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Rees SJ, Mohsin M, Kuowei Tay A, Moussa B, Klein L, Nadar N, Hussain F, Krishna Y, Khalil B, Yousif M, Silove D, Fisher J. COVID-19 stressors and mental health problems amongst women who arrived as refugees and those born in Australia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002073. [PMID: 37399172 PMCID: PMC10317230 DOI: 10.1371/journal.pgph.0002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/23/2023] [Indexed: 07/05/2023]
Abstract
Women from refugee background residing in high income countries are at greater mental health risk during the COVID-19 pandemic given their higher baseline prevalence of mental disorders, trauma exposures and social adversities. During the COVID-19 pandemic we drew on data from wave-4 of the WATCH cohort study, collected between October 2019 and June 2021. We conducted a cross-sectional analysis to compare the prevalence of common mental disorders (CMDs) from the sample of 650 consecutively recruited women, 339 (52.2%) from the refugee-background who were resettled in Australia and 311 (48.8%) randomly and contemporaneously selected Australian born women. We assessed COVID-19 psychosocial stressors: 1. COVID-related material hardship and 2. COVID-related fear and stress. We examined for associations between scores on these two items and CMDs in each group respectively. Compared to Australian-born woman, women from refugee background recorded a significantly higher prevalence of Major Depressive Disorder (MDD) (19.8% vs 13.5%), PTSD (9.7% vs 5.1%), Separation Anxiety Disorder (SEPAD) (19.8% vs 13.5%) and Persistent Complicated Bereavement Disorder (PCBD) (6.5% vs 2.9%). In refugee women, associations were found between COVID-related material hardship and CMDs [MDD, Relative Risk (RR) = 1.39, 95%CI: 1.02-1.89, p = 0.02] as well as between COVID-related fear and stress and CMDs (MDD, RR = 1.74, 95%CI: 1.04-2.90, p = 0.02 p = 0.02). For Australian-born women, associations were more commonly found between CMDs and material hardship. Our study demonstrates that both women from refugee background and those born in Australia are experiencing significant rates of CMD during the pandemic and that material hardship is an associated factor. We found that women from refugee background are at greater risk for mental health problems and are more likely to report an association of those problems with fear and stress related to COVID_19. All women, and particularly those from refugee background, require urgent and specialised attention to their mental health and psychosocial problems during this pandemic.
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Affiliation(s)
- Susan J. Rees
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Mohammed Mohsin
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Mental Health Research Unit, Liverpool Hospital, SWSLHD, New South Wales Health, Liverpool, Australia
| | - Alvin Kuowei Tay
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Batool Moussa
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Louis Klein
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Nawal Nadar
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Fatima Hussain
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Yalini Krishna
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Batoul Khalil
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Mariam Yousif
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Derrick Silove
- Faculty of Medicine, Discipline of Psychiatry, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Jane Fisher
- Division of Social Sciences in Public Health and Preventive Medicine, Global and Women’s Health, Monash University, Melbourne, Victoria, Australia
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Finsaas MC, Klein DN. Is adult separation anxiety associated with offspring risk for internalizing psychiatric problems? Psychol Med 2023; 53:3168-3177. [PMID: 35080196 PMCID: PMC10187056 DOI: 10.1017/s0033291721005249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Awareness of adult separation anxiety (ASA) is growing, but there is a dearth of knowledge about how separation anxiety aggregates in families. We examined the intergenerational associations of separation anxiety and other forms of internalizing problems in an American community sample of 515 predominantly white children and their parents. METHODS Children's separation anxiety (CSA), depression, and other anxiety disorders were modeled as latent factors using diagnoses from interviews and symptom scores from questionnaires completed by mothers, fathers, and children when children were 9 years old and again 3 years later. Parents' separation anxiety was assessed via a questionnaire and parents' other anxiety, depressive, and substance use disorders were assessed with a diagnostic interview when children were nine. Relationships between parents' and children's psychopathology were modeled using s.e.m. RESULTS Mothers' and fathers' ASA were related to all three psychopathology factors in offspring, over and above other parental disorders, in concurrent and prospective analyses. CSA was also related to maternal depression concurrently and prospectively and to maternal anxiety prospectively. Of all paternal psychopathology variables, only ASA was significantly related to children's psychopathology in either model. CONCLUSIONS Results indicate that parental separation anxiety is an important, but non-specific, risk factor for children's psychopathology. The pathway by which this risk is transmitted may be genetic or environmental, and the observed statistical associations likely also encompass child-to-parent effects.
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Affiliation(s)
- Megan C. Finsaas
- Department of Epidemiology, Columbia University, New York, NY, USA and
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Mordeno IG, Gallemit IMJS, Dinding DLL. To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults. Psychiatr Q 2023:10.1007/s11126-023-10024-z. [PMID: 37058269 DOI: 10.1007/s11126-023-10024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines.
- Department of Professional Education, College of Education, MSU-Iligan Institute of Technology, Andres Bonifacio Ave, Tibanga, Iligan City, 9200, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University, Iligan Institute of Technology, Iligan City, Philippines
| | - Dame Lent L Dinding
- Department of Psychology, Mindanao State University, Marawi City, Philippines
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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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Relationship of behavioral inhibition to separation anxiety in a sample (N = 377) of adult individuals with mood and anxiety disorders. Compr Psychiatry 2022; 116:152326. [PMID: 35569286 DOI: 10.1016/j.comppsych.2022.152326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Behavioral Inhibition (BI) is an early temperamental trait characterized by shyness, withdrawal, avoidance, uneasiness, and fear of unfamiliar situations, people, objects, and events. The DSM-5 refers to behavioral inhibition as a temperamental factor related to neurodevelopmental conditions in childhood, including attention deficit hyperactivity disorder, selective mutism, and specific phobias; and to its influence on adult anxiety disorders including social anxiety disorder, agoraphobia, and generalized anxiety disorder, but, interestingly, not separation anxiety disorder (SAD). However, there are phenomenological overlaps between BI and SAD. We aimed to explore whether there is a correlation between BI as an early temperamental trait and childhood or adult separation anxiety disorder. METHODS The study was conducted in 377 consecutive adults (mean age 40.2±12.4 years) outpatients with anxiety and mood disorders as the principal diagnosis, grouped on the presence/absence of a DSM-5 diagnosis of childhood or adult separation anxiety disorder. Separation anxiety was assessed by the Structured Clinical Interview for Separation Anxiety (SCI-SAS) and the Adult Separation Anxiety Checklist (ASA27). Behavioral inhibition was assessed by the Retrospective Self-Report of Inhibition (RSRI). RESULTS The four comparison groups included: 1) 168 patients without childhood or adult SAD, 2) 81 with adult SAD, 3) 97 with both adult SAD and childhood SAD, and 4) 31 with childhood SAD only. The group with both adult and childhood SAD had the highest scores on RSRI total and sub-scale scores. Both groups with adult SAD had significantly higher RSRI scores than the group with only childhood SAD or without SAD. Significant bivariate correlations were found between ASA-27 scores and RSRI scores. Correlations between RSRI scores and measures of anxiety and depressive symptoms were significantly weaker than those on the ASA-27. Regression analyses showed a significant predictive value of RSRI scores on ASA-27 total score, but not of age of onset of SAD. CONCLUSIONS BI has an onset in the very first years of life and may represent a potential developmental endophenotype for later anxiety disorders. Our findings indicate that BI and separation anxiety are connected in individuals with affective and anxiety disorders. This may have important clinical and therapeutic implications for preventive interventions.
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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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Méndez X, Espada JP, Ortigosa JM, García-Fernández JM. Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P). Front Psychol 2022; 13:783943. [PMID: 35478739 PMCID: PMC9037297 DOI: 10.3389/fpsyg.2022.783943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
The main objective of this research was to validate the parents’ version of the Children’s Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children’s Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children’s age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child’s self-report in the framework of the multi-source assessment.
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Affiliation(s)
- Xavier Méndez
- Department of Personality, Assessment, and Psychological Treatment, Universidad of Murcia, Murcia, Spain
| | - José P Espada
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Juan M Ortigosa
- Department of Personality, Assessment, and Psychological Treatment, Universidad of Murcia, Murcia, Spain
| | - José M García-Fernández
- Department of Developmental Psychology and Teaching, University of Alicante, Alicante, Spain
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Associates of Adult Seperation Anxiety Disorder among University Students: A Case Control Study. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.1004855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Finsaas MC, Klein DN. Adult separation anxiety: Personality characteristics of a neglected clinical syndrome. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:620-626. [PMID: 34553957 DOI: 10.1037/abn0000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past two decades, interest in the relationship between personality and psychopathology has resurged. However, the clinical problem of adult separation anxiety (ASA) has been largely excluded from this endeavor due to the age-of-onset criterion in older editions of the DSM that prohibited first-onset diagnoses in adulthood. This study tests relationships between ASA symptoms and higher- and lower-order personality traits in a community sample of 565 women. It accounts for systematic error by utilizing informant report, two personality inventories, and data from two time points over three years, and by adjusting for mood state. It also tests longitudinal ASA-personality models. Results indicate that ASA is robustly associated with negative emotionality and its facet of stress reaction, as well as with aggression, alienation, and absorption to somewhat lesser degrees. These relationships are not due to overlap with other traits (except in the case of alienation), or mood-state biases, and they are verified by informants. Moreover, negative temperament predicts greater levels of ASA three years later, adjusting for baseline ASA. Neither positive emotionality or temperament, nor positive emotionality's lower-order scales, were uniquely related to ASA in multitrait models, whereas relationships between ASA and disinhibition and constraint were inconsistent. These findings lay the groundwork for future research testing the mechanisms and causal links between these personality traits and ASA and may help clinicians anticipate traits that are associated with ASA in order to tailor treatments to patients' personalities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Unlubilgin E, Tetik S, Aksoy I, Yuksel D, Tekin OM. Relationship Between Adult Separation Anxiety and Attachment Styles and Vaginismus. J Sex Med 2021; 18:1752-1758. [PMID: 37057497 DOI: 10.1016/j.jsxm.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/30/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vaginismus has an unknown etiology, is comorbid with anxiety, and is the most common sexual dysfunction in sexual dysfunction outpatient clinics in Turkey. AIM This study aimed to determine the frequency of adult separation anxiety disorder (ASAD) and styles of attachment in patients with vaginismus and to investigate its relationship with female sexual dysfunction. METHODS Sixty women with vaginismus and 60 healthy controls were compared using the Relationship Scales Questionnaire, Female Sexual Function Index (FSFI), and Adult Separation Anxiety Questionnaire (ASA-27). OUTCOMES We report the results of the questionnaires with their implication on the etiology of vaginismus. RESULTS Separation anxiety and fearful and dismissive avoidance attachment style in the vaginismus group were significantly higher than in the control group. Both total FSFI scores and arousal, pain, and satisfaction subscale scores were higher in the control group. CLINICAL IMPLICATIONS ASAD should be evaluated and addressed separately, when necessary, in the treatment of vaginismus. STRENGTHS & LIMITATIONS The relationship between ASAD and vaginismus has been shown for the first time. Study limitations included the assessment of factors influencing the study results based on self-reporting and possible recall bias. CONCLUSION Attachment and comorbidity research in vaginismus needs to shift from just reporting disturbances, to identify various clinical variables, such as the severity of the vaginismus, response to therapy, and differences in therapeutic modalities, in terms of outcome. Unlubilgin E, Tetik S, Aksoy I, et al. Relationship Between Adult Separation Anxiety and Attachment Styles and Vaginismus. J Sex Med 2021;18:1752-1758.
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Affiliation(s)
- Eylem Unlubilgin
- Etlik Zubeyde Hanim Gynecology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Sinan Tetik
- Etlik Zubeyde Hanim Gynecology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ihsan Aksoy
- Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Dilek Yuksel
- Etlik Zubeyde Hanim Gynecology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Arkusha IA, Zakharova KV, Zinchuk MS, Avedisova AS. [Clinical variants and types of course of separation anxiety disorder in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:19-25. [PMID: 34184473 DOI: 10.17116/jnevro202112105119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study clinical manifestations of separation anxiety disorder (SAD) in adults with nonpsychotic mental disorders. MATERIAL AND METHODS Fifty outpatients over 18 years of age with SAD and comorbid non-psychotic mental disorders were assessed for diagnosis by MINI and the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), the Adult Separation Anxiety Self-Report Checklist (ASA-27), HARS, the Experiences in Close Relationship Scale (ECR), the Personality Inventory for DSM-5 (PID-5), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). RESULTS AND CONCLUSION Two clinical variants of the disorder: affective and cognitive-behavioral as well as two variants of the course: with onset in childhood and in adults are identified. Clinical variants and types differ in the spectrum of comorbidity, objects and styles of attachment, personality characteristics as well as correlations and prognosis.
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Affiliation(s)
- I A Arkusha
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - K V Zakharova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - M S Zinchuk
- Soloviev Scientific and Practical Psychoneurological Center, Moscow, Russia
| | - A S Avedisova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
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Bassi G, Mancinelli E, Di Riso D, Lis A, Salcuni S. Separation anxiety in a community sample of Italian emerging adults and its relationship with dimensions of borderline personality. ACTA ACUST UNITED AC 2021; 24:506. [PMID: 33937113 PMCID: PMC8082528 DOI: 10.4081/ripppo.2021.506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
Research studies focusing on separation anxiety and its relation with other measures of anxiety and personality-relevant variables in community samples are still scarce. This study aimed to describe in a dimensional perspective the relationship between separation anxiety symptoms, anxiety levels, and personality traits in a community sample of Italian emerging adults. A sample of 260 college students [mean age (Mage)=21.22, standard deviation (SD)=1.91, 79.6% females] completed the adult separation anxiety questionnaire-27 (ASA-27), the state and trait anxiety inventory-Y (STAI-Y), and the personality assessment inventory borderline scale (PAI-BOR). ASA-27 was significantly and positively correlated with the PAI borderline scale. The mediation model showed that ASA-27 influenced the PAI-BOR through trait anxiety. Clinical implications of the study for psychotherapy research are discussed.
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Affiliation(s)
- Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, Padova.,Fondazione Bruno Kessler, Trento, Italy
| | - Elisa Mancinelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova
| | - Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, Padova
| | - Adriana Lis
- Department of Developmental Psychology and Socialization, University of Padova, Padova
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padova
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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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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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Finsaas MC, Olino TM, Hawes M, Mackin DM, Klein DN. Psychometric analysis of the adult separation anxiety symptom questionnaire: Item functioning and invariance across gender and time. Psychol Assess 2020; 32:582-593. [PMID: 32162945 DOI: 10.1037/pas0000815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Adult Separation Anxiety Symptom Questionnaire (ASA-27) is the most widely used self-report assessment of adult separation anxiety (ASA). Despite its widespread use, relatively little is known about its psychometric properties, specifically whether it is unidimensional, its degree of precision (or information) across latent levels of ASA, the functioning of individual items in general and of DSM-derived versus non-DSM-derived items in particular, and whether the measure is invariant across gender and time. We addressed these issues in a sample of 509 adult women and 407 adult men from the local community participating in a longitudinal study of temperament and psychopathology in children. Two items from the ASA-27 were removed so that the measure met the item response theory (IRT) assumption of unidimensionality. Findings from a graded response model for categorical items suggested that the ASA-27 assesses ASA most reliably at moderate to high levels and that the DSM-derived items were more closely related to latent ASA than the non-DSM-derived items. Invariance tests employing single-factor confirmatory factor analysis models suggested that the measure is partially invariant across gender and time at the unique factor level, with fewer than 7% of parameters freed in both cases; this implies that the means and variances of the latent factors and differences in the observed responses are attributable to true differences in ASA. Future work should replicate these findings in a sample that includes individuals with a wider range of ASA severity and may consider removing additional items that provide little or redundant information. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Avedisova A, A Arkushae I, Akzhigitov R, Anosov Y, Zakharova K. Prevalence of anxiety separation disorder in adult outpatients with non-psychotic mental disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:92-98. [DOI: 10.17116/jnevro202012006192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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. [DOI: 10.1007/978-981-32-9705-0_12] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dogan B, Yoldas C, Kocabas O, Memis CO, Sevincok D, Sevincok L. The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients. Nord J Psychiatry 2019; 73:380-386. [PMID: 31322453 DOI: 10.1080/08039488.2019.1642381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.
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Affiliation(s)
- Bilge Dogan
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Caner Yoldas
- b Medical School, Department of psychiatry, Ahi Evran University , Kirsehir , Turkey
| | - Oktay Kocabas
- c Department of Psychiatry, Turhal State Hospital , Tokat , Turkey
| | - Cagdas Oyku Memis
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Doga Sevincok
- d Medical School, Department of Child and Adolescence Psychiatry, Adnan Menderes University , Aydin , Turkey
| | - Levent Sevincok
- a Medical School, Department of Psychiatry, Adnan Menderes University , Aydin , Turkey
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Koyuncu A, İnce E, Ertekin E, Tükel R. Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs Context 2019; 8:212573. [PMID: 30988687 PMCID: PMC6448478 DOI: 10.7573/dic.212573] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Comorbid disorders are highly prevalent in patients with social anxiety disorder, occurring in as many as 90% of patients. The presence of comorbidity may affect the course of the disease in several ways such as comorbidity in patients with social anxiety disorder (SAD) is related to earlier treatment-seeking behavior, increased symptom severity, treatment resistance and decreased functioning. Moreover, comorbidities cause significant difficulties in nosology and diagnosis, and may cause treatment challenges. In this review, major psychiatric comorbidities that can be encountered over the course of SAD as well as comorbidity associated diagnostic and therapeutic challenges will be discussed.
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Affiliation(s)
- Ahmet Koyuncu
- Academy Social Phobia Center, Atatürk Mah. İkitelli Cad. No:126 A/Daire:6 Küçükçekmece/Istanbul, Turkey
| | - Ezgi İnce
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Erhan Ertekin
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Raşit Tükel
- Department of Psychiatry, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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A Prediction Model for Separation Anxiety: The Role of Attachment Styles and Internalizing Symptoms in Italian Young Adults. JOURNAL OF ADULT DEVELOPMENT 2019. [DOI: 10.1007/s10804-019-09327-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Avedisova AS, Arkusha IA, Zakharova KV. [Separation anxiety disorder in adults - a new diagnostic category]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:66-75. [PMID: 30499500 DOI: 10.17116/jnevro201811810166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety separation disorder (SAD) became the subject of increased attention of researchers in recent decades. DSM-5 and project of ICD-11 allow us to treat this disorder as an independent nosological unit without attachment to age. The review provides information on the prevalence, clinical manifestations and diagnosis of SAD in adults, summarizes information on the etiopathogenesis, relations to other psychiatric disorders, and highlights the lack of modern therapeutic approaches to SAD. The purpose of this review is to raise the level of knowledge about SAD and its new positioning in classification systems.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - I A Arkusha
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - K V Zakharova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
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Mullick MSI, Hafizur Rahman Chowdhury M, Yasir Arafat SM. Separation Anxiety Blended with Superstitious Belief in an Adult Female: A Case Report in Bangladesh. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2018; 12. [DOI: 10.5812/ijpbs.10620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
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Schneier FR, Moskow DM, Choo TH, Galfalvy H, Campeas R, Sanchez-Lacay A. A randomized controlled pilot trial of vilazodone for adult separation anxiety disorder. Depress Anxiety 2017; 34:1085-1095. [PMID: 29071764 DOI: 10.1002/da.22693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Separation anxiety disorder was recently recognized by fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a diagnosis in adults, but no publications to date have characterized a sample of patients seeking treatment for adult separation anxiety disorder (ASAD) or assessed treatment efficacy. We hypothesized that vilazodone, a selective serotonin reuptake inhibitor (SSRI) and serotonin 1a (5HT1a ) receptor partial agonist, would have efficacy in ASAD, because SSRIs have appeared efficacious in children with mixed diagnoses including separation anxiety disorder and in animal models of separation anxiety. METHODS In this pilot study, 24 adults (ages 18-60) with a principal diagnosis of ASAD were randomized to 12 weeks of double-blind treatment with vilazodone (n = 13) or placebo (n = 11). Outcome was assessed by an independent evaluator and self-ratings, and analyzed with mixed effect models. RESULTS This sample was predominantly female (67%), with comorbid psychiatric disorders (58%), and adult onset of separation anxiety disorder (62%). Response rates at week 12 did not differ significantly between groups. Across all time points, the vilazodone group evidenced greater improvement on the Structured Clinical Interview for Separation Anxiety Symptoms (P = .026) and the Quality of Life Enjoyment and Satisfaction Questionnaire (P = .011), and trends toward greater improvement on the Adult Separation Anxiety Questionnaire (P = .054) and the Clinical Global Impression-Change Scale (P = .086), all with large between-group effect sizes. CONCLUSIONS Findings demonstrate feasibility of a clinical trial in ASAD, and they suggest that vilazodone may have efficacy in the treatment of ASAD and warrants further study.
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Affiliation(s)
- Franklin R Schneier
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Danielle M Moskow
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Raphael Campeas
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Arturo Sanchez-Lacay
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
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Childhood attachment and behavioral inhibition: Predicting intolerance of uncertainty in adulthood. Dev Psychopathol 2017; 30:1225-1238. [PMID: 29157325 DOI: 10.1017/s0954579417001614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intolerance of uncertainty (IU), the tendency to react negatively to uncertain situations, has been identified as an important cognitive component of anxiety disorders, yet little is known about its etiology. Links to temperament, particularly behavioral inhibition (BI), and insecure attachment have been proposed in the development of IU, but no prospective empirical investigation has been performed thus far. In the current study, attachment to caregiver and BI of 60 children were assessed at age 6, using observational measures. Mother's anxiety symptoms were assessed when participants were 14 years old. IU was reported by participants when they were 21 years old, as was neuroticism. Two types of insecure attachment (ambivalent and disorganized-controlling) and BI were positively related to IU over a 15-year span, even after controlling for participants' neuroticism and maternal anxiety. Attachment and BI had no significant interacting effect on the development of IU. Maternal anxiety was positively related to child BI and insecure attachment, but not IU. This study is the first to provide empirical support for a link between ambivalent and disorganized-controlling attachment and BI in preschool children to the development of IU in adulthood. Results have etiological and preventative implications not only for anxiety disorders but also for all disorders related to IU.
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Orenes A, Méndez X, García-Fernández JM. Spanish Validation of the Separation Anxiety Assessment Scale. Child Psychiatry Hum Dev 2017; 48:468-477. [PMID: 27430752 DOI: 10.1007/s10578-016-0673-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the factorial structure and psychometric properties of the Separation Anxiety Assessment Scale (SAAS) with Spanish schoolchildren. The participants in Study 1 were 1281 children aged 8-11. Exploratory factor analysis identified four factors: worry about calamitous events, fear of abandonment, fear of being alone, and fear of physical illness, which explained 47.77 % of the variance. The participants of Study 2 were 4628 schoolchildren aged 8-11. The four related factors model was validated by confirmatory factor analysis. The internal consistency (α = .84) and temporal stability (r = .77) were good. The convergent validity was evident from the pattern of correlations with the measures of separation anxiety, sensitivity to anxiety and school fears. The sensitivity of the scale was 83 %, and its specificity, 93 %. The complementary subscales predicted the diagnosis of separation anxiety disorder. The results support the reliability, validity and clinical utility of the SAAS.
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Affiliation(s)
- Aurora Orenes
- Department of Personality and Psychological Assessment and Treatment, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain.
| | - Xavier Méndez
- Department of Personality and Psychological Assessment and Treatment, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain
| | - José M García-Fernández
- Department of Developmental and Didactic Psychology, University of Alicante, Alicante, Spain
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Gesi C, Carmassi C, Shear KM, Schwartz T, Ghesquiere A, Khaler J, Dell'Osso L. Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates. Compr Psychiatry 2017; 72:6-12. [PMID: 27683967 DOI: 10.1016/j.comppsych.2016.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 08/21/2016] [Accepted: 09/07/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Complicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG. METHODS 151 adults with CG, enrolled in a randomized controlled trial comparing the effectiveness of (CG) treatment to that of interpersonal therapy, were assessed by means of the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HAM-D), the Work and Social Adjustment Scale (WSAS), the Adult Separation Anxiety Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Impact of Events Scale (IES). RESULTS 104 (68.9%) individuals with CG were considered to have SEPAD (ASA-27 score ≥22). Individuals with SEPAD were more likely to have reported a CG related to the loss of another close relative or friend (than a parent, spouse/partner or a child) (p=.02), as well as greater scores on the ICG (p=<.001), PDEQ (p=.004), GRAQ (p<.001), intrusion (p<.001) and avoidance (p=<.001) IES subscales, HAM-D (p<.001) and WSAS (p=.006). ASA-27 total scores correlated with ICG (p<.0001), PDEQ (p<.001) GRAQ (p<.0001) scores and both the IES intrusion (p<.0001) and IES avoidance (p<.0001) subscale scores. People with SEPAD had higher rates of lifetime post-traumatic stress disorder (PTSD) (p=.04) and panic disorder (PD) (p=.01). CONCLUSIONS SEPAD is highly prevalent among patients with CG and is associated with greater symptom severity and impairment and greater comorbidity with PTSD and PD. Further studies will help to confirm and generalize our results and to determine whether adult SEPAD responds to CG treatment and/or moderates CG treatment response.
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Affiliation(s)
- Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | | | | | - Julie Khaler
- Columbia University School of Social Work, NY, U.S.A
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Silove DM, Tay AK, Tol WA, Tam N, Dos Reis N, da Costa Z, Soares C, Rees S. Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence. J Affect Disord 2016; 205:292-300. [PMID: 27552593 DOI: 10.1016/j.jad.2016.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 06/19/2016] [Accepted: 07/09/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adult separation anxiety (ASA) symptoms are prevalent amongst young women in low and middle-income countries and symptoms may be common in pregnancy. No studies have focused on defining distinctive patterns of ASA symptoms amongst pregnant women in these settings or possible associations with trauma exposure and ongoing stressors. METHODS In a consecutive sample of 1672 women attending antenatal clinics in Dili, Timor-Leste (96% response), we assessed traumatic events of conflict, ongoing adversity, intimate partner violence (IPV), ASA, post-traumatic stress disorder (PTSD) and severe psychological distress. Latent Class Analysis was used to identify classes of women based on their distinctive profiles of ASA symptoms, comparisons then being made with key covariates including trauma domains of conflict, intimate partner violence (IPV) and ongoing stressors. RESULTS LCA yielded three classes, comprising a core ASA (4%), a limited ASA (25%) and a low symptom class (61%). The core ASA class reported exposure to multiple traumatic losses and IPV and showed a pattern of comorbidity with PTSD; the limited ASA class predominantly reported exposure to ongoing stressors and was comorbid with severe psychological distress; the low symptom class reported relatively low levels of exposure to trauma and stressors. LIMITATIONS The study is cross-sectional, cautioning against inferring causal inferences. CONCLUSIONS The core ASA group may be in need of immediate intervention given the high rate of exposure to IPV amongst this class. A larger number of women experiencing a limited array of non-specific ASA symptoms may need assistance to address the immediate stressors of pregnancy.
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Affiliation(s)
- D M Silove
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - A K Tay
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | - W A Tol
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - N Tam
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia
| | | | | | - C Soares
- Alola Women's Foundation, Timor-Leste
| | - S Rees
- Psychiatry Research and Teaching Unit, University of New South Wales, Academic Mental Health Unit, Level 2, Mental Health Centre, Liverpool Hospital, Sydney, New South Wales 2170, Australia.
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Silove D, Manicavasagar V, Pini S. Can separation anxiety disorder escape its attachment to childhood? World Psychiatry 2016; 15:113-5. [PMID: 27265693 PMCID: PMC4911766 DOI: 10.1002/wps.20336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | | | - Stefano Pini
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
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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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Tasdemir A, Tamam L, Keskin N, Evlice YE. Assessment of co-morbidity of adult separation anxiety in patients with bipolar disorder. Nord J Psychiatry 2016; 70:93-102. [PMID: 26107408 DOI: 10.3109/08039488.2015.1053098] [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: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess the co-morbidity of adult separation anxiety in bipolar patients and evaluate its effects on the course of disorder and functionality. METHOD A total of 70 patients who have been regularly followed in the Bipolar Disorder Unit were included in the study. The Structured Clinical Interview for DSM-IV - Axis I and Axis II disorders and demographic form were used. Separation anxiety was investigated by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Hamilton Anxiety Rating Scale (HAM-A) was filled out by an interviewer. In addition, all patients completed the Bipolar Disorder Functioning Questionnaire (BDFQ), Separation Anxiety Symptom Inventory (SASI) and Adult Separation Anxiety Questionnaire (ASA). RESULTS The prevalence rate of co-morbid adult separation anxiety disorder (A-SepAD) was 54% (n = 38) in our sample. Age of onset was in adulthood among 36% of patients with a diagnosis of A-SepAD and the others (64%) were childhood-onset. Co-morbidity of personality disorders was more common in bipolar patients with childhood-onset separation anxiety disorder (C-SepAD). The lifetime prevalence of co-morbidity of specific phobias and number of suicide attempts were significantly higher in the group with A-SepAD. Functionality loss due to feeling of stigmatization was higher, and total functionality as measured by the BDFQ was found to be lower in bipolar patients with A-SepAD. CONCLUSION The results of this study have shown that 54% of bipolar patients had a diagnosis of A-SepAD. A-SepAD seems to increase the number of suicide attempts and have negative effects on functionality. A-SepAD should be assessed in regular interviews of patients with bipolar disorder.
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Affiliation(s)
- Ali Tasdemir
- a Ali Tasdemir, Cukurova University Faculty of Medicine Department of Psychiatry , Adana , Turkey
| | - Lut Tamam
- b Lut Tamam, Cukurova University Faculty of Medicine Department of Psychiatry , Adana , Turkey
| | - Necla Keskin
- c Necla Keskin, Cukurova University Faculty of Medicine Department of Psychiatry , Adana , Turkey
| | - Yunus Emre Evlice
- d YunusEmre Evlice, Cukurova University Faculty of Medicine Department of Psychiatry , Adana , Turkey
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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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Silove D, Alonso J, Bromet E, Gruber M, Sampson N, Scott K, Andrade L, Benjet C, de Almeida JMC, De Girolamo G, de Jonge P, Demyttenaere K, Fiestas F, Florescu S, Gureje O, He Y, Karam E, Lepine JP, Murphy S, Villa-Posada J, Zarkov Z, Kessler RC. Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey. Am J Psychiatry 2015; 172:647-56. [PMID: 26046337 PMCID: PMC5116912 DOI: 10.1176/appi.ajp.2015.14091185] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. METHOD The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. RESULTS Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. CONCLUSIONS Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.
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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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Adult separation anxiety and TCI-R personality dimensions in patients with anxiety, alcohol use, and gambling: a preliminary report. BIOMED RESEARCH INTERNATIONAL 2014; 2014:680985. [PMID: 25105134 PMCID: PMC4106061 DOI: 10.1155/2014/680985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/19/2014] [Indexed: 11/26/2022]
Abstract
Background. Nowadays, adult separation anxiety disorder (ASAD) is an established diagnostic category but is little investigated in subjects with addictive behaviours. Objective. To assess the presence of ASAD among patients with addictive disorders in comparison with anxiety patients and measure the personality correlates in all these groups. Methods. 103 outpatients, meeting DSM-IV-TR criteria for anxiety disorders (38 patients), alcohol dependence (30 patients), or pathological gambling (35 patients), were assessed by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Adult Separation Anxiety Checklist (ASA-27) for separation anxiety and by the Temperament and Character Inventory-Revised (TCI-R) for personality characteristics. Results. ASAD is detected in 34.2% of anxiety patients, 13.3% of alcoholics, and 11.4% of gamblers. Separation anxiety scores correlate positively with harm avoidance and negatively with self-directedness in all groups; further correlations are seen among addictive patients only, that is, self-transcendence for gamblers and cooperativeness for both alcoholics and gamblers. Conclusions. The prevalence of ASAD is lower among addictive patients than in those with anxiety disorders; correlations are found between separation anxiety and specific TCI-R dimensions, with some matching across the three diagnostic groups.
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Redlich R, Grotegerd D, Opel N, Kaufmann C, Zwitserlood P, Kugel H, Heindel W, Donges US, Suslow T, Arolt V, Dannlowski U. Are you gonna leave me? Separation anxiety is associated with increased amygdala responsiveness and volume. Soc Cogn Affect Neurosci 2014; 10:278-84. [PMID: 24752071 DOI: 10.1093/scan/nsu055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The core feature of separation anxiety is excessive distress when faced with actual or perceived separation from people to whom the individual has a strong emotional attachment. So far little is known about the neurobiological underpinnings of separation anxiety. Therefore, we investigated functional (amygdala responsiveness and functional connectivity during threat-related emotion processing) and structural (grey matter volume) imaging markers associated with separation anxiety as measured with the Relationship Scale Questionnaire in a large sample of healthy adults from the Münster Neuroimaging Cohort (N = 320). We used a robust emotional face-matching task and acquired high-resolution structural images for morphometric analyses using voxel-based morphometry. The main results were positive associations of separation anxiety scores with amygdala reactivity to emotional faces as well as increased amygdala grey matter volumes. A functional connectivity analysis revealed positive associations between separation anxiety and functional coupling of the amygdala with areas involved in visual processes and attention, including several occipital and somatosensory areas. Taken together, the results suggest a higher emotional involvement in subjects with separation anxiety while watching negative facial expressions, and potentially secondary neuro-structural adaptive processes. These results could help to understand and treat (adult) separation anxiety.
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Affiliation(s)
- Ronny Redlich
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Dominik Grotegerd
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Nils Opel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Carolin Kaufmann
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Pienie Zwitserlood
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Harald Kugel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Walter Heindel
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Uta-Susan Donges
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Thomas Suslow
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany Department of Psychiatry, University of Muenster, Albert Schweizer-Campus 1, G 9A, 48149 Muenster, Germany, Department of Psychology, University of Muenster, Fliednerstr. 21, 48149 Muenster, Germany, Department of Clinical Radiology, University of Muenster, Albert Schweizer-Campus 1, G A1, 48149 Muenster, Germany, Department of Psychosomatic Medicine, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany, and Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
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Bögels SM, Knappe S, Clark LA. Adult separation anxiety disorder in DSM-5. Clin Psychol Rev 2013; 33:663-74. [DOI: 10.1016/j.cpr.2013.03.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/27/2022]
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Affiliation(s)
- Vladan Starcevic
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
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Affiliation(s)
- Claire Marnane
- School of Psychiatry, University of New South Wales, Randwick, Australia.
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Silove D, Marnane C. Overlap of symptom domains of separation anxiety disorder in adulthood with panic disorder-agoraphobia. J Anxiety Disord 2013; 27:92-7. [PMID: 23247205 DOI: 10.1016/j.janxdis.2012.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 09/26/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
There is a need to explain the high level of comorbidity between separation anxiety disorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood.
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Affiliation(s)
- Derrick Silove
- School of Psychiatry, University of New South Wales, Randwick, Australia.
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Hypersensitivity to 35% carbon dioxide in patients with adult separation anxiety disorder. J Affect Disord 2012; 141:315-23. [PMID: 22542862 DOI: 10.1016/j.jad.2012.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/21/2012] [Accepted: 03/22/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adults with panic disorder (PD) and children with separation anxiety disorder (CSAD) show higher reactivity to CO(2). Our hypothesis was patients with adult separation anxiety disorder (ASAD) would show similar hypersensitivity to CO(2). In the present study, we determined whether sensitivity to CO(2) was enhanced in adult patients with separation anxiety disorder with no history of panic attacks. METHODS Patients with PD (n=38), adult separation anxiety disorder (ASAD) patients with no history of panic attacks (n=31), and healthy subjects (n=40) underwent a 35% CO(2) inhalation challenge procedure. Baseline and post-inhalation anxiety were assessed with the Acute Panic Inventory, Visual Analog Scale, and Anxiety Sensitivity Index-3 (ASI-3). RESULTS As hypothesized the rate of CO(2)-induced panic attacks was significantly greater in PD and ASAD patient groups (55.3% and 51.6% respectively) than healthy comparison group (17.5%). Nine (69.2%) of 13 patients in PD group who have ASAD concurrent with PD had a CO(2)-induced panic attack. ASI-3 total scores were not different between PD and ASAD groups and both were significantly higher than controls. However, anxiety sensitivity did not predict the occurrence of panic attacks. LIMITATIONS The researchers were not blind to the diagnosis and there was no placebo arm for comparison. Besides, parameters of respiratory physiology were not evaluated. CONCLUSION ASAD was associated with CO(2) hypersensitivity quite similar to PD. This finding partly unfolds the complex relationship of 'CSAD, PD, and CO(2) hypersensitivity' and indicates that CO(2) hypersensitivity and separation anxiety extend together beyond childhood.
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Mertol S, Alkın T. Temperament and character dimensions of patients with adult separation anxiety disorder. J Affect Disord 2012; 139:199-203. [PMID: 22440427 DOI: 10.1016/j.jad.2012.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is growing evidence suggesting that separation anxiety can occur in adults. We aimed to determine temperament and character dimensions in patients with adult separation anxiety disorder (ASAD) compared to patients with panic disorder (PD) and healthy subjects. METHODS The study sample included 77 outpatients with ASAD, 44 outpatients with a PD with or without agoraphobia diagnosis, and 35 healthy subjects. ASAD diagnoses were confirmed with Structured Clinical Interview for Separation Anxiety Symptoms. Other measures included Adulthood Separation Anxiety Checklist, Separation Anxiety Symptom Inventory, and Temperament and Character Inventory (TCI). Group comparisons according to presence or absence of PD comorbidity in ASAD were also done. RESULTS Patients with ASAD scored higher in harm avoidance (HA) and scored lower in self-directedness (SD) compared to PD and control groups. Moreover, both PD patients and ASAD patients scored higher in RD, and self-transcendence dimensions than control subjects. All subscales of HA (anticipatory worry, fear of uncertainty, shyness, and fatigability) were significantly higher than controls. While HA scores were not different between ASAD and 'ASAD+PD' patients, HA levels of both groups were higher than PD alone and control groups. SD scores of patients with ASAD were lower than PD and control groups. LIMITATIONS Cross-sectional design and ASAD group have other anxiety disorders comorbidity which might affect the results. CONCLUSION Similar to PD and other anxiety disorders HA and RD was higher, and SD was lower in patients with ASAD compared to healthy subjects. Observed TCI profile is related to the ASAD itself since depression comorbidity was controlled.
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Eapen V, Silove DM, Johnston D, Apler A, Rees S. Adult separation anxiety in pregnancy: how common is it? Int J Womens Health 2012; 4:251-6. [PMID: 22723732 PMCID: PMC3379859 DOI: 10.2147/ijwh.s30981] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The present study, the first to examine adult separation anxiety (ASA) in the context of pregnancy, found that ASA is a common yet unrecognized condition. Women attending an antenatal clinic were evaluated for the presence of ASA. A quarter of the women reached an established symptom threshold for ASA, with significantly more primigravida women (P = 0.003) identified as having the problem. There were no significant differences in the sociodemographic characteristics between those with and without ASA. Around one-third acknowledged that ASA was causing significant impairment in day-to-day functioning, suggesting the clinical importance of the pattern. Further research is indicated to explore this clinical entity and its impact on maternal and infant psychosocial wellbeing.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney
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Manicavasagar V, Marnane C, Pini S, Abelli M, Rees S, Eapen V, Silove D. Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep 2010; 12:290-7. [PMID: 20552302 DOI: 10.1007/s11920-010-0131-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article explores accruing evidence supporting the occurrence of an adult form of separation anxiety disorder (ASAD), a category yet to be recognized by international classification systems. ASAD can have its first onset in adulthood, although in a portion of cases, it represents a persistence or recurrence of the childhood-onset type. Recent large-scale clinic studies have suggested that ASAD is associated with high levels of disability. In addition, the presence of ASAD in individuals with anxiety disorders seems to signal a poor outcome to cognitive-behavioral therapy. The existing evidence suggests possible grounds for removing the childhood-onset requirement for the category of separation anxiety disorder, thereby allowing for first onset in adulthood. There is a pressing need to design and test appropriate treatments for ASAD and to educate clinicians to identify and manage the condition.
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Affiliation(s)
- Vijaya Manicavasagar
- School of Psychiatry, Prince of Wales Hospital, University of New South Wales and Black Dog Institute, Randwick, New South Wales 2031, Australia.
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