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Separation Anxiety Disorder in Adulthood: Often Undetected

It differs from development-related separation anxiety in childhood in that it is no longer functional in the sense of ensuring survival. So far, there has been little research into separation anxiety disorder in adults.

Young children start crying when they are separated from a caregiver. Their reaction is quite functional because it ensures their survival. In the course of childhood and adolescence, however, most people learn to deal with breakups, so that the initial separation anxiety largely disappears.

Since separation anxiety is widespread in childhood, it is also well described and researched. However, it is less well known that adults suffer from separation anxiety as well. It differs from the normal, developmental separation anxiety in childhood in that it is no longer functional in the sense of ensuring survival; in addition, it does not grow out, but persists and has the character of a disorder. One speaks therefore of a separation anxiety disorder.

The main symptom of the disorder is an excessive fear of being separated or abandoned by important people. While these important people in childhood are typically the parents, in adulthood separation anxiety relates to partners, family members, and friends.

The causes are manifold. For example, one assumes a strong genetic influence. In addition, the attachment and parenting style as well as interactions and conflicts in the family of origin, model learning, trauma and personality traits play a role. In some cases, the disorder continues from childhood into adulthood. It is often triggered by the threatened or experienced loss of an important person, for example as a result of a divorce or a death.

"Living with the disorder is stressful and full of limitations," say clinical psychologists working with Susan Bögels from the University of Amsterdam, Netherlands. Research shows that the majority of those affected live alone and that their relationships often fail. In addition, many are unable to pursue a job and regulate their everyday lives. Those affected suffer from pronounced fears, worries and panic attacks, sleep disorders and obsessive thoughts and actions. They are convinced that they cannot live without a certain person and feel that their quality of life is severely impaired if they are separated from that person, even for a short period of time. In addition, most have additional mental health disorders, such as anxiety and personality disorders, bipolar and obsessive-compulsive disorder, depression, and addictions.

Separation anxiety disorder in adulthood is often not recognized. Instead, diagnoses such as "depression" or "anxiety disorder" are made, with the result that no treatment takes place or incorrect treatment takes place. However, this can result in treatment for comorbid disorders not being successful or in a more likely onset of mental illnesses such as depression, anxiety disorders, or schizophrenia. "Separation anxiety disorder seems to be a vulnerability factor for all types of mental disorders," says psychiatrist Prof. Dr. Katherine Shear from Columbia University, USA.

Separation anxiety disorder manifests itself in manifestations that do not always allow direct conclusions to be drawn about the diseases. For example, an excessively strict upbringing of a child can be intended to take full control of his or her life so that one day it does not go its own way. The fear of separation can also cause jealousy of the partner, which is expressed in irrational suspicions, brackets and excessive control behavior. The inability to separate from one's parents as an adult and to start a life of one's own or to accept the parents' aging and death can also be seen as an expression of the disease. The disorder can also keep people in relationships that are harmful to them. In addition, separation anxiety disorder can manifest itself in the compulsive need to do everything together with the partner or friend, with the result that those affected often have to take part in activities of the caregiver that they are not really interested in, or that the partner or Friends feel overwhelmed by being too close - many partnerships and friendships cannot stand this in the long run.

Separation anxiety disorder is one of the anxiety and panic disorders. Around a third of adults have suffered from it since childhood, but two thirds of those affected only develop the disease in adulthood. This is special because most anxiety disorders start in childhood. More women than men are affected.

Shear and her colleagues, using a representative survey of the US population, found that approximately 6.6 percent of all adults have the disorder at least once in their life, meaning that millions of adults around the world are believed to be occasionally or permanently affected. However, scientists, doctors and psychotherapists have hardly noticed this, because little research has been carried out into separation anxiety disorder in adulthood, and there are still no specific treatments or therapy manuals. Instead, experiments are carried out, for example with psychotropic drugs (including antidepressants), cognitive-behavioral procedures (including exposure, systematic desensitization) or relaxation procedures. However, there is evidence that many patients do not respond particularly well to these traditional methods of anxiety management. There is therefore no way around paying more attention to separation anxiety disorder in adulthood than before and developing appropriate interventions.

Dr. phil. Marion Sonnenmoser

Bögels S, Knappe S, Clark LA: Adult separation anxiety disorder in DSM-5. Clinical Psychology Review 2013; 33: 663-74 CrossRefMEDLINE
Kins E, Soenens B, Beyers W: Separation anxiety in families with emerging adults. Journal of Family Psychology 2013; 27: 495-505 CrossRefMEDLINE
Shear K, Jin R, Meron Ruscio A, Walters E, Kessler R: Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. American Journal of Psychiatry 2006; 163: 1074-83 CrossRefMEDLINE PubMed Central