane
- Bankstown Anxiety Clinic, Sydney South West Area Health Service, Bankstown Hospital , Bankstown
| | - Renate Wagner
- Bankstown Anxiety Clinic, Sydney South West Area Health Service, Bankstown Hospital , Bankstown
- School of Psychiatry, University of New South Wales , Randwick, New South Wales, Australia
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Anxiety, mood, and substance use disorders in parents of children with anxiety disorders. Child Psychiatry Hum Dev 2009; 40:405-19. [PMID: 19229606 DOI: 10.1007/s10578-009-0133-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in parents of AD children relative to NPD children. Specific child-mother relationships were found between child separation anxiety and panic disorder and maternal panic disorder, as were child and maternal social phobia, obsessive compulsive disorder, and specific phobias. Findings are discussed with reference to theory, clinical implications, and future research needs.
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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; 43:167-72. [PMID: 19153925 DOI: 10.1080/00048670802607139] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Attachment theory suggests that anxious attachment styles are associated with risk to psychiatric disorder, especially anxiety disorders. Separation anxiety would appear to be a core form of anxiety that is associated with anxious attachment. Nevertheless, as yet no research has examined the relationship of attachment styles to adult separation anxiety disorder, a condition that has only recently been fully recognized. METHOD The Attachment Style Questionnaire was used to examine attachment styles among 83 consecutive anxiety clinic patients diagnosed with panic disorder with agoraphobia and those re-assigned from that category to adult separation anxiety disorder. RESULTS Dimensional associations showed strong correlations with scales measuring anxious attachment and separation anxiety. Patients assigned to the separation anxiety group scored significantly higher than those in the panic disorder group on the scales of Need for Approval and Preoccupation with Relationships. CONCLUSIONS The findings finally dispel the notion that separation anxiety and anxious attachment are relevant to panic disorder with agoraphobia, suggesting instead that that constellation is confined to a separate group, namely that of adult separation anxiety disorder. Possible implications for treatment are considered.
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Rucci P, Miniati M, Oppo A, Mula M, Calugi S, Frank E, Shear MK, Mauri M, Pini S, Cassano GB. The structure of lifetime panic-agoraphobic spectrum. J Psychiatr Res 2009; 43:366-79. [PMID: 18499126 DOI: 10.1016/j.jpsychires.2008.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/31/2008] [Accepted: 04/08/2008] [Indexed: 11/16/2022]
Abstract
The heterogeneity of the clinical presentation of panic disorder (PD) has prompted researchers to describe different subtypes of PD, on the basis of the observed predominant symptoms constellation. Starting from a dimensional approach to panic disorder, an instrument to assess lifetime panic-agoraphobic spectrum (PAS) available in interview or self-report form (SCI-PAS, PAS-SR) was developed which proved to have sound psychometric properties and the ability to predict delayed response to treatment in patients with mood disorders. However, the structure of the instrument was defined a priori and an examination of its empirical structure is still lacking. Aim of the present report is to analyse the factor structure of the PAS taking advantage of a large database of subjects with panic disorders (N=630) assessed in the framework of different studies. Using a classical exploratory factor analysis based on a tetrachoric correlation matrix and oblique rotation, 10 factors were extracted, accounting overall for 66.3% of the variance of the questionnaire: panic symptoms, agoraphobia, claustrophobia, separation anxiety, fear of losing control, drug sensitivity and phobia, medical reassurance, rescue object, loss sensitivity, reassurance from family members. The first two factors comprise the DSM-IV criteria for panic disorder and agoraphobia. The other factors had received limited empirical support to date. We submit that these symptoms profiles might be clinically relevant for tailoring drug treatments or psychotherapeutic approaches to specific needs. Future perspectives might include the use of these factors to select homogeneous subgroups of patients for brain-imaging studies and to contribute to elucidating the causes and pathophysiology of panic disorder at molecular level.
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Affiliation(s)
- P Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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40
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Corcos M, Speranza M, Stephan P, Lang F, Venisse JL, Loas G, Perez-Diaz F, Verrier A, Nezelof S, Bizouard P, Jeammet P. Risk Factors for Addictive Disorders: A Discriminant Analysis on 374 Addicted and 513 Nonpsychiatric Participants. Psychol Rep 2008; 102:435-49. [DOI: 10.2466/pr0.102.2.435-449] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many common risk factors have been described in addictive disorders. Little is known about factors' respective contributions to discrimination of addicted and nonaddicted participants. Two large samples were compared including 513 nonpsychiatric participants and 374 addicted participants meeting the DSM–IV criteria for eating disorders, alcohol, or substance dependence. Twenty-six risk factors were assessed by interview or self-rating scales. A discriminant analysis determined the respective weight of each risk factor. One discriminant function emerged and characterized a depressive dimension. The results suggest that the different risk factors described in addiction could be related to a depressive dimension.
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Affiliation(s)
- Maurice Corcos
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris
| | - Mario Speranza
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris
| | - Philippe Stephan
- University Department of Child and Adolescent Psychiatry, Lausanne, Switzerland
| | - François Lang
- University Department of Psychiatry, Saint Etienne, Prance
| | | | - Gwenolé Loas
- University Department of Psychiatry Hôpital Pinel
| | | | | | | | - Paul Bizouard
- University Department of Psychiatry Besançon, France
| | - Philippe Jeammet
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris, Institut National de la Santé et de la Recherche, Médicale (INSERM)
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41
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Chelli B, Pini S, Abelli M, Cardini A, Lari L, Muti M, Gesi C, Cassano GB, Lucacchini A, Martini C. Platelet 18 kDa Translocator Protein density is reduced in depressed patients with adult separation anxiety. Eur Neuropsychopharmacol 2008; 18:249-54. [PMID: 18054208 DOI: 10.1016/j.euroneuro.2007.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/23/2007] [Accepted: 10/01/2007] [Indexed: 11/24/2022]
Abstract
RATIONALE Recent studies indicate that Adult Separation Anxiety Disorder (ASAD) may represent a discrete diagnostic entity worthy of attention. Adults with separation anxiety report extreme anxiety and fear about separations from major attachment figures (partner, children or parents). These symptoms affect individual's behavior, lead to severe impairment in social relationships and are not better accounted for by the presence of agoraphobia. In a previous study we found platelet expression reduction of the 18 kDa Translocator Protein (TSPO) (the new nomenclature for the peripheral-type benzodiazepine receptor) in patients with panic disorder who also fulfilled the diagnostic criteria for ASAD. OBJECTIVES To explore whether separation anxiety might be a factor differentiating TSPO expression in a sample of patients with major depression. METHODS The equilibrium binding parameters of the specific TSPO ligand [3H]PK 11195 were estimated on platelet membranes from 40 adult outpatients with DSM-IV diagnosis of MDD, with or without separation anxiety symptoms, and 20 healthy controls. Patients were assessed by SCID-I, HAM-D, the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS-A) and the Adult Separation Anxiety Self-report Checklist (ASA-27). RESULTS A significant reduction of platelet TSPO density mean value was found in depressed patients with associated ASAD symptoms, while no significant differences were found between depressed patients without ASAD and the control group. Individual TSPO density values were significantly and negatively correlated with both SCI-SAS-A and ASA-27 total scores, but not with HAM-D total score or HAM-D anxiety/somatization factor score. CONCLUSIONS The reduction of platelet TSPO density in our sample of patients with depression was specifically related to the presence of ASAD. These data suggest that TSPO expression evaluation is a useful biological marker of ASAD.
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Affiliation(s)
- Beatrice Chelli
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Via Bonanno 6, 56100 Pisa, Italy
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42
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Kirsten LT, Grenyer BFS, Wagner R, Manicavasagar V. Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders. COUNSELLING & PSYCHOTHERAPY RESEARCH 2008. [DOI: 10.1080/14733140801892620] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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43
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Silove D, Slade T, Marnane C, Wagner R, Brooks R, Manicavasagar V. Separation anxiety in adulthood: dimensional or categorical? Compr Psychiatry 2007; 48:546-53. [PMID: 17954140 DOI: 10.1016/j.comppsych.2007.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 05/21/2007] [Indexed: 01/22/2023] Open
Abstract
Recent evidence suggests that a clinical form of separation anxiety can be observed in adults. An important question of relevance to defining the construct of adult separation anxiety is whether there is discontinuity between that constellation and other forms of anxiety. In the present study, 2 taxometric procedures - Mean Above Minus Below a Cut and Maximum Eigenvalue - were used to assess whether adult separation anxiety conformed primarily to a categorical or a dimensional pattern. The data were derived from a separation anxiety symptom questionnaire completed by 840 consecutive adult patients attending an anxiety disorders clinic. Although some results of the analysis were ambiguous, the overall findings suggested a dimensional pattern. The relevance of the finding to the status of adult separation anxiety is discussed.
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Randwick NSW, 2031, Australia.
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44
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Seligman LD, Wuyek LA. Correlates of separation anxiety symptoms among first-semester college students: an exploratory study. THE JOURNAL OF PSYCHOLOGY 2007; 141:135-45. [PMID: 17479584 DOI: 10.3200/jrlp.141.2.135-146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Separation anxiety disorder (SAD) is rarely considered in college students with anxious symptomatology, but a growing body of evidence suggests that its symptoms are experienced by a significant number of young adults. The authors examined separation anxiety symptoms in a group of first-semester college students living on campus and experiencing extended separation from significant others, generally for the first time. They examined prevalence of separation anxiety symptoms among college students and the relationship between separation anxiety symptoms and students' educational decisions and performance. Results showed that 21% of first-semester college students reported symptoms of separation anxiety. In addition, separation anxiety symptoms were related to childhood SAD, panic attacks, and educational decisions. Results suggest that SAD may be a valid diagnosis in college students and may impact their educational choices and experiences.
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Affiliation(s)
- Laura D Seligman
- Center for the Study of Anxiety Disorders and Depression, Department of Psychology, The University of Toledo, Toledo, OH 43606, USA.
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45
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Annicchino AGPDS, Matos EGD. Ansiedade de separação em adultos com transtorno de pânico: um tratamento cognitivo-comportamental. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2007. [DOI: 10.1590/s0103-166x2007000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo foi desenvolvido com pacientes adultos, ambulatoriais, com transtorno de pânico segundo os critérios do Manual de Estatísticas e Diagnósticos-IV. O objetivo foi avaliar a incidência e a severidade de sintomas de ansiedade de separação e o efeito da terapia cognitivo-comportamental sobre eles. O processo psicoterapêutico baseou-se no manual "Vencendo o Pânico". Foram também utilizados Inventário Beck de Depressão, Escala Sheehan de Ansiedade, e o Mood Anxiety Spectrum Project. Os resultados demonstraram a minimização ou o desaparecimento dos sintomas de ansiedade de separação após o tratamento, bem como o decréscimo nos graus de ansiedade e depressão. Pode-se afirmar, portanto, que há sintomas da ansiedade de separação no adulto, e que a terapia cognitivo-comportamental apresentase como eficaz tanto quanto no tratamento do transtorno de pânico, provavelmente, por serem os mesmos sistemas que fundamentam os pensamentos em ambos os casos.
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46
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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. [PMID: 16741209 DOI: 10.1176/appi.ajp.163.6.1074] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite its inclusion in DSM-IV, little is known about the prevalence or correlates of adult separation anxiety disorder or its relationship to the childhood disorder. Results of the first epidemiological study of adult separation anxiety disorder, to the authors' knowledge, and its relationship to childhood separation anxiety disorder are presented. METHOD Data were from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of U.S. households. A fully structured, lay-administered diagnostic interview assessed a wide range of DSM-IV disorders, including separation anxiety disorder. No independent clinical validation was obtained of the assessment. RESULTS Lifetime prevalence estimates of childhood and adult separation anxiety disorders were 4.1% and 6.6%, respectively. Approximately one-third of the respondents who were classified as childhood cases (36.1%) had an illness that persisted into adulthood, although the majority classified as adult cases (77.5%) had first onset in adulthood. The assessment of separation anxiety disorder in the NCS-R was comorbid with other NCS-R or DSM-IV disorders and associated with severe role impairment in roughly half of the comorbid cases and one-fourth of the pure cases. The majority of people with estimated adult separation anxiety disorder are untreated, even though many obtain treatment for comorbid conditions. CONCLUSIONS Criteria for adult separation anxiety disorder should be refined in future editions of DSM because the disorder is likely to be much more common in adults than previously recognized. Research is needed to develop and evaluate treatments that take into consideration its high comorbidity with other DSM-IV disorders.
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Affiliation(s)
- Katherine Shear
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA.
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47
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Troisi A, Di Lorenzo G, Alcini S, Nanni RC, Di Pasquale C, Siracusano A. Body dissatisfaction in women with eating disorders: relationship to early separation anxiety and insecure attachment. Psychosom Med 2006; 68:449-53. [PMID: 16738078 DOI: 10.1097/01.psy.0000204923.09390.5b] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It has been suggested that an insecure style of attachment may be one of the factors implicated in the etiology of body dissatisfaction, which, in turn, is a risk factor for eating disorders. The present study analyzed the association among early separation anxiety, insecure attachment, and body dissatisfaction in a clinical sample of 96 women with anorexia nervosa (n = 31) or bulimia nervosa (n = 65). METHODS Body dissatisfaction was measured using the Body Shape Questionnaire (BSQ), early separation anxiety was measured using the Separation Anxiety Symptom Inventory (SASI), and adult attachment style was measured using the Attachment Style Questionnaire (ASQ). RESULTS In both anorectic and bulimic women, BSQ scores were strongly correlated with SASI and ASQ scores. In a hierarchical regression model controlling for the confounding effects of body mass index and depressive symptoms, early separation anxiety and preoccupied attachment emerged as significant predictors of high levels of body dissatisfaction. CONCLUSIONS Based on the cross-sectional findings of this study, insecure attachment appears to be a consistent correlate of negative body image evaluations in women with either anorexia nervosa or bulimia nervosa. If future prospective studies will confirm that an insecure style of attachment plays a role in promoting the development of body dissatisfaction, prevention and treatment of disordered eating pathology might be enhanced by focusing greater attention on attachment relationships.
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Affiliation(s)
- Alfonso Troisi
- Department of Neuroscience, University of Rome Tor Vergata, via Guattani 14, 00161 Rome, Italy.
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48
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Pini S, Abelli M, Mauri M, Muti M, Iazzetta P, Banti S, Cassano GB. Clinical correlates and significance of separation anxiety in patients with bipolar disorder. Bipolar Disord 2005; 7:370-6. [PMID: 16026490 DOI: 10.1111/j.1399-5618.2005.00216.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate frequency and severity of separation anxiety (SA) symptoms, as well as frequency of DSM-IV diagnosis of childhood separation anxiety disorder (CSAD) and adult separation anxiety disorder (ASAD), in a group of patients with bipolar disorder (BD) when compared with patients with panic disorder (PD) or major depression (MDD) and to a control group of healthy individuals (HC). METHODS Outpatients with, respectively, bipolar I disorder (BD), PD, MDD and a group of individuals with no psychiatric diagnoses (HC) were assessed for diagnosis by the SCID-I and for SA by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), the Separation Anxiety Symptoms Inventory (SASI) and the Adult Separation Anxiety Checklist (ASA-CL). RESULTS Thirty-one patients with BD without comorbid PD (BD-PD), 22 with BD with comorbid PD (BD + PD), 24 with PD, 20 with MDD and 15 HC were included in the analyses. As to childhood SA, the BD-PD group had higher scores than PD group and HC. The BD + PD group had higher scores than the PD group, MDD group and HC. As to adulthood SA, the BD-PD group had higher scores than HC on both SCI-SAS and Adult Separation Anxiety Questionnaire (ASA-27). The BD + PD had higher scores on both scales than BD-PD, PD group, MDD group and HC. The PD group and MDD group had higher scores than HC on the ASA-27. Adult SA symptoms were significantly associated with an earlier age at onset of BD. CONCLUSIONS This is the first study, to our knowledge, exploring the frequency and severity of SA symptoms during childhood and adulthood in a sample of bipolar patients in comparison to subjects with other anxiety and mood disorders. Our data appear to be preliminary grounds for investigating further the possibility that SA may deserve greater recognition in adults with BD.
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Affiliation(s)
- Stefano Pini
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, School of Medicine, University of Pisa, Pisa, Italy.
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49
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Manicavasagar V, Silove D, Wagner R, Drobny J. A self-report questionnaire for measuring separation anxiety in adulthood. Compr Psychiatry 2003; 44:146-53. [PMID: 12658624 DOI: 10.1053/comp.2003.50024] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Little attention has been given to measuring symptoms of separation anxiety (SA) in adulthood. The development of an Adult Separation Anxiety Questionnaire (ASA-27) is described and compared to a previously derived Adult Separation Anxiety Semistructured Interview (ASA-SI). Principal components analysis revealed a coherent construct of SA with high internal consistency (Cronbach's alpha =.95) and sound test-retest reliability (r =.86; P <.001). A receiver operation characteristic (ROC) analysis against the semistructured interview yielded a high area under the curve index (AUC = 0.9) suggesting that the questionnaire is an adequate alternative measure of SA. Results of this study support previous research suggesting that a construct of SA may be readily measured in adults.
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Affiliation(s)
- V Manicavasagar
- Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales at Liverpool Hospital, Liverpool, NSW, Australia
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Silove D, Manicavasagar V, Drobny J. Associations between juvenile and adult forms of separation anxiety disorder: a study of adult volunteers with histories of school refusal. J Nerv Ment Dis 2002; 190:413-5. [PMID: 12080215 DOI: 10.1097/00005053-200206000-00013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, Sydney, Australia
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