Separation-related Problems and Their Interaction with Physical Disease

The condition of separation-related problems (SRPs) is common in companion dogs and clinicians should be comfortable diagnosing it. There are numerous diagnoses related to physical disease that have clinical signs similar to SRP, that exacerbate SRP, or may cause regression in treatment of SRP. Common examples include conditions affecting the following systems: musculoskeletal, neurologic, gastrointestinal, and dermatologic. Therefore, it is important for clinicians to rule out causes of physical disease and address them accordingly. The signalment of the patient, medications they are receiving, and other behavioral comorbidities should also be considered.

A LONGITUDINAL STUDY OF CHILDHOOD SEPARATION ANXIETY DISORDER AND ITS IMPLICATIONS FOR ADOLESCENT PSYCHOPATHOLOGY

A prevalent psychiatric disorder called Child Separation Anxiety Disorder (SAD) is characterized by extreme discomfort when a child gets separated from their primary carers. While SAD's quick consequences on kids are well-researched, its long-term implications for teenage psychopathology have received less attention. This longitudinal study aims to ascertain the connection between child SAD and future psychopathological consequences in adolescents. 500 adolescents were chosen as part of the adolescent depression project, and at the age of 17, we retrospectively evaluated past and present mental disorders. At ages 25 and 32, they conducted diagnostic evaluations of these people during adolescence while they continued to monitor them. Based on childhood/adolescent assessments, the participants were split into different groups: SAD (n=34), other forms of Anxiety (n=76), a control group with combined psychiatric conditions (n=205), and mentally sound control group (n=185). Statistics were evaluated by hierarchical multiple logistic regression after various illnesses and pertinent demographic variables were considered. It implies that SAD has a high risk (80.2%) of being a significant risk indicator for the emergence of mental illnesses in young adults. This study highlights the importance of early SAD management and therapy and the possible advantages of treating SAD in lowering the likelihood of developing other mental health problems in adolescence. It also emphasizes the value of continuous studies to comprehend these connections and enhance the effects on SAD sufferers' psychological well-being.

Hypothalamus-pituitary-adrenal axis imbalance and inflammation contribute to sex differences in separation- and restraint-induced depression

Whether social contact contributes to the underlying mechanisms of depression and the observed sex differences is unclear. In this study, we subjected young male and female mice to separation- and restraint-induced stress for 4 weeks and assessed behaviors, neurotransmitter levels, hormones, and inflammatory cytokines. Results showed that, compared with controls, male mice exposed to stress displayed significant decreases in body weight and sucrose preference after 1 week. In the fourth week, they exhibited a higher degree of anxiety (open field test) and depressive-like behavior (forced swim test). Moreover, the males showed significant decreases in monoamine neurotransmitters, including norepinephrine and dopamine in striatum, and an increase in pro-inflammatory cytokines, such as tumor necrosis factor α and interleukin 1β in serum. In contrast, females showed persistent loss of weight during stress and displayed significant decreases in sucrose preference after stress. Importantly, the females but not males showed activation of the hypothalamus-pituitary-adrenal (HPA) axis, with significantly higher levels adrenocorticotropic hormone. Additionally, mRNA level of c-fos and AVP showed there was significant interaction between stress and sex. Finally, we conclude that an imbalance of the HPA axis and inflammation might be important contributors to sex differences in separation/restraint-induced depressive behavior and that changes might be mediated by c-fos and AVP.

Ambiguous Loss in Transnational Families' Adolescents: An Exploratory Study in Ecuador

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent-child relationships characterized by ambiguity.

Content-Specific Interpretation Bias in Children with Varying Levels of Anxiety: The Role of Gender and Age

The current study examined whether children varying in their levels of social anxiety, separation anxiety and spider fear exhibit a negative interpretation bias specific for their fears. Furthermore, age and gender were assessed as moderators of this relation. Children (N = 603) of the age of 7-12 years were asked to solve ambiguous scenarios reflecting social threat, separation threat or spider threat. Children's levels of anxiety were assessed with self-report questionnaires. Results indicated that children scoring higher on self-reported social anxiety, separation anxiety or spider fear, displayed a negative interpretation bias for the threat-scenarios pertaining to their specific anxiety or fear, even after controlling for comorbidity with other anxiety subtypes. Contrary to our hypotheses, we did not find moderating effects of age or gender. These results indicate that even in a community sample, content-specificity of negative interpretation biases is present.

Investigation of the Fear of 7-18-Year-Old Hospitalized Children for Illness and Hospital

Illness and hospitalization are conditions leading to negative effects in children's lives regardless of their age. This study was performed descriptively in order to examine the fears of hospitalized children for illness and hospital. The study was descriptive and sectional and performed in Karabük University (Turkey) Training and Research Hospital between February 1 and May 1, 2015. Sample of the study was composed of 144 children who were hospitalized due to an acute illness and their parents who approved to participate in the study. Participant information form and an information form that was prepared to evaluate the fears of children for illness and hospital were used as data collection tools. Data were collected by face-to-face interview technique. Statistical analyses were used to assess data. It was found that 56.2% of children in the study were males and were between 7 and 10 years of age; 42.4% were scared of getting illness. 39.5% of 86 children who were previously hospitalized have stated that they experienced fear due to hospitalization; injections were in the first place among causes of fear by 64.7%. When the causes of children's fear for illness and hospital were examined, it was determined that "undergoing an operation (3.21 ± 1.13)," "staying away from the family during hospitalization (3.11 ± 0.96)" and "worrying the family when he/she gets an illness (3.02 ± 1.05)" were in the first three ones. When the relationship between some characteristics of the children and their parents and children's status of fear for illness was investigated, it was detected that there was a significant difference between their previous fear of hospitalization and their current status of fear for getting illness (p = 0.003). It was observed that children in the study experienced fear for illness and hospitalization and the percentage of children with fears was found to be high. It was also determined that undergoing an operation, staying away from the family during hospitalization and worrying the family when he/she gets an illness were among the first causes of their fears.

Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Separation

OBJECTIVES

In light of the current U.S. family separation crisis, there is growing attention to Childhood Traumatic Separation, defined here as a significant traumatic stress reaction to a familial separation that the child experiences as traumatic. When living in a family setting, Childhood Traumatic Separation may interfere with the child's relationships with the current caregiver(s). Effective treatments for Childhood Traumatic Grief can be modified to address Childhood Traumatic Separation. This article describes current applications of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Childhood Traumatic Separation.

METHODS

Using two composite clinical cases, TF-CBT applications for Childhood Traumatic Separation are described. These include: (1) implementing the safety component first; (2) tailoring coping skills to address the uncertainty of Childhood Traumatic Separation; (3) integrating past traumas into trauma narration and processing of the traumatic familial separation; (4) providing Childhood Traumatic Separation-focused components to address challenges of committing to new relationships while retaining connections to the separated parent; and (5) addressing role changes.

RESULTS

These modifications have been implemented for many youth with Childhood Traumatic Separation and have anecdotally resulted in positive outcomes. Research is needed to document their effectiveness.

CONCLUSIONS

The above practical strategies can be incorporated into TF-CBT to effectively treat children with Traumatic Separation.

PRACTICAL IMPLICATIONS

Practical strategies include starting with safety strategies; tailoring skills components to address the ongoing uncertainty of traumatic separation; integrating past traumas into trauma narration and processing of traumatic separation; providing traumatic separation-focused components to balance the challenges of committing to new relationships with retaining connections to the separation parent; and addressing role changes. Through these strategies therapists can successfully apply TF-CBT for Childhood Traumatic Separation.

Transgenerational improvements following child anxiety treatment: An exploratory examination

Background

The present study conducted secondary analyses of a randomized controlled trial to examine the transgenerational relationship between cognitive-behavioral therapy for child Separation Anxiety Disorder (SepAD) and the mental health of parents. Symptoms of anxiety and depression were compared before and after child treatment between parents of children treated for SepAD and parents of healthy children, who did not receive any treatment.

Methods

One hundred and seven children aged 4–14 years with SepAD received one of two cognitive behavioral treatment programs for SepAD (TAFF; TrennungsAngstprogramm Für Familien; English: Separation Anxiety Family Therapy or CC; Coping Cat). Their parents (N = 189; 101 mothers and 88 fathers) were assessed at baseline and post-treatment for symptoms of separation anxiety, general anxiety, and depression. A comparison group of parents (N = 74; 42 mothers and 32 fathers) of 45 children without SepAD, who did not receive any treatment, were also assessed.

Results

Results indicated a significant interaction effect between group and time on mothers’ depression and separation anxiety, indicating that maternal symptoms of depression and separation anxiety improved in the child treatment condition in comparison to mothers of healthy children. There was no significant improvement in parental pathology levels among fathers of children treated for SepAD.

Conclusions

Treatment for child SepAD may have subsequent positive effects on mothers’ own levels of separation anxiety and depression, though the mechanisms are yet unknown. Future studies are needed that test the transgenerational effect of child SepAD treatment on parental mental health as the primary research question.

Anxiety, happiness and self-esteem of western Chinese left-behind children

China's unprecedented economic boom has led a massive number of children left-behind by their peasant parents who have immigrated to urban areas in search of work. In current study, we explored how being left behind is associated with children's positive emotions and negative psychological traits by examining the differences in levels of happiness, self-esteem and anxiety between left-behind children (LBC) and non-LBC. A total of 448 students (aged 7-16) from three schools in Sichuan Province in China responded to the questionnaire. Fourteen teachers of LBC were invited to one-to-one interviews for in depth responses to LBC's behaviors and psychological well-being. The results revealed that non-LBC showed a higher level of happiness (t=-0.21, df=258, p<0.01) and a lower level of anxiety (t=1.41, df=406, p<0.05) than LBC children. Among LBC, low grade children (primary school grades 3 and 4) reported a lower level of happiness (t=-0.73, df=216, p<0.01) and self-esteem (t=-0.24, df=191, p<0.01) than their older counterparts (primary school grades 5 and 6). The teachers' accounts confirmed the statistical results that LBC suffered from the deprivation of parental care. According to the teachers, as LBC grew older, they developed an understanding of their own circumstances and came to appreciate their parents' decisions. With appropriate and adequate support provided to both LBC and the caretakers around them such as relatives and teachers, it may be possible to reduce the adverse impacts of parental deprivation on LBC.

Progressive habituation to separation alleviates the negative effects of weaning in the mother and foal

Early and definitive separation between offspring and their mothers has negative consequences on behavioral and physiological responses. This study compared sudden and definitive weaning (Sudd group, N = 16) and weaning involving progressive habituation to separation using a fence line during the month preceding definitive separation (Prog group, N = 18). The impact of these two methods was assessed in both foals and their mothers through behavioral and biological parameters, including salivary cortisol, telomere length and blood transcriptomes. On the day of definitive separation, Prog foals neighed and trotted less and presented lower cortisol levels than Sudd foals. The weaning type also acted on the foals' personality development; Prog foals became more curious, less fearful and less gregarious than Sudd foals, and the effects remained visible for at least 3 months. In principal component analysis, the Sudd and Prog groups were well separated along a factor where fear, reactivity and gregariousness correlated with high cortisol levels, but curiosity was associated with an increased telomere length and higher expression of genes involved in mitochondrial functions. Progressive weaning was also beneficial in mares. Principal component analysis showed that most Sudd group mares had higher cortisol levels and displayed more alert postures, neighs and activity on the day of weaning, indicating higher stress levels, while Prog mares had profiles that were characterized by more time spent resting on the day of weaning and longer telomere lengths. In conclusion, this study shows that progressive habituation to separation alleviates the negative effect of definitive weaning on both the mother and her young compared to sudden separation.

Interaction between the Opioid Receptor OPRM1 Gene and Mother-Child Language Style Matching Prospectively Predicts Children's Separation Anxiety Disorder Symptoms

Recent research suggests that lower mother-child language style matching (LSM) is associated with greater physiological reactivity and insecure attachment in school-aged children, but to date no studies have explored this measure of parent-child behavioral matching for its association with children's anxiety symptoms, a well-known correlate of attachment insecurity and heightened physiological reactivity. There is also considerable evidence of genetic risk for anxiety, including possession of the OPRM1 minor allele, 118G. In the current study (N = 44), we expand upon what is known about children's genetic and environmental risk for anxiety by examining the unique and interactive effects of mother-child LSM and the OPRM1 polymorphism A118G on school-aged children's separation anxiety disorder (SAD) symptoms. SAD symptoms were measured both concurrently with LSM and OPRM1 genotype and two years later through self-report. No significant associations emerged between LSM or OPRM1 and concurrent Time 1 SAD symptoms. However, lower LSM and 118G minor allele possession were both associated with greater SAD symptoms at Time 2; further, the interaction between LSM and OPRM1 genotype significantly predicted SAD symptoms beyond the main effects of the two variables. Possession of the minor allele was only associated with greater SAD symptoms among children in low LSM dyads, whereas children with the minor allele in high LSM dyads showed non-significantly lower SAD symptoms. These findings and a proportion affected analysis provide support for a differential susceptibility model of gene by environment interactions for the OPRM1 gene. We discuss the implications for predicting children's separation anxiety across development.

Mind and mourning: The primacy of "we" in complicated grief

Standard models of complicated grief rely on a self-other divided mind that reflects the physical separateness of individuals. In these models, grief persists for those mourners who cannot reorganize self-and-other mental representations or adapt to identity changes after loss. However, advances in cognitive science indicate that relationships are often processed via distributed social-cognitive coding whereby individuals together form a psychologically extended common mind. I propose a novel "we" hypothesis in which shared representations, rather than self-other distinctions, shape the mind for a subgroup of mourners with complicated grief. Recognition of "we-experiences" in mourning can enhance grief theory, research, and practice.

A randomized interventional study to promote milk secretion during mother-baby separation based on the health belief model: A consort compliant

BACKGROUND

Breast milk is the most important nutrition for premature babies, but mothers of premature infants have difficulty in initiating and sustaining lactation. Breastfeeding infants who are separated with mothers have decreased morbidity. Nevertheless, such decrease is limited due to insufficient milk supply resulting from mother-baby separation during lac.

OBJECTIVE

To evaluate the effect of intervention methods based on the health belief model on promoting the secretion of milk among mothers who were separated with their babies.

METHODS

In this prospective, randomized controlled clinical trial, we enrolled 260 separation mothers between September 26, 2016 and March 7, 2017, in a 3rd-grade women and children hospital of Chengdu. The mothers all had cesarean delivery and were randomized into 2 groups: the intervention group (educated by investigators based on the health belief) and the control group (routinely educated by obstetric nurses). Data on the onset of lactation and the milk volume during 3 days postpartum were collected. The breast swelling rate within 3 days postpartum and the exclusive breastfeeding rate at 42 days postpartum were compared. The psychologic scores of separation maternal in both groups were assessed with State-Trait Anxiety Inventory at the 3rd day postpartum.

RESULTS

Compared with the control group, the intervention group had significantly earlier lactation time (P < .01), significantly larger milk volume (P < .01) during 24, 24 to 48, and 48 to 72 hours, and significantly lower psychologic scores (P < .01) at the 3rd-day postpartum.The onset of lactation among mothers who initiated milk expression within 1 hour after childbirth were earlier than those who initiated milk expression between 1 and 6 hours (P < .01); the milk volume within 24-hour postpartum did not differ significantly between the 2 groups (P > .05). However, the milk volume of the early-expression group (<1 hour) was significantly higher than that of the late-expression group (1-6 hours) during 24 to 48 and 48 to72 hours (P < .05).The breast swelling rate of separation mothers within 3 days postpartum in the intervention group was lower than that in the control group (P < .05). The exclusive breastfeeding rate of mothers in the intervention group was significantly higher than that in the control group (59% vs 35%; P < .01) at 42 days postpartum.

CONCLUSION

Nursing intervention based on the health belief model can stimulate milk secretion in mothers who were separated with their babies.

Persistent complex bereavement symptoms explain impairments above depression, posttraumatic stress, and separation anxiety: an incremental validity study

The present study examined the incremental validity of persistent complex bereavement disorder (PCBD) symptoms using an on-line survey of 255 bereaved college students. A series of hierarchical multiple regression analyses examined the extent to which PCBD symptoms explained unique variance in different domains of life impairment, beyond symptoms of depression, posttraumatic stress, and separation anxiety. The results supported the incremental validity of PCBD symptoms for fear of future losses, sleep impairment, and work/social impairment. However, PCBD symptoms did not account for loneliness scores. These findings collectively support the validity and clinical utility of the DSM-5's PCBD construct.

Postnatal stress is associated with impaired fear conditioning and extinction, and heightened hippocampal fibroblast growth factor 2, in mother rats

Rats exposed to early-life maternal separation (MS) exhibit later alterations in fear conditioning and impairments in fear extinction. As MS creates long-lasting anxiety in the mother, the present study assessed the influence of MS on fear conditioning and extinction in mother rats. It also examined whether estrous cycle effects on extinction, which are robust in nulliparous rats, but abolished in primiparous rats, re-emerge after MS. Following parturition, pups were removed from their mothers for 3 h daily from postpartum day 2-14 (MS), or remained housed with their mothers (standard reared condition, SR). Pups were weaned at postpartum day 24, and three months later, mothers received fear conditioning, extinction training, and test for extinction recall over three days. Extinction training took place during Proestrus (high estradiol and progesterone) or Metestrus (low estradiol and progesterone). Similar to past findings in non-stressed mothers, estrous cycle was not associated with conditioned fear expression (indexed by fear responses at the start of extinction training) or extinction recall in either MS or SR mothers. However, MS mothers exhibited weaker conditioned fear expression and impaired extinction recall, relative to SR mothers. Hippocampal fibroblast growth factor-2, a neurotrophin involved in stress regulation and fear expression, was elevated in MS relative to SR mothers. These results indicate that postnatal stress has long-lasting consequences for neural and behavioral systems involved in fear learning and inhibition without altering the involvement of ovarian hormones in these processes.

Body Image Dissatisfaction and Anxiety Trajectories During Adolescence

The primary goal of this study was to examine the associations between baseline body image dissatisfaction (BID) and subsequent anxiety trajectories in a diverse, community sample of adolescent girls and boys. Participants were 581 adolescents (baseline age: M = 16.1, SD = 0.7; 58% female; 65% non-Hispanic White) from U.S. public high schools. Self-report questionnaires were administered during school at 3 annual assessment waves. Latent growth curve modeling examined the association between baseline BID and growth factors of anxiety disorder symptom trajectories. Covariates included baseline gender, age, race/ethnicity, parental education attainment, body mass index standard scores, and depressive symptoms. Higher BID at baseline was significantly associated with higher initial symptoms of generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and significant school avoidance (SSA; ps = .001-.04) but was unrelated to initial separation anxiety disorder (SEP) symptoms (p = .27). Higher baseline BID also was associated with attenuated decreases in SAD symptoms across time (p = .001). Among adolescents with low baseline anxiety symptoms only, higher BID was associated with more attenuated decreases in SAD symptoms (p = .01) and greater increases in PD symptoms (p = .02). BID was unrelated to changes in GAD, SEP, and SSA symptoms (ps = .11-.94). Findings suggest that BID is associated with concurrent symptoms of multiple anxiety disorders and may have a prospective link to SAD and PD symptoms during adolescence. As such, assessing body image issues may be important to assess when identifying adolescents at risk for exacerbated SAD and PD symptoms.

Experience of Child-Parent Separation and Later Risk of Violent Criminality

INTRODUCTION

Separation from a parent during childhood has been linked with heightened longer-term violence risk, but it remains unclear how this relationship varies by gender, separation subgroup, and age at separation. This phenomenon was investigated by examining a wide array of child-parent separation scenarios.

METHODS

National cohort study including individuals born in Denmark, 1971-1997 (N=1,346,772). Child-parent separation status was ascertained each year from birth to 15th birthday, using residential addresses from the Danish register. Members were followed up from their 15th birthday until the date of first violent offense conviction, or December 31, 2012. Incidence rate ratios were estimated using survival analyses techniques. Analyses were conducted during 2016-2017.

RESULTS

Separation from a parent during childhood was associated with elevated risk for subsequent violent offending versus those who lived continuously with both parents. These links were attenuated but persisted after adjustment for parental SES. Associations were stronger for paternal than for maternal separation at least up until mid-childhood and rose with the number of separations. Separation from a father for the first time at a younger age was associated with higher risks than if paternal separation first occurred at an older age, but there was little variation in risk associated with age at first maternal separation. Increasing risks were linked with rising age at first separation from both parents.

CONCLUSIONS

Violence prevention should include strategies to tackle a range of correlated familial adversities, with promoting a stable home environment being one salient aspect.

Newcomer immigrant adolescents: A mixed-methods examination of family stressors and school outcomes

Family stressors predict negative psychological outcomes for immigrant adolescents, yet little is known about how such stressors interact to predict school outcomes. The purpose of this study was to explore the interactive role of family stressors on school outcomes for newcomer adolescent immigrants. Using a convergent parallel mixed-methods design, we used quantitative methods to explore interactions between family separation, acculturative family conflict, and family life events to predict 2 school outcomes, academic achievement (via grade point average [GPA]), and externalizing problems (student- and teacher-reported). The sample included 189 newcomer immigrant public high school students from 34 countries of origin. Quantitative measures included the Multicultural Events Scale for Adolescents, Family Conflicts Scale, and the Achenbach System of Empirically Based Assessment (ASEBA). Qualitative data were collected through a semi-structured interview. Quantitative results found that more family life events were associated with lower GPA, but this association was weaker for participants who had been separated from their parents. More family conflict was associated with more externalizing symptoms (both youth- and teacher-reported). However, the association between family conflict and teacher-reported externalizing symptoms was found only among participants reporting a greater than average number of life events. Qualitative results show that separation from extended family networks was among the most stressful of experiences, and demonstrate the highly complex nature of each family stressor domain. At a time when immigration is rapidly changing our school system, a better understanding of early risk factors for new immigrants can help teachers, administrators, and mental health practitioners to identify students with greatest need to foster behavioral, academic, and emotional well-being. (PsycINFO Database Record

[Examination of Adult Separation Anxiety and Bonding Styles in Patients with Panic Disorder Who Applied to a Psychiatric Clinic]

INTRODUCTION

The attachment processes give us a theoretical frame work to understand the psychopathological development. Unsafe attachment type is often associated with the emergence of psychopathology in the later periods of life.

METHOD

This study includes 65 patients from psychiatry outpatient clinic with a diagnosis of panic disorder and 65 healthy volunteers as a control group. In order to determine clinical status and disease severity of patients with panic disorder according to SCID-I (Structured Clinical Interview for DSM Disorders-I) Panic-Agoraphobia Scale, Adults Separation Anxiety Scale, Relationship Scale Questionnaire were used.

RESULTS

Separation anxiety levels showed statistically significant difference among panic disorder group and control group. According to means of attachment style solely obsessive sub-dimension showed statistical significance difference among the two groups. In panic disorder group separation anxiety showed significant difference according to gender and the presence of agoraphobia. When attachment styles of patients with an early parent loss or divorce of parents assessed anxious and obsessive sub-dimensions the difference were found to be statistically significant.

CONCLUSION

High Comorbidity of panic disorder (dominantly coexisting with agoraphobia) and adult separation anxiety was observed. This comorbidity was even higher in females. In both groups obsessive attachment style was the highest among the attachment styles. In patients with panic disorder there was no significant correlation between adult separation anxiety and/or existence of agoraphobia and attachment styles. Coexistence of adult separation anxiety and panic disorder was found to result in higher depression comorbidity rates.

Separation anxiety among birth-assigned male children in a specialty gender identity service

Previous research suggested that separation anxiety disorder (SAD) is overrepresented among birth-assigned male children clinic-referred for gender dysphoria (GD). The present study examined maternally reported separation anxiety of birth-assigned male children assessed in a specialty gender identity service (N = 360). SAD was determined in relation to DSM-III and DSM-IV criteria, respectively. A dimensional metric of separation anxiety was examined in relation to several additional factors: age, ethnicity, parental marital status and social class, IQ, gender nonconformity, behavioral and emotional problems, and poor peer relations. When defined in a liberal fashion, 55.8% were classified as having SAD. When using a more conservative criterion, 5.3% were classified as having SAD, which was significantly greater than the estimated general population prevalence for boys, but not for girls. Dimensionally, separation anxiety was associated with having parents who were not married or cohabitating as well as with elevations in gender nonconformity; however, the association with gender nonconformity was no longer significant when statistically controlling for internalizing problems. Thus, SAD appears to be common among birth-assigned males clinic-referred for GD when defined in a liberal fashion, and more common than in boys, but not girls, from the general population even when more stringent criteria were applied. Also, the degree of separation anxiety appears to be linked to generic risk factors (i.e., parental marital status, internalizing problems). As such, although separation anxiety is common among birth-assigned male children clinic-referred for GD, it seems unlikely to hold unique significance for this population based on the current data.

Thinking with, and about, patients too scared to think: Can non‐interpretive maneuvers stimulate reflective thought?

Patients incapable of higher-order (symbolic) thinking can often not tolerate evidence of the analyst's separate existence, particularly when that "otherness" becomes evident in the process of the analyst's reflecting upon and interpreting how the patient experiences or represents the analyst. The patient's intolerance of the analyst's efforts to think (reflect upon and interpret) renders the usual psychoanalytic maneuvers employed to stimulate reflective thought ineffective with such patients. Such patients have to learn to tolerate multiple perspectives before they can allow the analyst, or themselves, to think in the other's presence. The author presents two clinical vignettes that illustrate how the analyst's efforts to think about the patient were experienced by the patient as both intolerably distancing and as rejecting of an aspect of the patient's subjective reality. Working psychoanalytically with such patients requires the analyst to forego the use of narrow interpretations that elucidate unconscious meanings and motives in favor of alternate technical maneuvers capable of facilitating the development of symbolic thinking and reflective thought (insightfulness). These maneuvers include a demonstration of the analyst's willingness and ability to withstand (rather than "interpret away") how he is being psychically represented by the patient, without becoming destroyed by, or lost within, the patient's characterization of him. Beside modeling a tolerance of alternate perspectives of one's self, other non-interpretive maneuvers that help facilitate the development of self-reflective thought include: stimulating the patient's curiosity about the workings of his own mind by identifying incompletely understood behaviors or reactions worthy of greater psychological understanding, and insinuating doubt about the adequacy of the patient's explanations of such phenomena.

Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD

Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.

Perceived Parental Styles and Adult Separation Anxiety

The Mediating Role of Interpersonal Cognitive Distortions OBJECTIVE: This study primarily aimed to determine whether perceived parental styles and interpersonal cognitive distortions are predictors of adult separation anxiety. Further, this study aimed to examine the mediating role of interpersonal cognitive distortions in the relationship between perceived over-permissive/boundless parental styles and adult separation anxiety in university students.

METHOD

This study included 444 university students (281 female (63,3%) and 163 male (36,7%) with a mean age of sample 21,02 years (SS = 1,70). The Demographic Information Form, Young Parenting Inventory, Interpersonal Cognitive Distortions Scale, and Adult Separation Anxiety Questionnaire were used.

RESULTS

The regression analyses revealed that the age of the participants and their percieved controlling/shaping father parenting style negatively predicted adult separation anxiety, while percieved over-permissive/boundless mother parenting style, exploitative/abusive and overprotective/anxious father parenting styles and the subscales of the interpersonal cognitive distortions scale positively predicted adult separation anxiety. As hypothesized, data from this study reveal that subscales of the interpersonal cognitive distortions scale play a full mediating role in the relationship between over-permissive/boundless parenting styles and adult separation anxiety.

CONCLUSION

Results indicate that the perceived over-permissive/boundless parenting style positively predicts adult separation anxiety symptoms by distorting interpersonal cognitions. Furthermore, the over-permissive parenting style and lack of boundaries and/or discipline lead to similar adverse effects as do authoritarian and normative parenting. To our knowledge, there are very few studies investigating adult separation anxiety symptoms in Turkey. Therefore, our current study provides practical information to mental health professionals regarding adult separation anxiety symptoms, which are likely to be accompanied by other psychological symptoms.

Is social dispersal stressful? A study in male crested macaques (Macaca nigra)

In gregarious species, dispersal events represent one of the most dramatic changes in social life and environment an animal will experience during life due to increased predation risk, aggression from unfamiliar conspecifics and the lack of social support. However, little is known about how individuals respond physiologically to dispersal and whether this process is stressful for the individuals involved. We therefore studied the physiological stress response during dispersal in the crested macaque, a primate species in which males often change groups. Over a period of 14months and 14 dispersal events in 4 groups, we determined faecal glucocorticoid metabolite (FGCM) levels during the process of immigration into a new group and examined a variety of factors (e.g. male age, rank achieved, number of males in the group) potentially affecting FGCM levels during this process. We found that FGCM levels were significantly elevated in the first few days upon immigration, after which levels returned quickly to baseline. FGCM response levels upon immigration were significantly and positively influenced by the number of males in the group. The rank a male achieved upon immigration, aggression received, as well as the proximity to other males did not significantly influence FGCM levels. Our data confirm previous findings on other species demonstrating that in crested macaques immigration into a new social group is associated with an acute endocrine stress response. However, given that stress hormone levels remained elevated only for a short period of time, we do not expect males to experience high physiological costs during immigration. Given our limited knowledge on the physiological responses to dispersal in animals, this study contributes to our understanding of dispersal more generally, and particularly inter-individual differences in the stress response and the potential physiological costs associated with these.

Recalled Separation Anxiety in Childhood in Istmo Zapotec Men, Women, and Muxes

The Istmo Zapotec are a pre-Columbian cultural group indigenous to the Istmo region of Oaxaca, Mexico. Istmo Zapotec recognize three genders: men, women, and muxes. Like Istmo Zapotec men, muxes are biological males. However, unlike Istmo Zapotec men, most muxes are exclusively androphilic (i.e., sexually attracted to adult males), relatively feminine, and routinely adopt the receptive role during anal intercourse. Furthermore, the Istmo Zapotec recognize two types of muxes: muxe gunaa, who resemble the transgender androphilic males that are common in many non-Western cultures, and muxe nguiiu, who resemble the cisgender androphilic males ("gay" men) common in Western cultures. Retrospective research conducted in Canada and Samoa demonstrates that cisgender and transgender androphilic males recall elevated indicators of childhood separation anxiety (i.e., feelings of distress related to separation from major attachment figures) when compared to males who are gynephilic (i.e., sexually attracted to adult females). The present study compared recalled indicators of childhood separation anxiety among Istmo Zapotec men, women, muxe gunaa, and muxe nguiiu (N = 454). Men recalled significantly lower levels of childhood separation anxiety compared to all other groups (all p < .042). No additional group differences were found. Our results are consistent with previous research conducted in Canada and Samoa, suggesting that elevated childhood separation anxiety is a developmental correlate of male androphilia that is cross-culturally universal. This research is also consistent with the conclusion that cisgender and transgender male androphiles share a common biological and developmental foundation despite being different in appearance.

Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates

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.

Maternal Encouragement to Approach Novelty: A Curvilinear Relation to Change in Anxiety for Inhibited Toddlers

Various parenting behaviors (e.g., protection, intrusiveness, sensitivity) have been shown to impact young children's anxiety development, particularly for temperamentally inhibited children. These behaviors have sometimes predicted both increases and decreases in anxiety in inhibited children, suggesting that linear relations may not adequately model their influence. In the current study, we proposed the dimension of encouragement to approach novelty to characterize parenting behavior ranging from very little encouragement (i.e., protective behavior) to very strong encouragement (i.e., intrusiveness), with gentle encouragement residing in the middle. In a sample of 110 toddlers (48 female, 62 male) and their mothers, the linear and curvilinear effects of this parenting dimension were investigated in relation to change in child separation anxiety and shyness from age 2 to age 3. Inhibited temperament was also investigated as a moderator. Encouragement to approach novelty displayed the hypothesized curvilinear relation to change in separation anxiety, but not shyness, at extreme levels of inhibited temperament. Toddlers increased in separation anxiety when mothers' encouragement resided at either extreme end of the continuum, with lower child anxiety occurring when mothers displayed behavior closer to the middle of the continuum. Implications for the study of parenting outcomes for inhibited toddlers are discussed.

Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents

OBJECTIVE

To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents.

METHODS

Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors.

RESULTS

Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties.

CONCLUSIONS

Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.

Differential effects of tianeptine on the dorsal hippocampal volume of rats submitted to maternal separation followed by chronic unpredictable stress in adulthood

Early maternal separation (MS) may produce lasting effects in the dorsal hippocampus (DH) that can change its response to chronic stress in adulthood. Chronic stress affects DH morphology and function, but tianeptine (an anti-depressant) can reverse the stress-induced morphological impairments. Morphologic alterations of hippocampus can affect contextual memory. Therefore, we evaluated the effect of tianeptine in MS and chronically stressed rats on: 1) volume of the DH and its areas using stereology and 2) hippocampal-dependent memory using a fear conditioning test. Male Wistar rats were subjected to daily MS for 4.5 h between postnatal days (PND) 1-21, or to animal facility rearing (AFR). Between (PND) days 50 and 74, rats were exposed to chronic unpredictable stress and were treated daily with tianeptine (10 mg/kg) or vehicle, providing eight groups: AFR-unstressed/vehicle (n = 5 for stereology, n = 18 for fear conditioning test); AFR unstressed/tianeptine (n = 6 and n = 10); AFR-chronic stress/vehicle (n = 6 and n = 14); AFR-chronic stress/tianeptine (n = 6 and n = 10), MS-unstressed/vehicle (n = 5 and n = 19), MS-unstressed/tianeptine (n = 6 and n = 10), MS-chronic stress/vehicle (n = 6 and n = 18), and MS-chronic stress/tianeptine (n = 6 and n = 10). MS-chronic stress/tianeptine rats showed a diminished CA1 area than the corresponding MS-unstressed/tianeptine rats. The combination of stressors produced a freezing response similar to those of the control group during postconditioning. During retrieval, MS led to a diminished freezing response compared to the AFR-unstressed groups. Tianeptine had no effect on freezing behavior. Our results show that tianeptine can affect the CA1 area volume differently depending on the nature and quantity of stressors but cannot alter freezing to context.

Associations among Homesickness, Anger, Anxiety, and Depression

The study investigated the association of homesickness with the related concepts of anxiety, depression, and anger. Two conceptualizations of homesickness were used, one considering homesickness as a state, characterized by severe symptoms of a depressive episode, and the other one as a self-reported tendency to experience homesickness in times of separation from the familiar environment. The latter conceptualization can rather be considered as an enduring trait and does not specifically refer to actual feelings of depression. We compared these two conceptualizations of homesickness in a random sample from the Dutch population ( n = 485) by assessing their uni- and multivariate associations with anger, anxiety, depression, and anxiety-sensitivity. Both conceptualizations of homesickness were associated with anxiety and depression and with the externalization of anger. No association was found between internalization of anger or control over internalized and externalized anger for either conceptualization of homesickness. The pattern of multivariate associations between homesickness and its emotional correlates was similar for both conceptualizations, although homesickness as a state appeared to have a stronger association with depression, whereas the tendency to develop homesickness showed a particularly strong association with anxiety. It is concluded that homesickness can be considered as a mixed emotion of anxiety and depression (“Cothymia”), but that depression is more characteristic of homesickness as a state, whereas anxiety is more important if homesickness is conceptualized as an enduring tendency.

The Functional Profiles of School Refusal Behavior

School refusal behavior is a common problem seen by mental health professionals and by educators but little consensus is available as to its classification, assessment, and treatment. This study assessed 143 youth with primary school refusal behavior and their parents to examine diagnoses that are most commonly associated with proposed functions of school refusal behavior. As expected, results indicated that great heterogeneity in diagnoses marks this population. In general, anxiety-related diagnoses were associated more with negatively reinforced school refusal behavior; separation anxiety disorder was associated more with attention-seeking behavior; and oppositional defiant disorder and conduct disorder were associated more with pursuit of tangible reinforcement outside of school. These results are discussed within the context of classification, assessment, and treatment of this population.

Separation-individuation processes of adolescent children of parents with multiple sclerosis

The current study examines the implications of responsibility and obligation on separationindividuation processes and the appearance of various symptoms of psychological distress in adolescent children of multiple sclerosis (MS) parents. We examined 56 children, between the ages of 10 and 18 years, each with a parent with MS. The results were compared to a control group of 156 children whose parents were healthy. Children's emotions were examined by means of two questionnaires: Youth Self Report (YSR), and Separation Individuation Test of Adolescence (SITA). It was found that children with a MS-affected parent displayed higher levels of depression and anxiety than children from the control group. Furthermore, children in the study group reported a greater degree of separation anxiety, compared to the control group. We conclude with clinical recommendations for developing therapeutic interventions for adolescents to MS-affected parents, as well as for their ill and healthy parents.

Adult separation anxiety in treatment nonresponders with anxiety disorders: delineation of the syndrome and exploration of attachment-based psychotherapy and biomarkers

Clinically significant separation anxiety [SA] has been identified as being common among patients who do not respond to psychiatric interventions, regardless of intervention type (pharmacological or psychotherapeutic), across anxiety and mood disorders. An attachment formation and maintenance domain has been proposed as contributing to anxiety disorders. We therefore directly determined prevalence of SA in a population of adult treatment non-responders suffering from primary anxiety. In these separation anxious nonresponders, we pilot-tested an SA-focused, attachment-based psychotherapy for anxiety, Panic-Focused Psychodynamic Psychotherapy-eXtended Range [PFPP-XR], and assessed whether hypothesized biomarkers of attachment were engaged. We studied separation anxiety [SA] in 46 adults (ages 23-70 [mean 43.9 (14.9)]) with clinically significant anxiety symptoms (Hamilton Anxiety Rating Scale [HARS]≥15), and reporting a history of past non-response to psychotherapy and/or medication treatments. Thirty-seven (80%) had clinically significant symptoms of separation anxiety (Structured Clinical Interview for Separation Anxiety Symptoms [SCI-SAS] score≥8). Five of these subjects completed an open clinical trial of Panic Focused Psychodynamic Psychotherapy eXtended Range [PFPP-XR], a 21-24 session, 12-week manualized attachment-focused anxiolytic psychodynamic psychotherapy for anxiety. Patients improved on "adult threshold" SCI-SAS (current separation anxiety) (p=.016), HARS (p=0.002), and global severity, assessed by the Clinical Global Impression Scale (p=.0006), at treatment termination. Salivary oxytocin levels decreased 67% after treatment (p=.12). There was no significant change in high or low frequency HRV after treatment, but change in high frequency HRV inversely correlated with treatment change in oxytocin (p<.02), and change in low frequency HRV was positively associated with change in oxytocin (p<.02). SA is surprisingly prevalent among non-responders to standard anti-anxiety treatments, and it may represent a novel transdiagnostic target for treatment intervention in this population. Anxiety and global function improved in a small trial of a brief, manualized, attachment-focused psychodynamic psychotherapy, potentially supporting the clinical relevance of attachment dysfunction in this sample. The large decrease in oxytocin levels with treatment, although not statistically significant in this very small sample, suggests the need for further study of oxytocin as a putative biomarker or mediator of SA response. These pilot data generate testable hypotheses supporting an attachment domain underlying treatment-resistant anxiety, and new treatment strategies.

Female rats are resistant to developing the depressive phenotype induced by maternal separation stress

Many stress-related psychiatric disorders are more common in women than in men. We aimed to determine how female rats respond to maternal separation (MS; removal of the dam from the litter for 3 h/day from postnatal day (P) 2-14)). A subset of MS females were also exposed to chronic constant light for 3 weeks during adolescence (P42-63) to investigate whether the antidepressant effect of light treatment, previously observed in male rats, could be seen in female rats. Ultrasonic vocalizations (22 kHz) were recorded and the forced swim test was conducted immediately after light exposure (P65-67) and 33 days later (P98-99) to determine depressive-like behaviour. Key proteins in the MAPK signal transduction pathway (MKP-1, phospho-ERK, total ERK) and a synaptosomal marker (synaptophysin) were measured in the ventral hippocampus. We found that MS decreased the duration of 22 kHz vocalizations at P65 which was reversed by subsequent light. Light exposure increased time spent in the inner zone of the open field and the number of 22 kHz calls in response to novelty at P98. MS decreased the time females spent immobile and increased time actively swimming in the forced swim test at P67 but not at P99. MKP-1 and synaptophysin levels remained unchanged while MS decreased phospho-ERK levels in the ventral hippocampus. In contrast to clinical findings, the results suggest that female rats may be resistant to MS-induced depression-like behaviour. The behavioural effects of MS and light treatment in female rats may involve the MAPK/ERK signal transduction pathway.

Behavioural and biochemical changes in maternally separated Sprague-Dawley rats exposed to restraint stress

Early life adversity has been associated with the development of various neuropsychiatric disorders in adulthood such as depression and anxiety. The aim of this study was to determine if stress during adulthood can exaggerate the depression-/anxiety-like behaviour observed in the widely accepted maternally separated (MS) Sprague-Dawley (SD) rat model of depression. A further aim was to determine whether the behavioural changes were accompanied by changes in hippocampal brain-derived neurotrophic factor (BDNF) and the protein profile of the prefrontal cortex (PFC). Depression-/anxiety-like behaviour was measured in the elevated plus maze, open field and forced swim test (FST) in the MS SD rats exposed to chronic restraint stress in adulthood. As expected, MS increased immobility of SD rats in the FST but restraint stress did not enhance this effect of MS on SD rats. A proteomic analysis of the PFC revealed a decrease in actin-related proteins in MS and non-separated rats subjected to restraint stress as well as a decrease in mitochondrial energy-related proteins in the stressed rat groups. Since MS during early development causes a disruption in the hypothalamic-pituitary-adrenal axis and long-term changes in the response to subsequent stress, it may have prevented restraint stress from exerting its effects on behaviour. Moreover, the decrease in proteins related to mitochondrial energy metabolism in MS rats with or without subsequent restraint stress may be related to stress per se and not depression-like behaviour, because rats subjected to restraint stress displayed similar decreases in energy-related proteins and spent less time immobile in the FST than control rats.

Caregiver-mediated therapy for an adult with visual and intellectual impairment suffering from separation anxiety

BACKGROUND

Separation anxiety among intellectually disabled (ID) persons with comorbid visual impairment could be rooted in a weak sense of person permanence. Technology-assisted Therapy for Separation Anxiety (TTSA) was used to address this problem.

AIMS

The primary aim was to determine whether technology alone or including caregivers was the best option, and whether TTSA decreased separation anxiety and challenging behaviour. Also, how the caregivers and the client experienced TTSA.

METHODS AND PROCEDURES

A pre-experimental, quantitative approach (AB1C1B2C2D) was used for this single-subject study. The frequency of the client's text messages was recorded daily. The variables were monitored with standardised instruments and caregivers rated the intensity and frequency of the client's anxious and challenging behaviour. The social validity was evaluated by means of questionnaires.

OUTCOMES AND RESULTS

There was a significant decrease in the anxious and angry messages sent, and in anxious and challenging behaviour, in the phase in which the caregivers were included, compared with the phase in which technology alone was used. The client and the caregivers were positive about TTSA.

CONCLUSION AND IMPLICATION

Technology and the caregivers reactions reduces the anxiety and challenging behaviour. It might also aid the acquisition of the concept of person permanence.

Psychodynamic Treatment for Separation Anxiety in a Treatment Nonresponder

Separation anxiety, long an area of interest for psychoanalysts, has been included in DSM-5 among general "anxiety disorders" that span across age groups. The syndrome of separation anxiety has been shown to correlate with nonresponse to treatments for anxiety and mood disorders (Milrod et al. 2014). It is therefore of public health importance to develop targeted treatments for this syndrome. Some psychoanalysts have suggested that brief psychoanalytic interventions may be of particular value in addressing separation anxiety. Our clinical work with patients with anxiety disorders with high levels of separation anxiety indicates that they have such intense anger and ambivalence in fraught intimate relationships that they feel stuck and helpless, almost eliminating more positive feelings. This ambivalence and associated unconscious conflicts inevitably emerge in the therapeutic relationship and can threaten to disrupt treatment efforts. We propose a set of focused psychodynamic psychotherapeutic interventions to address separation anxiety, developed as part of Panic-Focused Psychodynamic Psychotherapy-eXtended Range (PFPP-XR; Busch et al. 2012). We present a case from our research study of treatment nonresponders with anxiety disorders and separation anxiety. The patient was successfully treated with PFPP-XR in a 21-session treatment.

Incidence, clinical correlates and treatment effect of rage in anxious children

Episodic rage represents an important and underappreciated clinical feature in pediatric anxiety. This study examined the incidence and clinical correlates of rage in children with anxiety disorders. Change in rage during treatment for anxiety was also examined. Participants consisted of 107 children diagnosed with an anxiety disorder and their parents. Participants completed structured clinical interviews and questionnaire measures to assess rage, anxiety, functional impairment, family accommodation and caregiver strain, as well as the quality of the child's relationship with family and peers. Rage was a common feature amongst children with anxiety disorders. Rage was associated with a more severe clinical profile, including increased anxiety severity, functional impairment, family accommodation and caregiver strain, as well as poorer relationships with parents, siblings, extended family and peers. Rage was more common in children with separation anxiety, comorbid anxiety, attention deficit/hyperactivity disorder and behavioral disorders, but not depressive symptoms. Rage predicted higher levels of functional impairment, beyond the effect of anxiety severity. Rage severity reduced over treatment in line with changes in anxiety symptoms. Findings suggest that rage is a marker of greater psychopathology in anxious youth. Standard cognitive behavioral treatment for anxiety appears to reduce rage without adjunctive treatment.

Mild effects of gestational stress and social reactivity on the onset of mother-young interactions and bonding in sheep

Consequences of prenatal stress on mother-young relationships are well-documented in altricial mammals but less so in precocial mammals. In this study, we investigated the effects of unpredictable aversive events on maternal behavior and mutual mother-young recognition in pregnant ewes while accounting for modulatory effects of ewe reactivity. From a population of 120 Romane-breed ewes, we selected 20 high-responsive (HR) and 20 low-responsive (LR) ewes according to pre-mating reactivity assessed in isolation tests. Over the final third of pregnancy, 10 HR ewes and 10 LR ewes were exposed daily to various aversive events such as social isolation, mixing and transport (stressed ewes), while the other 20 ewes were not exposed to aversive events (control ewes). Although the treatment induced chronic stress, physiologically confirmed by an increase in salivary cortisol following transport and sham shearing, maternal behavior of stressed ewes observed during the first 30 min postpartum and in the selectivity test 1 h 30 min later did not differ from controls. However, in a maternal motivation test performed 48 h postpartum, stressed ewes vocalized less than controls when separated from their lambs, and walked less readily past an unknown object to reach their lambs. Lambs of stressed ewes spent more time near their dam in a preference test performed 15 h after birth compared to control-ewe lambs. HR ewes spent more time grooming their lambs than LR ewes. We posit that domestication could have selected animals displaying robust expression of maternal behavior related to social reactivity and producing offspring that are better adapted to challenging situations.

The diagnostic utility of separation anxiety disorder symptoms: an item response theory analysis

At present, it is not clear whether the current definition of separation anxiety disorder (SAD) is the optimal classification of developmentally inappropriate, severe, and interfering separation anxiety in youth. Much remains to be learned about the relative contributions of individual SAD symptoms for informing diagnosis. Two-parameter logistic Item Response Theory analyses were conducted on the eight core SAD symptoms in an outpatient anxiety sample of treatment-seeking children (N = 359, 59.3 % female, M Age = 11.2) and their parents to determine the diagnostic utility of each of these symptoms. Analyses considered values of item threshold, which characterize the SAD severity level at which each symptom has a 50 % chance of being endorsed, and item discrimination, which characterize how well each symptom distinguishes individuals with higher and lower levels of SAD. Distress related to separation and fear of being alone without major attachment figures showed the strongest discrimination properties and the lowest thresholds for being endorsed. In contrast, worry about harm befalling attachment figures showed the poorest discrimination properties, and nightmares about separation showed the highest threshold for being endorsed. Distress related to separation demonstrated crossing differential item functioning associated with age-at lower separation anxiety levels excessive fear at separation was more likely to be endorsed for children ≥9 years, whereas at higher levels this symptom was more likely to be endorsed by children <9 years. Implications are discussed for optimizing the taxonomy of SAD in youth.

Separation anxiety, attachment and inter-personal representations: disentangling the role of oxytocin in the perinatal period

In this paper, we aimed to assess cross-sectionally and longitudinally associations between disturbances in maternal early attachment experiences, symptoms of separation anxiety and depression and oxytocin plasma levels. We examined a mediational model that tested the hypothesis that anxious attachment style arising from the mothers’ early bonding experiences with her own parents was associated with high levels of separation anxiety which, via its impact on depression, was associated with reduced levels of oxytocin in the postnatal period. Data is reported on a structured sample of 127 women recruited during pregnancy from a general hospital antenatal clinic and an initial follow up cohort of 57 women who were re-assessed at 3-months post-partum. We found an association between lower oxytocin level in the post partum period and symptoms of separation anxiety and depression during pregnancy, as well as maternal negative interpersonal representations, upbringing attributes and anxious attachment style. Further meditational analysis revealed that the unique association between anxious attachment and depression is mediated by separation anxiety and that depressed mood mediated the relationship between separation anxiety and oxytocin. In conjunction with evidence from the literature suggesting that lower oxytocin level is associated with bonding difficulties, our findings have significant implications for understanding the biological processes underpinning adverse attachment experiences, negative affect state, and mother-to-infant bonding difficulties.

Children's separation anxiety scale (CSAS): psychometric properties

This study describes the psychometric properties of the Children's Separation Anxiety Scale (CSAS), which assesses separation anxiety symptoms in childhood. Participants in Study 1 were 1,908 schoolchildren aged between 8 and 11. Exploratory factor analysis identified four factors: worry about separation, distress from separation, opposition to separation, and calm at separation, which explained 46.91% of the variance. In Study 2, 6,016 children aged 8-11 participated. The factor model in Study 1 was validated by confirmatory factor analysis. The internal consistency (α = 0.82) and temporal stability (r = 0.83) of the instrument were good. The convergent and discriminant validity were evaluated by means of correlations with other measures of separation anxiety, childhood anxiety, depression and anger. Sensitivity of the scale was 85% and its specificity, 95%. The results support the reliability and validity of the CSAS.

Relationship factors in sex offender couples: a pilot study in an outpatient setting

Research indicates that sex offenders' relationships are often unstable and superficial. Sex offenders are portrayed as showing little empathy toward their partners and being incapable of sharing intimacy. This study aimed to explore sex offenders' intimate relationships and identify potential stabilizing factors in an outpatient setting. In an exploratory pilot study, the authors used standardized instruments to assess 17 heterosexual sex offenders and their intimate partners. Results indicate that both partners rate high in attachment anxiety. The authors found a high level of correlation between both partners with regard to attachment avoidance. The sex offender couples demonstrate similarly low scores for "dominance, pugnaciousness, and aggression" in intimate relationships, and the female partners revealed high neuroticism and conscientiousness scores.

Personality dimensions as common and broadband-specific features for internalizing and externalizing disorders

Several researchers have suggested that the nature of the covariation between internalizing and externalizing disorders may be understood better by examining the associations between temperament or personality and these disorders. The present study examined neuroticism as a potential common feature underlying both internalizing and externalizing disorders and novelty seeking as a potential broad-band specific feature influencing externalizing disorders alone. Participants were 12- to 18-year-old twin pairs (635 monozygotic twin pairs and 691 dizygotic twin pairs; 48 % male and 52 % female) recruited from the Colorado Center for Antisocial Drug Dependence. Genetic and nonshared environmental influences shared in common with neuroticism influenced the covariation among distinct internalizing disorders, the covariation among distinct externalizing disorders, and the covariation between internalizing and externalizing disorders. Genetic influences shared in common with novelty seeking influenced the covariation among externalizing disorders and the covariation between major depressive disorder and externalizing disorders, but not the covariation among internalizing disorders or between anxiety disorders and externalizing disorders. Also, after accounting for genetic and environmental influences shared in common with neuroticism and novelty seeking, there were no significant common genetic or environmental influences among the disorders examined, suggesting that the covariance among the disorders is sufficiently explained by neuroticism and novelty seeking. We conclude that neuroticism is a heritable common feature of both internalizing disorders and externalizing disorders, and that novelty seeking is a heritable broad-band specific factor that distinguishes anxiety disorders from externalizing disorders.

Limbic brain responses in mothers with post-traumatic stress disorder and comorbid dissociation to video clips of their children

Maternal dissociative symptoms which can be comorbid with interpersonal violence-related post-traumatic stress disorder (IPV-PTSD) have been linked to decreased sensitivity and responsiveness to children's emotional communication. This study examined the influence of dissociation on neural activation independently of IPV-PTSD symptom severity when mothers watch video-stimuli of their children during stressful and non-stressful mother-child interactions. Based on previous observations in related fields, we hypothesized that more severe comorbid dissociation in IPV-PTSD would be associated with lower limbic system activation and greater neural activity in regions of the emotion regulation circuit such as the medial prefrontal cortex and dorsolateral prefrontal cortex (dlPFC). Twenty mothers (of children aged 12-42 months), with and without IPV-PTSD watched epochs showing their child during separation and play while undergoing functional magnetic resonance imaging (fMRI). Multiple regression indicated that when mothers diagnosed with IPV-PTSD watched their children during separation compared to play, dissociative symptom severity was indeed linked to lowered activation within the limbic system, while greater IPV-PTSD symptom severity was associated with heightened limbic activity. Concerning emotion regulation areas, there was activation associated to dissociation in the right dlPFC. Our results are likely a neural correlate of affected mothers' reduced capacity for sensitive responsiveness to their young child following exposure to interpersonal stress, situations that are common in day-to-day parenting.

Postpartum maternal separation anxiety, overprotective parenting, and children's social-emotional well-being: longitudinal evidence from an Australian cohort

Postpartum maternal separation anxiety refers to a mothers' experience of worry and concern about leaving her child for short-term separations. The long-term effects of high maternal separation anxiety on maternal parenting behaviors and child outcomes have been not been established empirically. The aim of this study was to ascertain the prospective relationships between maternal separation anxiety during the child's first year of life, and overprotective parenting and children's social and emotional functioning at age 2-3 years. Structural equation modeling with a large representative cohort of Australian mother-child dyads (N = 3,103) indicated that high maternal separation anxiety was associated with more overprotective parenting behaviors and poorer child socioemotional functioning at age 2-3 years. Findings suggest women with high postpartum maternal separation anxiety may sustain this vigilance across the first years following birth, promoting overprotective behaviors, and resulting in increased behavior problems in their children. Support for women around negotiating separation from their children early in parenthood may prevent the establishment of a repertoire of parenting behaviors that includes unnecessarily high vigilance, monitoring, and anxiety about separation.

Separation anxiety in families with emerging adults

In several developmental theories, separation anxiety has been identified as an important feature of close interpersonal relationships. Most often, separation anxiety has been examined in the context of mother-child dyads in infancy. Increasingly, however, it is recognized that separation anxiety is also relevant in other relationships (e.g., the father-child relationship) and in later developmental periods (e.g., adolescence and emerging adulthood). The present study aimed to investigate separation anxiety at the family level in families with emerging adults. By using the Social Relations Model, we aimed to determine the extent to which the actor, the partner, their specific relationships, and the family contribute to separation anxiety in dyadic family relationships. A total of 119 Belgian two-parent families with an emerging adult participated in a round-robin design, in which family members reported on their feelings of separation anxiety toward each other. Findings showed that separation anxiety can be represented as a personal characteristic (i.e., an actor effect) and as a specific feature of the mother-child dyad. Further, findings indicate that separation anxiety is also characteristic of the father-mother marital relationship and of the family climate as a whole. Implications for the meaning of separation anxiety and clinical practice are discussed.

Cortisol regulation in 12-month-old human infants: associations with the infants' early history of breastfeeding and co-sleeping

Experiences during early life are suggested to affect the physiological systems underlying stress responses, including the hypothalamic-pituitary-adrenal axis (HPA axis). While stressful early experiences have been associated with dysregulated HPA-axis functioning, positive early experiences, i.e. high maternal caregiving quality, contribute to more optimal HPA-axis functioning. Influences of other early caregiving factors, however, are less well documented. The goal of this study was to examine whether breastfeeding and co-sleeping during the first 6 months of life were associated with infant cortisol regulation, i.e. cortisol reactivity and recovery, to a stressor at 12 months of age. Participants were 193 infants and their mothers. Information on breastfeeding and co-sleeping was collected using weekly and daily sleep diaries, respectively, for the first 6 months of life. Co-sleeping was defined as sleeping in the parents' bed or sleeping in the parents' room. At 12 months of age, infants were subjected to a psychological stressor [Strange Situation Procedure (SSP); Ainsworth et al. 1978]. Salivary cortisol was measured prestressor and at 25, 40, and 60 min poststressor to measure reactivity and recovery. Regression analyses showed that after controlling for maternal sensitivity, infant attachment status, feeding, and sleeping arrangements at 12 months of age and other confounders, more weeks of co-sleeping predicted lower infant cortisol reactivity to the SSP. Also, more weeks of breastfeeding predicted quicker cortisol recovery. These results indicate that an early history of co-sleeping and breastfeeding contributes positively to cortisol regulation in 12-month-olds.

Neonatal handling prevents anxiety-like symptoms in rats exposed to chronic mild stress: behavioral and oxidative parameters

This study investigated the influence of neonatal handling on behavioral and biochemical consequences of chronic mild stress (CMS) in adulthood. Male rat pups were submitted to daily tactile stimulation (TS) or maternal separation (MS), from postnatal day 1 (PND1) to postnatal day 21 (PND21), for 10 min/day. In adulthood, half the number of animals were exposed to CMS for 3 weeks and submitted to behavioral testing, including sucrose preference (SP), elevated plus maze (EPM), and defensive burying tasks (DBTs), followed by biochemical assessments. CMS reduced SP, increased anxiety in EPM and DBT, and increased adrenal weight. In addition, CMS decreased plasma vitamin C (VIT C) levels and increased protein carbonyl (PC) levels, catalase (CAT) activity in hippocampus and cortex, and superoxide dismutase (SOD) levels in cortex. In contrast, both forms of neonatal handling were able to prevent reduction in SP, anxiety behavior in DBT, and CMS-induced adrenal weight increase. Furthermore, they were also able to prevent plasma VIT C reduction, hippocampal PC levels increase, CAT activity increase in hippocampus and cortex, and SOD levels increase in cortex following CMS. Only TS was able to prevent CMS-induced anxiety symptoms in EPM and PC levels in cortex. Taken together, these findings show the protective role of neonatal handling, especially TS, which may enhance ability to cope with stressful situations in adulthood.