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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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2
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Attachment Style and Its Relationships with Early Memories of Separation Anxiety and Adult Separation Anxiety Symptoms among Emerging Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148666. [PMID: 35886517 PMCID: PMC9321009 DOI: 10.3390/ijerph19148666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023]
Abstract
Emerging adulthood concerns the transition from adolescence to adulthood. It foresees the separation from the family and the creation of new significant relationships, whereby specific attachment styles might be triggered when facing these challenges. The present study investigates the influence of retrospective memories associated with childhood separation anxiety symptoms upon emerging adults’ romantic avoidant vs. anxious attachment styles including adult separation anxiety symptoms as mediators. Age and gender were included as covariates. A community sample of N = 394 Italian emerging adults (Mage = 23.64, SD = 4.00, 70% females) completed self-report measures. The results showed that the participants presented a greater anxious attachment rather than an avoidant attachment style. Moreover, both adult separation anxiety and the memories of early separation anxiety were positively and significantly associated with anxious attachment and not with avoidant attachment. A mediation model conducted and focused on anxious attachment showed that, although not directly associated, child separation anxiety did show a significant positive indirect effect on anxious attachment as mediated by adult separation anxiety symptoms. Thus, the findings highlighted the influence of adult separation anxiety symptoms and retrospective childhood memories of separation anxiety upon anxious adult romantic attachment, yet not on avoidant attachment style. Clinical implications are discussed and suggestions for future research are provided.
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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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Ruiz-García A, Jiménez Ó, Resurrección DM, Ferreira M, Reis-Jorge J, Fenollar-Cortés J. Portuguese validation of the Adult Separation Anxiety-Questionnaire (ASA-27). PLoS One 2021; 16:e0248149. [PMID: 33690669 PMCID: PMC7946201 DOI: 10.1371/journal.pone.0248149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
Adult separation anxiety disorder (ASAD) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Despite the high rates of this diagnosis among Portuguese adults, there is a lack of measures to assess it. In this study, we assessed the psychometric properties of a Portuguese adaptation of the Adult Separation Anxiety questionnaire (ASA-27) on a sample of 267 adults (72.7% women) aged 18–80 years (M = 40.5, SD = 13.1). Factor structure, internal consistency, and convergence validity were examined. This study confirmed the single-factor structure of the Portuguese version of ASA-27. Consistency was high for the total sample (ω = .92) and by gender (ω = .93 and 92, men and women groups, respectively). The scale was positively related to the Portuguese version of State-Trait Anxiety Inventory (STAI) (r = .57, p< .001, for both State and trait anxiety scales) and Composite Codependency Scale total score (r = .29, p< .001). In addition, the ASA-27 total score showed incremental validity in the explanation of anxiety measured by STAI. In conclusion, results show that the Portuguese version of the ASA-27 is a reliable and valid measure of ASAD.
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Affiliation(s)
| | - Óliver Jiménez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Universidad de Málaga, Málaga, Spain
| | | | - Marco Ferreira
- Instituto Superior de Educação e Ciências, ISEC Lisboa, Lisboa, Portugal
| | - José Reis-Jorge
- Instituto Superior de Educação e Ciências, ISEC Lisboa, Lisboa, Portugal
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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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Dowsett E, Delfabbro P, Chur-Hansen A. Adult separation anxiety disorder: The human-animal bond. J Affect Disord 2020; 270:90-96. [PMID: 32339110 DOI: 10.1016/j.jad.2020.03.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The introduction of an adult onset Separation Anxiety Disorder in the DSM-V recognises that separation anxiety can occur at any stage across the lifespan. In this paper, we examine whether adult separation anxiety, which is known to occur when people are apart from other people close to them, can also develop when people are separated from animal companions. The social and individual psychological correlates of this reported phenomenon are examined. METHODS Participants (N = 313, aged 18-76, M = 41.89 years), completed demographic information and questionnaires measuring separation anxiety from companion animals and humans, attachment towards companion animals and humans, and social support. RESULTS Significant positive relationships were observed between separation anxiety from humans, people substitution and separation anxiety from animals. Participants with greater separation anxiety from animals also reported less social support and greater attachment anxiety involving humans. People substitution was also positively related to greater animal-related separation anxiety. Associations were generally weaker when cats were identified as the principal companion animal. Participants without children reported significantly less attachment-related avoidance (human); less perceived social support; greater people substitution; and, greater separation anxiety towards companion animals. Separation anxiety from humans, attachment avoidance, and attachment anxiety accounted for 41% of variance in separation anxiety from animals. LIMITATIONS The correlational design does not allow the investigation of causal associations. CONCLUSIONS A strong, positive relationship was observed between human-related separation anxiety and animal-related separation anxiety, which was significantly stronger for people with lower levels of social support.
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Affiliation(s)
- Elisha Dowsett
- School of Psychology, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Paul Delfabbro
- School of Psychology, University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Anna Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, SA, 5005, Australia
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Park SC, Kim YK. Anxiety Disorders in the DSM-5: Changes, Controversies, and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:187-196. [PMID: 32002930 DOI: 10.1007/978-981-32-9705-0_12] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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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Milrod B, Altemus M, Gross C, Busch F, Silver G, Christos P, Stieber J, Schneier F. Adult separation anxiety in treatment nonresponders with anxiety disorders: delineation of the syndrome and exploration of attachment-based psychotherapy and biomarkers. Compr Psychiatry 2016; 66:139-45. [PMID: 26995247 PMCID: PMC8363051 DOI: 10.1016/j.comppsych.2016.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Barbara Milrod
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA.
| | - Margaret Altemus
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Charles Gross
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Fredric Busch
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Gabrielle Silver
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Paul Christos
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Joshua Stieber
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
| | - Franklin Schneier
- Weill Cornell Medical College, 525 East 68(th) Street, NY 10065, USA
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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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Tay AK, Rees S, Chen J, Kareth M, Silove D. Pathways involving traumatic losses, worry about family, adult separation anxiety and posttraumatic stress symptoms amongst refugees from West Papua. J Anxiety Disord 2015; 35:1-8. [PMID: 26275507 DOI: 10.1016/j.janxdis.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/15/2022]
Abstract
There is some evidence that adult separation anxiety disorder (ASAD) symptoms are closely associated with posttraumatic stress disorder (PTSD) amongst refugees exposed to traumatic events (TEs), but the pathways involved remain to be elucidated. A recent study suggests that separation anxiety disorder precedes and predicts onset of PTSD. We examined a path model testing whether ASAD symptoms and worry about family mediated the path from traumatic losses to PTSD symptoms amongst 230 refugees from West Papua. Culturally adapted measures were applied to assess TE exposure and symptoms of ASAD and PTSD. A structural equation model indicated that ASAD symptoms played an important role in mediating the effects of traumatic losses and worry about family in the pathway to PTSD symptoms. Although based on cross-sectional data, our findings suggest that ASAD symptoms may play a role in the path from traumatic losses to PTSD amongst refugees. We propose an evolutionary model in which the ASAD and PTSD reactions represent complementary survival responses designed to protect the individual and close attachments from external threats.
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Affiliation(s)
- Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia.
| | - Susan Rees
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
| | - Jack Chen
- Simpson Centre for Health Services Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, NSW, Australia
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Abstract
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.
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Rochester J, Baldwin DS. Adult separation anxiety disorder: accepted but little understood. Hum Psychopharmacol 2015; 30:1-3. [PMID: 25572307 DOI: 10.1002/hup.2452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jo Rochester
- Clinical and Experimental Sciences Academic Unit, University of Southampton Faculty of Medicine, UK
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Assess the changes in DSM-5 relative to earlier versions.• Evaluate the implications of the DSM-5 for practicing geriatric psychiatrists. ABSTRACT About every 20 years, the American Psychiatric Association revises its official classification of mental disorders. The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, prompting considerable commentary, debate, and criticism. This article briefly describes the process leading up to DSM-5 and the main changes from the previous version (DSM-IV) that would be of interest to a geriatric psychiatrist. The changes in the areas of schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders have been many, but the majority of them are minor and unlikely to have major treatment implications. The classification of neurocognitive disorders, however, has seen a major revision and elaboration in comparison to DSM-IV; of special note is the introduction of "mild and major neurocognitive disorders," the latter equated with dementia. A common language has also been introduced for the criteria for the various etiological subtypes of neurocognitive disorders. All physicians treating patients with neurocognitive disorders should familiarize themselves with these criteria. Their use in research has the potential to harmonize the field.
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Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis. Asian J Psychiatr 2014; 11:98-101. [PMID: 25453710 DOI: 10.1016/j.ajp.2014.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/24/2014] [Indexed: 01/15/2023]
Abstract
DSM-5 has lifted the age criterion in the definition of separation anxiety disorder thereby overturning the long-standing convention of restricting the diagnosis to childhood. Previously, adults with separation anxiety symptoms were assigned to other conventional categories such as panic disorder, agoraphobia or generalized anxiety disorder. Over the past two decades, an evolving body of research has identified separation anxiety disorder in adulthood, with 20-40% of adult psychiatric outpatients being assigned that diagnosis. In the US, the lifetime prevalence of the disorder in adulthood is 6.6%. The removal of the age restriction on diagnosis has important implications for clinical practice. Whereas parents (particularly mothers) of children with separation anxiety disorder commonly attracted the diagnosis of agoraphobia, the latter are more likely now to be diagnosed with the adult form of separation anxiety disorder, focusing attention on the importance of intervening with both members of the dyad to overcome mutual reinforcement of symptoms. In addition, adults with separation anxiety disorder have been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments. There is an urgent need therefore to devise novel psychological and pharmacological interventions for the adult form of the disorder. The reformulation of separation anxiety disorder in DSM-5 therefore requires a paradigm shift in which clinicians are alerted to identifying and treating the condition in all age groups. Research across countries is needed to examine the new formulation of separation anxiety disorder amongst populations of diverse ethnic and cultural backgrounds.
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Separation anxiety disorder in adult patients with obsessive-compulsive disorder: prevalence and clinical correlates. Eur Psychiatry 2014; 30:145-51. [PMID: 24908152 DOI: 10.1016/j.eurpsy.2014.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Individuals with obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) tend to present higher morbidity than do those with OCD alone. However, the relationship between OCD and SAD has yet to be fully explored. METHOD This was a cross-sectional study using multiple logistic regression to identify differences between OCD patients with SAD (OCD+SAD, n=260) and without SAD (OCD, n=695), in terms of clinical and socio-demographic variables. Data were extracted from those collected between 2005 and 2009 via the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders project. RESULTS SAD was currently present in only 42 (4.4%) of the patients, although 260 (27.2%) had a lifetime diagnosis of the disorder. In comparison with the OCD group patients, patients with SAD+OCD showed higher chance to present sensory phenomena, to undergo psychotherapy, and to have more psychiatric comorbidities, mainly bulimia. CONCLUSION In patients with primary OCD, comorbid SAD might be related to greater personal dysfunction and a poorer response to treatment, since sensory phenomena may be a confounding aspect on diagnosis and therapeutics. Patients with OCD+SAD might be more prone to developing specific psychiatric comorbidities, especially bulimia. Our results suggest that SAD symptom assessment should be included in the management and prognostic evaluation of OCD, although the psychobiological role that such symptoms play in OCD merits further investigation.
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Boelen PA, Reijntjes A, Carleton RN. Intolerance of Uncertainty and Adult Separation Anxiety. Cogn Behav Ther 2014; 43:133-44. [DOI: 10.1080/16506073.2014.888755] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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Boelen PA. Symptoms of prolonged grief, depression, and adult separation anxiety: distinctiveness and correlates. Psychiatry Res 2013; 207:68-72. [PMID: 23068081 DOI: 10.1016/j.psychres.2012.09.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/07/2012] [Accepted: 09/14/2012] [Indexed: 01/10/2023]
Abstract
Research has shown that prolonged grief disorder (PGD) is a disorder distinct from other disorders including major depression and posttraumatic stress disorder (PTSD). This study aimed to extend this research by examining the distinctiveness of symptoms of PGD relative to symptoms of adult separation anxiety disorder, also taking into account depression. Data were available from 205 bereaved individuals who completed measures tapping these symptoms together with a complementary measure of mental and physical health. Findings showed that symptoms of PGD, depression, and adult separation anxiety disorder were better conceptualized as distinct dimensions instead of a unitary dimension of distress. Correlations between the three symptom clusters were moderate to large. Cause of loss was the single variable that was associated with all three symptom clusters with loss due to violent cause giving rise to more severe symptoms. All three symptom clusters were associated with lower concurrent mental and physical health.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
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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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