Separation Anxiety Disorder: Latest Medical Breakthroughs

Wednesday, 03 Nov 2010 09:36 AM

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Separation anxiety disorder is a psychological condition where an individual has excessive and often disrupting, disabling distress and anxiety about separation from home or from people with whom the person has a strong emotional connection. It is often confused with separation anxiety that occurs in young children.
 
For the psychiatric community, separation anxiety disorder in adults did not exist a few years ago. However, this disorder is now accepted. As part of the ground-breaking research from the Psychiatry Research and Teaching Unit, Liverpool Hospital, New South Wales, Australia, V. Manicavasagar recognized adult separation anxiety disorder (ASAD) as a specific mental disorder some years ago. He described patients suffering from adult separation anxiety disorder as exhibiting, “…wide-ranging separation anxiety symptoms, such as extreme anxiety and fear when separated from major attachment figures, avoidance of being alone, and fears that harm will befall those close to them.” The major attachment figures could include a spouse, a friend, or a parent.
 
Katherine Shear, a professor of psychiatry at Columbia University, illustrates separation anxiety disorder in adults with her case study of Stacy, who could not bear being out of touch with her husband despite knowing she was behaving irrationally
 
Separation Anxiety Disorder Breakthroughs:
Separation Anxiety Disorder in adults was only recently recognized as a separate problem from that in children. The research was completed as recently as 2009. Manicavasagar says that it, “… finally dispels the notion that separation anxiety and anxious attachment are relevant to panic disorder with agoraphobia, suggesting instead that that constellation is confined to a separate group, namely that of adult separation anxiety disorder.”
 
The reason that separation anxiety disorder in adults is not diagnosed may include:
  • The Diagnostic and Statistical Manual of Mental Disorders (4th edition) mentions it as a part of childhood SAD. The manual was published in 1994, long before ASAD research started.
  • Confusing separation anxiety disorder in adults with other disorders and mistaking it for other anxiety or mood disorders.
A study by Katherine Shear and her colleagues (2006) shows that separation anxiety disorder in adults is actually more prevalent than childhood separation anxiety disorder. According to the study, childhood separation anxiety disorder was seen in 4.1 percent of children, while separation anxiety disorder in adults was estimated to stand at 6.6 percent of the American population. Because separation anxiety is rarely diagnosed in adults, Shear believes this estimate to be conservative.
 
In terms of the onset of separation anxiety, approximately one-third of adults exhibited childhood separation anxiety disorder. At least 77.5-78 percent of ASAD patients had the first onset of anxiety during childhood. Moreover, adults in the age group of 30 to 44 seem to be more prone to the onset of ASAD.
 
More adult women exhibit signs of separation anxiety disorder than men. This is despite the fact that men are more likely to suffer from ASAD later. Both childhood and adult separation anxiety runs in families. According to Manicavasagar, “Sixty-three percent of children diagnosed with juvenile separation anxiety disorder had at least one parent who suffered from the putative adult variant of the disorder. Affected parents reported high levels of separation anxiety in their own childhoods.”
 
Education, employment, and marital status play an important role in the case of separation anxiety disorder in adults. Separation anxiety disorder in adults often conjoins other disorders, especially anxiety disorders and mood disorders. Approximately 91.1 percent of people with ASAD could be having at least one other mental disorder, research suggests. The pioneering researcher Katherine Shear says, “I think that separation anxiety disorder is a vulnerability factor for all kinds of mental health problems.”
 
For psychiatrists, the field of anxiety disorder research is vast. The treatment for ASAD relies on the treatment for other anxiety disorders. At present, the treatment is only in its initial stages, and there are no FDA-approved drugs for separation anxiety disorder. Current drugs are mostly used to deal with co-occurring disorders rather than solely treating separation anxiety disorder in adults. Cognitive-behavioral treatments (CBTs) are to be fine-tuned and made efficacious to provide better ways to cope with the disorder.
 
Resources for further study:
 
1. Separation anxiety in adulthood: a phenomenological investigation.
Manicavasagar V, Silove D, Curtis J.
http://www.ncbi.nlm.nih.gov/pubmed/9298320?dopt=Abstract

2. Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication
Katherine Shear, M.D., Robert Jin, M.A., Ayelet Meron Ruscio, Ph.D., Ellen E. Walters, M.S., and Ronald C. Kessler, Ph.D.
http://ajp.psychiatryonline.org/cgi/content/full/163/6/1074

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