Artwork by Cristine Cambrea
Adult Separation Anxiety Disorder (ASAD) did not exist 15 years ago, at least as far as the psychiatric community was concerned.
Separation Anxiety Disorder is well recognized as a psychiatric disorder of childhood, but it is rarely diagnosed in adults. Yet the core symptoms of Separation Anxiety — excessive and often disabling distress when faced with actual or perceived separation from major attachment figures — may persist or even arise during adulthood.
A recent study led by Katherine Shear found that the adult lifetime estimate for ASAD was a conservative 6.6 percent of the American population. That’s 20,207,408 adults who will suffer with ASAD in their lifetimes! In contrast, only 4.1 percent of children will have childhood Separation Anxiety Disorder.
This two-part post accompanies the posting of the reference article on Adult Separation Anxiety Disorder. The current post is the first of two. The two posts are a short version of the reference article, which has full information about the disorder. The information in this post falls under the following headings:
- Just what is Adult Separation Anxiety Disorder?
- How many people have Adult Separation Anxiety Disorder?
- What are the diagnostic criteria for Adult Separation Anxiety Disorder?
Tomorrow’s post continues with these headings:
- How does Adult Separation Anxiety Disorder affect your life?
- Adult Separation Anxiety Disorder and other mental disorders
- What is the treatment for Adult Separation Anxiety Disorder?
Just what is Adult Separation Anxiety Disorder?
Fear of being separated from others is the core symptom
ASAD has only been recognized as a specific mental disorder since the late 90’s, with the pioneering work of Vijaya Manicavasagar.. He said in 1997 that:[1]
[A]dults may experience: 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. … Separation anxiety disorder may be a neglected diagnosis in adulthood.
If Americans were asked to give examples of ASAD, they might cite the classic Hollywood film “Casablanca,” where Ilsa (Ingrid Bergman) clings to Rick (Humphrey Bogart) shortly before they part forever. Or they might point to the Hollywood thriller “Psycho,” where lead character Norman Bates (Anthony Perkins) sleeps next to his mother long after she has died.[2]
A sample case of ASAD is that of “Stacy,” who was treated by Katherine Shear successfully (see “What is the treatment for Adult Separation Anxiety Disorder?” below):[3]
Stacy (not her real name) was an accomplished professional woman in her 30’s. But she couldn’t stand not knowing exactly where her husband was, or being away from him for long. She disliked golf, but accompanied him to every weekend game. It got so bad that if she couldn’t immediately contact him at work, she would leave her own office to find him, even though she knew she was behaving irrationally. She just couldn’t bear being out of touch.
How many people have Adult Separation Anxiety Disorder?
Almost 7% of adults have ASAD
A new finding that rocks the boat is that ASAD is actually more prevalent than childhood Separation Anxiety Disorder. Katherine Shear and her colleagues produced a groundbreaking study of ASAD in 2006. She found that, while the lifetime estimate of childhood Separation Anxiety Disorder was 4.1 percent, the adult estimate for ASAD was 6.6 percent. [4]
Approximately one-third of adults (36.1 percent) had a childhood case of Separation Anxiety Disorder that persisted into childhood. However, the vast majority (77.5 percent) of adults with ASAD had its first onset of the disorder in adulthood. The ages of onset of ASAD are ranked as follows:[5]
- 30-44 years at onset
- 18-29 years at onset
- 45-59 years at onset
- 60+ years at onset
What are the diagnostic criteria for Adult Separation Anxiety Disorder?
The DSM-IV only mentions ASAD in passing
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of the American Psychiatric Association is the standard used in the US and UK for diagnosing mental disorders. Since it was published last in 1994, it does not treat ASAD as a separate diagnosis.
The diagnostic criteria for Separation Anxiety Disorder in the DSM-IV are as follows. Note that adults are mentioned only in section “E,” and childhood ages are stated specifically in “C”:[6]
A. Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:
- Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.
- Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.
- Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure(e.g.; getting lost or being kidnapped).
- Persistent reluctance or refusal to go to school or elsewhere because fear of separation.
- Persistent and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings.
- Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home.
- Repeated nightmares involving the theme of separation.
- Repeated complaints of physical symptoms (such as headaches, stomach aches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated.
B. The duration of the disturbance is at least 4 weeks.
C. The onset is before age 18 years.
D. Part 1 OR Part 2
- Part 1. The disturbance causes clinically significant distress.
- Part 2. The disturbance causes clinically significant impairment in social, academic (occupational), or other important areas of functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder with Agoraphobia.
What do you think?
People have been living with ASAD for thousands of years. It seems odd to me that it has only been diagnosed as a separate Anxiety Disorder in the past 15 years.
Although it is relatively new diagnosis (about 7 percent of the population), it has been one of the most popular and persistent terms in my search engine requests. This shows that people are hungry for information about it, since there is not much information out there. An indication of this is how long it took me to research and write the reference article: over 30 hours!
- Do you know anybody that you think has ASAD?
- Do you think that ASAD deserves a separate diagnosis, or is it just human nature?
Artwork by Cristine Cambrea, found at Bucks County Gallery of Fine Art
As always, your comments are welcome!
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FOOTNOTES
1. Manicavasagar, Vijaya; Silove, Derrick; Curtis, J. (1997, September). Separation anxiety in adulthood: a phenomenological investigation. Retrieved April 6, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/9298320?dopt=Abstract ↑
2. Arehart-Treichel, Joan. (2006, July 7). Adult Separation Anxiety Often Overlooked Diagnosis. Retrieved April 1, 2009 from http://pn.psychiatryonline.org/cgi/content/full/41/13/30 ↑
3. Szalzvitz, Maia. (2006). Pathological Clinginess: Study: Adult Separation Anxiety Disorder is prevalent yet poorly understood. Retrieved April 1, 2009 from http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100235522 ↑
4. Shear, Katherine; Jin, Robert; Meron Ruscio, Ayelet; Walters, Ellen; Kessler, Ronald. (2006, June). Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication. Retrieved April 1, 2009 from http://ajp.psychiatryonline.org/cgi/content/full/163/6/1074 Table 1 ↑
5. Shear, Katherine.(2006, June). Table 2 ↑
6. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Association. 1994. ↑
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{ 25 comments… read them below or add one }
Count me among the ranks that had never heard of ASAD – but it’s pretty darn interesting, and I’ve certainly seen (and had) mild/temporary versions. Those examples were likely below the ‘clinical diagnosis’ level, but it still helps to have a label.
Tori Deaux’s last blog post..Monsters, Movies and Menaces: The Horror Film of Personal Growth & Project Launches
Thanks for your comment, Tori!
I’ve known numbers of people who were labeled “needy,” “clinging,” or “insecure.” I’m sure they have symptoms of ASAD, if they do not meet the criteria for a full-blown diagnosis. Between you and me, I just call them “annoying” and have tried to avoid them. But for some reason they seem attracted to me!
In tomorrow’s post, part 2, there is some discussion of ongoing research into what “symptoms” are normal under dire circumstances or cultural mores, and what is not.
I think I’ve seen mild examples, too but it seemed more like possessiveness or jealousy or excessive nervousness at the time. I guess the class example I can think of in my mind is the spouse that has to tag along everywhere and pitches a fit if the partner has to go out of town. Or, actually I can think of a couple of mothers who I think have separation anxiety with their children and infants, well beyond what I’d consider normal mom jitters at leaving a child with another caregiver.
Not sure what I think about it being a diagnosis, I don’t really have the training to give a real answer. I will say that as a parent of a child with fairly significant developmental disorders it does annoy me when parents of children with what I’d consider very mild forms diagnose their children themselves. Perhaps I should think about why I find it so annoying.
I’ll be interested in reading tomorrow about the cultural factors as it seems like every case I can think of has been a woman. Is it more socially acceptable for women to express these kinds of feelings? Or is it better masked when a man has them because of cultural mores?
Tracy’s last blog post..My First Life Coaching Session
Thank you, Tracy for your comment!
The diagnosis of Adult Separation Anxiety Disorder is so new that many mental health professionals are uncertain about it, too — especially the ones that don’t keep current in the professional journals. So don’t feel bad; a lot of people who should know don’t! Maybe I shouldn’t have asked that question under these circumstances.
Self-diagnosis bothers me a lot, too. You see it a lot in the mental health field. Many people who have never darkened the door of a psychiatrist’s office diagnose themselves, substituting for real knowledge half-truths, pop psychology, and the warped information that comes from television.
And it bugs the stew out of me for people to bandy about terms such as “OCD,” “autistic,” and “schizophrenic” in a kidding way. It, to me at least, shows gross insensitivity and a foolish ignorance of what these disorders are. But don’t get me started.
There’s a lot of research going on right now about cultural factors involved in ASAD, but no reports yet, unfortunately. Tomorrow’s post has information on what’s ahead for research on ASAD.
Women are much more likely to have ASAD than men. I speculate that it is more socially acceptable to express separation- and anxiety-type feelings for women than for men. I also wonder whether men who deliberately isolate their wives and friends from others have some symptoms of ASAD, if not the full-blown disorder. They cannot express these feelings themselves, so they separate others from the outside world through blustering and even physical violence.
Heh, Mike one day we could go sit down and have a drink or coffee and have our self diagnosis rant session. I also don’t care for people using terms like OCD to describe normal behavior.
I was thinking the same thing about how men might express ASAD symptoms differently. I’m guessing that the pressure to hide the symptoms on little boys that have these sorts of tendencies is different than on little girls.
The whole idea of cultural influences having an impact on how mental illnesses are perceived is fascinating.
Tracy’s last blog post..My First Life Coaching Session
Tracy: again, thanks for commenting!
You said, “The whole idea of cultural influences having an impact on how mental illnesses are perceived is fascinating.”
It is fascinating. Unfortunately, most of the time — at least in the American culture — those influences are negative, contributing to the stigma of mental illness. This is a real hot button for me, and I have forced myself not to write about it too often, so as not to bore my readers!
But if you’re interested, there are a bunch of articles I have written. Just enter “stigma” in the search box.
Mike’s last blog post..Adult Separation Anxiety Disorder: Not Just Kids, Part 2
i have read the symtoms and now know that i am not crazy as me and my daughter and 2 grandchildren haven’t seen one another for almost 8 mo. now. i have alot of these synptoms.Thank you so much for your helping me to know that this is normal and others do go through it also. Thank You so Ver, Very much for the information.
Thank you, Judy for your comment. It is gratifying to know that I have helped you in some small way. I do hope that you get to see your daughter and grandchildren soon.
One of the most commonly reported features of mental disturbances is the feeling of being alone, of feeling that no one else ever has had or ever will have the same experiences. And it is a universal relief to know that millions of others have suffered the same pains and heartache.
And just naming symptoms can be a great relief. In all the confusion of suffering, it can help to sort out your feelings to be able to hold on to some named symptoms.
It sometimes seems perverse to know that shared suffering is a comfort, but it is. It’s just one more reason to cling to the ideal that we should be there for each other and support one another in this bewildering journey called life.
I must say, that of all the panic attack blogs and anxiety disorder blogs I have read, this is the best and most informative one.
evl, thank you for the compliment! And thanks for dropping by — I hope to see you often!
You might want to dig deeper into the site using the “Category” tab at the top of each page. You can also do a search on the site using the search box.
Hi Mike,
Great information on ASAD. Thank you. I have been doing some research into my own feelings of anxiety lately. I have been in a long distance relationship for nearly a year now and have terrible anxiety when i return home after seeing my partner. We live on opposite sides of the planet. We can only see each other twice a year. I grave his presence, which leads to my anxiety. I dont know how to get my feelings under control.
Thank you, Melissa, for your comment and for the compliments!
It is really sad that you and your partner are separated by such a distance! I hope, for both of your sakes, that the situation can be resolved soon.
It is only natural to grieve and be anxious about your partner under such circumstances. And indeed, our feelings do seem to get out of control when things get bad.
You didn’t provide enough information (which is ok) for me to say more than this. I’m sorry if what I’ve said sounds sophomoric — I’m very empathetic of your situation. My daughter and her husband have been torn apart by circumstances for almost a year and a half, and I’ve seen how she suffers daily due to the separation. She sees a therapist and takes medication, but sometimes — like this past week — the anxiety and grief almost overwhelm her. There’s a chance he will get to come home in a couple of months, but if he doesn’t, I am very concerned for her mental stability.
Therapists do more than treat mental disorders; they can be very helpful in situations such as yours to help you cope with the separation. Have you thought about seeing a mental health professional to help you get through this sad situation?
Please keep me informed of your progress. If you want to email me privately, you can use the “Contact” tab at the top of each page.
Hello there, this is such an interesting site. I suffer with separation anxiety – I have been with my husband now for 20 years and we have been very close throughout our relationship, to the point that we work together, commute together and travel together. However, it has now become that I get severe anxiety if he has to go away on a trip on his own without me. We have a family now and pets to look after so one of us has to be at home for them. I find that if I am the one that goes away on a business trip, I am ok, but if I am the one that stays at home to look after the family, then I suffer severely with anxiety to the point that I just cannot think straight, have shocking panic attacks and my thinking becomes impaired and irrational. I know that I am being irrational, but how does one overcome this. Does it stem from my childhood? My mother left when I was just 3 years old and a wicked step mum moved in. I never had any contact with my real mum until I was 18 and then found that we really did not have a great deal in common. I dont want to have anxiety separation, but how does one overcome it. Many thanks and please, please keep up the good work on this site. I had searched through many more before finding this one and feel somewhat better already to learn that I am not on my own, but when the time comes for my husband to go on another trip, I will be feeling anxious again!!!!! J. xx
So i think that i have a mild case of seperation anxiety. However i have linked it to me moving away from california where i had lived for the past 15 1/2 years with the same people. i moved all the way to georgia and that’s when i had a strong sense of anxiety when i started school. i would beg my mom to take me to school and pick me up for as long as i could but after a week and a half she refused and i had to ride the bus. i learned to cope with it the best way i could and found that messing with my earrings or bitting my fingers helped ease me some. however my anxiety has become less i also formed a new one in the process of getting that one. There would be times when i could not be home by myself because i would have anxiety attacks because i had a sense of fear that something bad would happen, not so to those that i loved but to me. it became became pretty bad to where i would have to go to a friends house almost every day until my parents came home. i dont feel this as much as i use to however i do find myself still having some cases where i cannot be alone and if i am i get very anxious and nervous.
Mike, Around 10 mo. ago I emailed you on my anxiety seperation disorder. Then, I didn’t know what was wrong with me until you helped me to put a label on it. I then knew that I wasn’t alone in the feelings that I was feeling and that it is an actual disorder. Since I was made aware of this, I am now doing much better and I owe it all to you! Even though, I have not been able to see my daughter or grandchildren, I have realized that it is my disorder. That it does probally stem from my chilhood. Being aware of this, I have accepted that I may never talk to my daughter or grandchildren again and am not so sure that I would want to for fear of this happpening again. I focus on different things now and when I catch myself obbsessing over this matter I quickly redirect my attention to something more productive. I can not let this take over the rest of my life and I am trying desperatly not too! Although it still hurts and I beleive it is an injustice to me, as well as my grandchildren . While living only 10 minutes apart, I do not go places where I may run into them. I guess avoidense has helped. I do owe it to you Mike. Had I never known of this disorder and been able to identify it with, what I was feeling, I may not be where I am at today. I now realize that because of this disorder I had such a problem with being away from my daughter and grandkids. This is my problem and my daughter probally isn’t giving it a second thought. Thank you so much Mike for doing the research that you do on seperation anziety disorders. Good luck to all the people whom share this disorder and I hope they too find ways to refocus and redirect their attention when the terrible feelings of being afraid, nerveousness, lost and just not knowing what is wrong or what to do with those feelings. Thank You much Mike and Please keep up your good work. I know that you have helped more people than just me. Please keep me updated, as it always helps to read about it. After all, knowledge really is power!!! Judy
I have it with my little sister.
It affects my life everyday.
i dont know how to stop it.
its affecting me in a bad way and i need help
i cant even go to school without her
I have seperation anxiety from my mom. I’m 16 . I’m so miserable. I want it to go away but I seem to not be able to control it. I haven’t gone to school for weeks. They want to put me into a residential program where i’d be seperated from my mom. But the anxious feelings inside me just don’t go away. I’d never judge anyone with any type of psychological problem because no one can understand unless they’ve felt this. It’s pain within ones self, and it’s uncontrolable. I just want to be freed.
Hi Mike. I am pretty sure I suffer from ASAD and know that I suffered from separation anxiety as a child. However, as a child you could scream and cry and people would come to your rescue. As an adult, I need to deal with the anxiety on my own and let it fester, which is terribly uncomfortable. For me, ASAD manifests itself most horribly in breakups. I think I have come to take control of my ASAD in terms of leaving my family, or leaving home for a while, and while there is always the initial nerves, I have mentally overcome them and they do not effect me severely or for long periods of time (there is always an adjustment period, but it gets shorter as I get older). On top of the fact that I know my family will always be there for me. In terms of breakups, this could be with a close friend or with a boyfriend, I am effected horribly. And for years and months I have stayed in bad relationships, wrapped up in a person, and allow them to put me on the back burner (and I put up with this treatment) because the relief of being with them and the relief of my anxiety, generally outweighs the negatives in the relationship. I also feel this ASAD with friends, and often get very upset when friendships have ending points. I struggle with this anxiety on a daily basis when I am single and it effects my work and I cannot focus, however, it subsides when I am around alot of people and close friends. Further, having plans to do something with someone and knowing that I will not be alone also reduces this anxiety. It completely disappears when I am with an ex-boyfriend. Although, hanging around ex boyfriends has become increasingly unhealthy and I want to take the final stance to move on-any suggestions as far as what to do to deal with this anxiety?
Mike, Since I last wrote to you about 71/2 mo ago, my boyfriend also left me and married another woman. I have become totally unclinging. I do not associate with anyone. When someone tries to just be a friend, I immediately think this won’t last so why go there? Is this normal? I have become very cautious and stay to myself. I do not want to get close to anyone. I still have not seen my daughter or grandchildren and don’t want to for fear seperation will happen again. Am I actually getting over this? However, this is no life. Thanks Mike. Judy
Hello Mike, I actually stumbled across a website called ‘Misdiagnosed’ last night and could not believe what i was reading was actually true. I am a 34yr. old woman that has been been diagnosed with bi-polar about 5 yrs ago. I think i need to back up a little bit first. My mom and dad divorced when i was 6 mos old. She raised me ( the best she could). I have a sister and brother that was with my dad. I very vaguely remember going there and the only 2 mental pics I have was having asthma attacks and my brother wanting to play “spin the bottle”. I was like 4yrs. old. there wasnt ever a hug from my dad tho. In 1992, i was 16, mom moved us to Arkansas. Not 6 mos later she attempted suicide while i was at school. I got into a fight that day and needed her and she was dying. Got her to the ER and they took her to a Mental hospital in Springfld. she never came back. i was homeless. I’m 34 now. I was married for 7 years. I got involved with a church for 6 of those years. I got very close to the pastors. i didnt trust them for like 3 yrs but when i did I thanked God for them. it was like I was given a second chance to be a loveable daughter. In 2003 they left and I was divorced the next year. (no attachment to my husband)? after my divorced I met I believe was my soul-mate. I hadnt been diagnosed with bipolar yet and was emotionally everywhere. I know that A.J. had gotten me thru the grieve of losing my pastors. we were engaged but I left him (for my kids-was my reasoning) in 2005. he was only 21 and i believed we would end up marriedd. He died Oct. 25, 2006. After he died I started having siezures. since the seizures my short term memory has been damaged. Ive never had a long term one. I do not remember 7th grade down and it’s vague. I got addicted to opiads from back surgery in 04. Ive overdosed many times and finally i wnt to a drug rehab and was released Oct. 6 2009/ I havent touched pills since but I still self medicate with alcohol ect. I got into a fast relationship and he left me because of a fight in walmart. seemed silly to me but i felt myself breaking. In the past month my blood pressure has been high. it’s been perfect my whole life until now. My anxiety level is sky high. I forgot, my mom moved back here 2 yrs ago b/c she heard i was bad since A.J. died. well, i started having a burning spot on the back of my left shoulder and it will go thr me under my breastbone. i get sharp pains that radiates thru my side and a little down my arm. hurts to breath in. i have asthma and its not that but different like my lung has collapsed. I havent felt it for like 3 days tho. it was concerning me cause i would just walk out to the car and be just exhausted and in pain. I suppose that’s my story up to this point and cant wait for some input. p.s. i left out about my girls. me being poor “insane” and “selfish”( according to this town) i have given their dad and his family permission to let them live there. we have joint cust. but I know I’m not fit. I see them at least 3 times a week and feel guilty at times. it sucks to not ever been given a chance to be a “normal” mother, daughter, wife or sister. But i have to accept that is wasnt in the cards for me. I now have a little hope for a peaceful mind. if i have seperation anxiety disorder you havent a clue the guilt that i dont have to have anymore. It will put a “stamp of approval” on me if you will.
Hi Mike,
I think I suffer with this disorder, because anytime Im in a relationship I never want to end it even when I know that its not a healthy relatinship and it not going any where. I have sat down an thought about this over the years and I feel like I continue to go back an forth with these unhealthy relationships because I don’t want to be alone. I always feel a scense of abondonment.
the publish seems to upward being great and really much helpful to the people along with repetitive searches for these kind of articles. Thank you really much.
I think this might be what i have. I am planning on moving to Canada, on my own and until i got my visa i was fine, but the minute this came through, i started feeling very scared at the prospect of moving so far away from my parents who live just 10 minutes away now. I was shaking and feeling nauseas and keep having “what if” thoughts, what if something happens to them and i cannot get back in time, what if i don’t fit in, what if no one likes me, what if i cannot find another job and give up everything i have here etc etc.
My main worry, however, is moving so far away from my dad and mum, which is very worrying as i am nearly 37 years of age and i think this must be crazy at my age.
I feel like i am losing it and cannot stop worrying about everything.
Hi. Separation anxiety disorder is destroying my life, and probably my husband’s and two sons as well. My sons are just graduated from University and may want to go abroad to further their studies, I am falling apart at the thought of it, how will I manage without them, they would be so far away if anything happened to me/them. I ring my husband constantly during the day and if he doesn’t answer I become obsessed and keep ringing until he answers. I had a childhood trauma, I was in a childrens home for about 8 weeks when I was 20 months old because my mother was in hospital and my father couldnt mind me. It had an awful impact on me, right through my whole life. I can remember it, I fretted so much apparently I wouldn’t eat and got pneumonia. This is affecting me so much right now, I suffer from generalised anxiety disorder, panic disorder and depression. I cannot enjoy the present because I am so afraid of the future if this makes sense ? I really need advice on what to do to be able to move forward and and also be happy for my sons if they are furthering their education away from home. I just don’t want anyone to leave me, I am very needy and that is not good at 54 years of age. Can anyone help ?
I beLieve I have been affected by Adult Separation Disorder since my early twenties (currently 52). I lost my parents in my early twenties and my only brother never recovered from their death. I now have a wonderful family – an 11 yearold boy and an 8 year old girl. Whenever my wife and children go away I am plagued with excessive worrying and sometimes very fearful about their safety. I have learned to manage it but it is not fun at all – the feeling can be relentless.