Adult Separation Anxiety Disorder
Separation Anxiety Disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood.[1] It has traditionally been characterized and assessed as a disorder that is unique to childhood. 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.[2]
Fifteen years ago Adult Separation Anxiety Disorder (ASAD) did not exist, at least as far as the psychiatric community was concerned. ASAD has only been recognized as a specific mental disorder since the late 90’s, with the pioneering work of Vijaya Manicavasagar of the Psychiatry Research and Teaching Unit, Liverpool Hospital, New South Wales, Australia. He said in 1997 that:[3]
[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.
Katherine Shear, M.D. is a professor of psychiatry at Columbia University and the lead investigator of an important new study. She finds recent research setting ASAD apart from childhood Separation Anxiety Disorder unsurprising. She says:[4]
Our group in Pittsburgh, as well as colleagues in Australia and in Italy, has observed adult separation anxiety disorder in clinical populations for a number of years now. It is clear that this is an identifiable syndrome.
Just what is Adult Separation Anxiety Disorder?
Separation Anxiety Disorder is a psychological condition in which an individual has excessive Anxiety regarding separation from places or from people to whom the individual has a strong emotional attachment. In children, the strong emotional attachment is likely to a parent; in Adult Separation Anxiety Disorder, the attachment might be to a spouse or friend.
Separation Anxiety Disorder should not be confused with Separation Anxiety, which occurs as a normal stage of development for healthy, secure babies. Separation Anxiety typically starts at around 8 months of age and increases until 13-15 months, when it begins to decline.
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.[5]
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, for more details on her treatment.):[6]
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.
Infant Separation Anxiety is one of the most strongly preserved behaviors in human beings. Given the importance of attachment relationships in adulthood, ASAD may be more easily elicited in adults than is commonly recognized, and might be the norm under certain extreme life circumstances.[7] (See “What’s in the future for Adult Separation Anxiety Disorder research?” below for more information.)
Separation Anxiety would appear to be a core form of Anxiety that is associated with anxious attachment. Nevertheless, as yet no research has examined the relationship of attachment styles to ASAD. In his research, Manicavasagar found that those with ASAD had a prominent Need for Approval and Preoccupation with Relationships attachment styles.[8]
What is the prevalence of Adult Separation Anxiety Disorder?
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, based on thousands of respondents to the National Comorbidity Survey Replication, a national mental health survey taken between 2001 and 2003.[9][10]
Shear found that, while the lifetime estimate of childhood Separation Anxiety Disorder was 4.1 percent, the adult estimate for ASAD was 6.6 percent. [11] In the current American population, that’s 20,207,408 adults who will suffer with ASAD in their lifetimes! Shear believes these numbers are low:[12]
Because separation anxiety disorder is only rarely diagnosed among adults in treatment, documentation of nontrivial prevalence and clinical significance would point to a problem of low recognition and treatment.
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:[13]
- 30-44 years at onset
- 18-29 years at onset
- 45-59 years at onset
- 60+ years at onset
The accompanying chart shows that most childhood cases of Separation Anxiety Disorder begin the illness in early or middle childhood. Adult-onset cases of ASAD begin in late teens or early 20’s, with 80 percent of all first onsets occurring by age 30.[14]
More women than men suffer from ASAD[15]. And Separation Anxiety Disorder, both the adult and the childhood versions, seems to run in families. Manicavasagar states the results of one of his studies showed that:[16]
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.
What are the diagnostic criteria for Adult Separation Anxiety Disorder?
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. It only mentions obliquely that adults may have a disorder similar to childhood Separation Anxiety Disorder.[17]
The ICD-10 Classification of Mental and Behavioural Disorders (ICD), published by the World Health Organization in 1992, is the standard in some other parts of the world. Its entry on Separation Anxiety Disorder does not mention adults at all. Its diagnostic criteria are roughly the same as those of the DSM-IV.[18]
The diagnostic criteria for Separation Anxiety Disorder in the DSM-IV are as follows:[19]
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.
Associated Features:[20]
- Depressed Mood
- Somatic [bodily] or Sexual Dysfunction
- Anxious or Fearful or Dependent Personality
Differential Diagnosis:
Some disorders have similar or even the same symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.
Pervasive Developmental Disorders:
- Schizophrenia, or other Psychotic Disorders
- Generalized Anxiety Disorder
- Panic Disorder with Agoraphobia
- Agoraphobia Without History of Panic Disorder
- Conduct Disorder
- Developmentally appropriate levels of separation anxiety.
Who is most affected by Adult Separation Anxiety Disorder?
There are more women than men with ASAD. However, men are more likely than women to have the first onset of ASAD in adulthood.[21]
The odds of being not married are elevated both among those who had childhood Separation Anxiety Disorder and those with ASAD. This suggests that childhood Separation Anxiety Disorder might be a risk factor for subjects remaining unmarried and, once married, for marital instability. The marital status of adults with ASAD are ranked as follows:[22]
- Separated, widowed, or divorced
- Never married
- Married or cohabiting
Education seems to play a large role in an adult’s susceptibility to ASAD. Those with fewer years of education are more likely to suffer from ASAD than those who have more years. The number of years of education among those with ASAD are ranked:[23]
- 0-11 years of education
- 12 years of education
- 13-15 years of education
- 16+ years of education
ASAD plays havoc with employment, with a large portion of ASAD sufferers being unemployed or employed in a non-traditional manner. It is not known whether ASAD caused the unemployment, or if the ASAD was triggered by the unemployment. The following list shows the employment status of ASAD sufferers in rank order:[24]
- Unemployed or non-traditional employment
- Employee
- Homemaker
- Retiree
- Student
How does Adult Separation Anxiety Disorder affect your life?
ASAD takes a dreadful toll on a person’s life and on the lives of those around them. For the person with ASAD the recurring distress, worrying, fear and sleep disturbances make every day a confusing and torturous experience.[25] For those who are the “subject of attachment” — the spouse, friend, parent, etc — the continual clinginess, neediness, and drama of life with a person with ASAD can be almost more than one can take.
ASAD is extremely hard on relationships. Many people cannot handle such neediness in a partner. Those with childhood Separation Anxiety that persists into adult life may not be able to form stable romantic relationships at all. As noted above, people with ASAD are much more likely not to have been married or to be divorced or separated.
The suffering of ASAD can take many faces: Adults may endure ASAD when dealing with a marital separation, a rocky relationship, or the death of a loved one. Occasionally, a parent may struggle with ASAD as a child becomes more socialized and less dependant upon mom or dad for companionship.[26]
ASAD is often linked to personal and social impairment. As noted above, ASAD is associated with roughly doubling of the odds that a sufferer will have low (0–12 years) education, be unemployed, and be unmarried or experiencing marital disruption. This is consistent with the findings of several studies that ASAD can be seriously damaging to one’s life.[27][28]
The following table shows the personal and social impairment experienced by people with ASAD:[29]
Housework
- Any personal and social impairment: 56.1 percent
- Severe personal and social impairment: 21.1 percent
Work
- Any personal and social impairment: 51.6 percent
- Severe personal and social impairment: 21.7 percent
Personal relationships
- Any personal and social impairment: 66.6 percent
- Severe personal and social impairment: 28.0 percent
Social relationships
- Any personal and social impairment: 66.4 percent
- Severe personal and social impairment: 31.5 percent
Maximum impaired performance in any role area
- Any personal and social impairment: 73.4 percent
- Severe personal and social impairment: 45.0 percent
Those with two or more simultaneous mental disorders often report significant impairment in their daily roles. Nearly half of the respondents in Shear’s study experienced severe role impairment if their ASAD was associated with another mental disorder.
But “pure” ASAD can be debilitating, too: One-fourth of those with ASAD alone reported severe role impairment. Because this is the case, the question arises whether co-occurring ASAD accounts for some of the impairment previously attributed to other Anxiety, mood, or substance use disorders alone. None of the many studies that estimated the societal costs of these co-occurring conditions included ASAD as a possible contributor to impairment.[30] (See “Adult Separation Anxiety Disorder and other mental disorders” below for more information.)
Adult Separation Anxiety Disorder and other mental disorders
ASAD often occurs along with other psychiatric conditions, especially other Anxiety Disorders or mood disorders. Research findings indicate that up to 91.1 percent of people with ASAD could be classified as meeting the criteria for at least one other mental disorder found in the DSM-IV.[31][32]
People with ASAD are nearly three times as likely to become addicted to illegal drugs, compared to those without the disorder. They are nearly five times more likely to have an additional Anxiety Disorder and four times more likely to have a mood disorder.[33] Katherine Shear, lead author of one of the most important ASAD studies to date, says:[34]
I think that separation anxiety disorder is a vulnerability factor for all kinds of mental health problems.
There is a question that has not been fully answered by research up to this point: Which comes first, ASAD or other mental disorders? There is compelling research that indicates that ASAD predates other DSM-IV Axis I disorders,[35] which include depression, Anxiety Disorders, bipolar disorder, and schizophrenia.[36][37] This means that the ASAD could actually cause other mental disorders.
In addition, a significant proportion of people with Anxiety Disorders tend to relapse, or remain significantly symptomatic, despite improvements in medications and psychiatric therapy. Theorists have proposed that untreated attachment anxieties and Separation Anxiety Disorder occurring along with other mental disorders contribute to the ineffectiveness of treatment.[38] In other words, if co-occurring ASAD is untreated, it tends to cause the treatment to be ineffective or fail entirely.
The following table lists the most common co-occurring mental disorders that appear with ASAD:[39]
Anxiety Disorders
- Panic Disorder: 14.8 percent
- Agoraphobia without Panic Disorder: 5.8 percent
- Generalized Anxiety Disorder (GAD): 16.1 percent
- Specific phobias: 35.8 percent
- Social Anxiety Disorder (SAD or Social Phobia): 34.5 percent
- Post Traumatic Stress Disorder (PTSD): 23.7 percent
- Obsessive-Compulsive Disorder (OCD): 9.9 percent
- Any other Anxiety Disorder: 65.6 percent
Mood Disorders
- Major depressive disorders: 40.8 percent
- Dysthymia: 8.9 percent
- Bipolar disorder: 19.4 percent
- Any mood disorder: 61.7 percent
Substance Abuse
- Alcohol abuse: 33.1 percent
- Alcohol dependence: 20.1 percent
- Drug abuse: 22.5 percent
- Drug dependence: 12.6 percent
- Any substance abuse disorder: 35.9 percent
Any mental disorder: 88.5 percent
It has also been found that adults with borderline personality disorder (BPD) have higher rates of Separation Anxiety Disorder than others — around 31 percent. The relationship is not explained by the presence of Panic Disorder, Post Traumatic Stress Disorder (PTSD), or multiple Anxiety Disorders. It was found also that the duration of ASAD was longer than in borderline personality disorder patients without ASAD.[40]
Why has Adult Separation Anxiety Disorder not been studied before now?
There seems to be a number of factors at play in the reason why ASAD has not been recognized as a separate diagnosis from childhood Separation Anxiety Disorder. First, psychiatry’s diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), only mentions it in passing as a part of the childhood disorder. Katherine Shear says that:[41]
…part of the problem is that it’s not highlighted as a separate condition for adults [in the DSM-IV]. In the book, the entry on the childhood diagnosis notes that it can continue into adulthood, and the diagnostic criteria for some other anxiety disorders suggest ruling it out. But ASAD does not have its own entry.
In defense of the DSM-IV, it was published in 1994, well before research began that clearly showed a separate diagnosis was needed for ASAD. And the ICD-10 Classification of Mental and Behavioural Disorders, mostly used in Europe and Asia, was published in 1992. These publication dates are long before research indicated that ASAd was a separate diagnosis.
Another reason is that ASAD is often mistaken for other Anxiety or mood disorders, particularly Panic Disorder with Agoraphobia.[42] This is especially true if childhood Separation Anxiety Disorder persists into adulthood, where its symptoms may be overlooked, or obscured by other mental disorders.[43] Notably, it was only in early 2009 that research was completed that:[44]
…finally dispel 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.
What is the treatment for Adult Separation Anxiety Disorder?
Due to the recentness of the separate diagnosis for ASAD, there is no standard treatment for the disorder. Most therapies treat it similarly to other Anxiety Disorders with a combination of medication and therapy, especially a form of cognitive behavioral therapy called exposure therapy. Exposure therapy is often used to treat phobias. It involves slowly increasing the person’s ability to tolerate a stressful situation.
The person named Stacy, whose story was told above in the “Just what is Adult Separation Anxiety Disorder?” section, was treated successfully by Katherine Shear. She used an antidepressant similar to Prozac that also helps reduce obsessive thinking. In addition, Shear used cognitive behavioral therapy, along with exposure therapy, to slowly increase Stacy’s tolerance of separation from her husband. Working with the couple together, Shear gradually helped Stacy learn how to cope with longer and longer periods without her husband by helping her see that each increment didn’t result in catastrophe. When one situation or time period was no longer stressful, another would be tackled.[45]
Sadly, the majority of people with ASAD remain untreated, even though many obtain treatment for co-occurring mental conditions such as Anxiety Disorders or depression. The vast majority of patients are treated for co-occurring conditions rather than for ASAD. Less than one-third of patients with ASAD (31.9 percent) report that ASAD was ever a focus of their treatment. This suggests that treatment providers often fail to recognize ASAD in the context of other co-occurring mental conditions.[46]
Although those age 60 and older represent the smallest group of adults with ASAD, the number is still significant. This age group is subject to more separations from friends and loved ones due to moves to another city to be close to children, moves to a nursing home, and deaths. Clinicians working with the elderly need to routinely explore ASAD as it may complicate how other Anxiety and affective disorders appear in the patient, and require specific forms of intervention.[47]
The upshot of all the new research on ASAD means that psychiatrists and other mental health care professionals need to be much more vigilant about the condition. Katherine Shear says:[48]
They need to be aware of the occurrence, prevalence, and comorbidities [co-occurance] of this syndrome, which could be confused with agoraphobia and which could complicate another Axis I disorder [such as Anxiety Disorders and depression], since it is co-occurring with so many. Following the principle of measurement-based care, it will be very important to follow these symptoms in patients who are treated for adult separation anxiety and/or co-occurring conditions.
What’s in the future for Adult Separation Anxiety Disorder research?
As mentioned, ASAD started being recognized as a distinct disorder in the late 1990’s. Since then research has proven that it is very different from childhood Separation Anxiety Disorder. Still, the absence of research on the treatment of ASAD suggests that researchers have largely overlooked this disorder, along with psychiatrists and other mental health care professionals.[49]
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently being revised, and the new edition is due out in 2012. The committees working on the revision must take into account the distinctness of ASAD from childhood Separation Anxiety Disorder in the new edition. As it stands in the current edition, the diagnostic criteria mention ASAD only in passing, concerning itself almost entirely with the childhood disorder.[50][51] In considering the possible revision of diagnostic criteria for adults, it would be useful to focus on issues of symptom overlap with other mental disorders, and the differences of ASAD with a number of the disorders mentioned above.[52]
The treatment of ASAD is only in its infancy. It relies on treatments for other Anxiety Disorders and the intuition of psychiatrists and other mental health professionals. Therapies specific to ASAD need to be developed, especially the modification of conventional exposure-based cognitive-behavioral treatments, to provide better strategies that address ASAD.[53]
Other directions for future research are:[54][55]
- The extent that dependence of family members and others on each other is culturally determined and acceptable, and when it is pathological.
- When the pain of separation from a loved one during war, natural disasters, or other dire circumstances is to be expected, and when it is not.
- What are normal and abnormal responses to the loss of a loved one through death?
- Whether co-occurring mental disorders involving ASAD are because of overlapping symptoms, imprecision of diagnostic criteria, or other factors that confound evaluation and treatment.
- Whether the mental disorders involved in co-occurrances with ASAD cause it, and if so, whether early successful treatment of Separation Anxiety Disorder in childhood and early adulthood would lower the rates of secondary ASAD.
- Whether adult separation anxiety disorder has any effect on the persistence or severity of other co-occurring mental disorders.
Updated April 13, 2009
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. Cyranowski, Jill; Shear, Katherine; Rucci, Paola; Fagiolini, Andrea; Frank, Ellen; Grochocinski, Victoria; Kupfer, David; Banti, Susanna; Armani, Antonella, Cassano, Giovanni. (2001, December 27). Adult separation anxiety: psychometric properties of a new structured clinical interview. Retrieved April 1, 2009 from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8T-44SHD6X-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=30c67985bd9fb567c38bdfd342440796#_jmp0_ ↑
3. Manicavasagar, Vijaya; Silove, Derrick. (1997, April). Is there an adult form of separation anxiety disorder? A brief clinical report. Retrieved April 1, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/9140640 ↑
4. Staff of Insight Journal. (2007). Adult separation anxiety often overlooked. Retrieved April 1, 2009 from http://www.anxiety-and-depression-solutions.com/articles/news/071706_sep_anxiety.php ↑
5. 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 ↑
6. 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 ↑
7. 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 ↑
8. Manicavasagar, Vijaya; Silove, Derrick; Marnane, Claire; Wagner, Renate. (2009, February 2). Adult attachment styles in panic disorder with and without comorbid adult separation anxiety disorder. Retrieved April 1, 2009 from http://www.informaworld.com/smpp/content~content=a907922151~db=all~jumptype=rss#_jmp0_ ↑
9. Staff of Insight Journal. (2007) ↑
10. Arehart-Treichel, Joan. (2006, July 7).↑
11. Shear, Katherine.(2006, June). Table 1 ↑
12. Shear, Katherine.(2006, June).↑
13. Shear, Katherine.(2006, June). Table 2 ↑
14. Shear, Katherine.(2006, June). Figure 1 ↑
15. Shear, Katherine.(2006, June).↑
16. Manicavasagar, Vijaya; Silove, Derrick; Rapee, Ronald; Waters, Felicity; Momartin, Shakeh. (2001, May 2). Parent-child concordance for separation anxiety: a clinical study. Retrieved April 1, 2009 from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T2X-42YDM3K-D&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=0b88db10b139bd52283a4a2d3efc2007 ↑
17. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Association. 1994. ↑
18. The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization. 1992. ↑
19. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.↑
20. Staff of PsychNet-UK. (2000). Separation Anxiety Disorder. Retrieved April 6, 2009 from http://www.psychnet-uk.com/dsm_iv/separation_anxiety_disorder.htm ↑
21. Shear, Katherine.(2006, June).↑
22. Shear, Katherine.(2006, June). Table 2 ↑
23. Shear, Katherine.(2006, June). Table 2 ↑
24. Shear, Katherine.(2006, June). Table 2 ↑
25. Staff of Depression Perception. (2006). Separation Anxiety Disorder. Retrieved April 1, 2009 from http://www.depressionperception.com/anxiety/anxiety_conditions/separation_anxiety_disorder.asp#_jmp0_ ↑
26. Staff of All About Life Challenges. (2009). Is adult separation anxiety disorder and generalized anxiety disorder the same thing? Retrieved April 1, 2009 from http://www.allaboutlifechallenges.org/adult-separation-anxiety-faq.htm ↑
27. Shear, Katherine.(2006, June).↑
28. Staff of Insight Journal. (2007) ↑
29. Shear, Katherine.(2006, June). Table 4 ↑
30. Shear, Katherine.(2006, June).↑
31. Shear, Katherine.(2006, June).↑
32. Wijeratne, Chanaka; Manicavasagar, Vijaya. (2002, September 11). Separation anxiety in the elderly. Retrieved April 1, 2009 from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VDK-46RCS0B-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2d783326f3f9f29f343c838507b168cd ↑
33. Szalzvitz, Maia. (2006).↑
34. Szalzvitz, Maia. (2006).↑
35. Staff of PsyWeb.com. (2009). Axis I. Retrieved April 13, 2009 from http://psyweb.com/Mdisord/DSM_IV/jsp/Axis_I.jsp ↑
36. Manicavasagar, Vijaya; Silove, Derrick; Curtis, J. (1997, September).↑
37. Manicavasagar, Vijaya; Silove, Derrick; Wagner, R. (2000, January). Continuities of separation anxiety from early life into adulthood. Retrieved April 1, 2009 from http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=ADOLEC&lang=p&nextAction=lnk&exprSearch=10770232&indexSearch=ID ↑
38. Kirsten, Laura; Grenyer, Brin; Wagner, Renate; Manicavasagar, Vijaya. (2008, March). Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders. Retrieved April 1, 2009 from http://www.informaworld.com/smpp/35862073-66953207/content~db=all~content=a790668570~tab=content ↑
39. Shear, Katherine.(2006, June). Table 3 ↑
40. Aaronson, Cindy. (2001). Separation anxiety disorder in adults with borderline personality disorder. Retrieved April 1, 2009 from http://academiccommons.columbia.edu:8080/ac/handle/10022/AC:P:4570 ↑
41. Szalzvitz, Maia. (2006).↑
42. Arehart-Treichel, Joan. (2006, July 7).↑
43. Manicavasagar. (2000, January).↑
44. Manicavasagar. (2009, February 2).↑
45. Szalzvitz, Maia. (2006).↑
46. Shear, Katherine.(2006, June).↑
47. Wijeratne. (2002, September 11).↑
48. Staff of Insight Journal. (2007).↑
49. Shear, Katherine.(2006, June).↑
50. Manicavasagar. (2009, February 2).↑
51. Shear, Katherine.(2006, June).↑
52. Shear, Katherine.(2006, June).↑
53. Kirsten. (2008, March).↑
54. Staff of Insight Journal. (2007).↑
55. Shear, Katherine.(2006, June).↑
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Very interesting, I have struggled with my anxiety and mood problems for many years and only ever make marginal progress or recovery. If asked what my main concerns are I say loneliness. I am separated from most of my family and friends after coming to terms with my gender identity issues and although I feel substantially more complete and accept in society my separation from loved ones and companionship makes me extremely dysfunctional. When I do socialise I act like a “little puppy” glad to see its owner return but, soon tire or become uncomfortable because I know “they will not take me home.” This induces depression, withdrawal and detachment from my work.
As a child (2 yo) I spent a long time in hospital in the days when parents were not encouraged to visit (I am now 61 yo) and can see a reoccurring pattern but now it has become extremely debilitating and my search for relief is becoming desperate. In some ways it would be nice to put a name to my problems my Psychologists and psychiatrist have assumed everything else over the years.
Jasmine.
This was very helpful to me. Now I know why I act and feel the way I do about being away from my fiance, and any other mate in the past. I’ve been suffering from this for years, actually ever since my first boyfriend at the age of 17. I am now 24 and I still suffer from this, it’s actually gotten worse. But I feel better that I know what is wrong with me and that I’m not alone. I used to just think that I was just in love and those feelings were normal, but they’re really not. I just hope now that I can find a cure that does not involve medicine.
I’ve had this my entire life. I have all the symptoms, and as a matter of fact, I missed tons of school growing up. I almost feel like a posterchild for ASAD. I’ve been so severely misdiagnosed. Now I can’t even work. I lock myself in my room when my husband isn’t home, because I don’t trust the relative we’re living with. I’m an aspiring author and hope I’ll get published and be able to get my husband’s and my student loans paid off. It’s sort of a desperate “last hope”. I’d rather go through childbirth every day for a week than to have ASAD, if in fact that’s what these feelings and fears are.
Also, I HATE medicine. It never helped me. I’d feel better for a while until my body got used to it and the dosage wasn’t enough anymore. So, I stopped taking it. I was tortured by the school system. They never listened to me. You’d think they’d know the difference between a sick child and a delinquent when said child spends all day in bed awake and crying or crawls under a table and panics when the bus pulls up. That says a lot about our government. Now I can’t work because of this, and I’m financially stuck. I’ve applied for disability because of it, but that’s only led to more ridicule. I don’t know what I’m going to do. I just keep praying and hoping.
I’ve known for years that I’ve suffered from some kind of anxious separation disorder, and it’s been very interesting to read about ASAD. I have a disablingly powerful fear of not being able to contact my mother that goes back so far I can’t remember when it started, though it has been a real problem only as I’ve grown older. I obsessively plan all of my phone calls, visits etc around times when I know that, even if my mother’s unobtainable or out, somebody else (sister, aunt…) will, because of the times they visit, know exactly where she’ll be. If there’s no answer on the phone, I’ll go straight into a pit of terrors, reflexively and utterly certain that she’s died/been kidnapped/hit by a car or so on. The otherwise reasonable thought that she’s popped out for a moment or didn’t hear the phone is not an option, and I’ll be hopelessly panicking until I find out where she is. If I’m staying at her home (I’m happily married and living a 3-hour drive away) I’ll obsessively wait at the window if she goes out to the shop right over the road, terrified that she’s taking a second too long to reappear, or else find an excuse to tag along. I arrange all my departures for my frequent foreign trips to coincide with her being at home with somebody else (as she is on certain days of the week), so that I won’t need to call to say goodbye before a trip and find her inexplicably not answering. I only call to say ‘hi’ on certain days, at certain times, to reduce the possibility of her not answering to zero, as I only call when I know she’ll be with somebody else. I can’t call when she’s at home alone, as I’m simply too afraid that I’ll get no answer. I’m otherwise a very well-adjusted adult, an independent travel writer, well-educated, intelligent, with plenty of friends and interests. But my life seems to be moulded around these ridiculous and increasingly involved coping mechanisms. The case of the woman and the golfing husband made so much sense.
I have been living with this for my whole adult life, without a name to it. Since I was diagnosed and treated for PTSD starting about 7 years ago, I have begun to learn coping tools such as grounding, self care, self soothing, safety etc. It has been very slow progress, and there are times when I just cannot cope well. What surprises me is that while I was being treated for PTSD I kept telling the treatment team that I felt that panic over having to go home and be alone was a trigger of being abandoned as a young adolescent, and the staff kept telling me that I was “yes-butting” when I panicked a cried when they would tell me in a cold tone that I had to go home. I really hope that this information about Adult Separation Anxiety disorder becomes distributed. I, for one, am going to print this article out and deliver it to the two directors of the local PTSD treatment programs. I have been through so much invalidation and shaming in my life time going for “help” to deal with my extreme emotional pain, anxiety etc. over the past 37 years.
One comment I have to make to the Psychiatric community at large is: Do not assume that patients do not understand what they are dealing with…even though it may not yet have a formal diagnosic label…We are sentient and intelligent beings and deserve to be treated as equals, not “less than” just because we are suffering emotionally. One day I may be writing a book of my own about my experiences with the mental health system and society, as a person who has been shunned, blamed, shamed, dismissed and totally misunderstood for most of my life. It is sad to me that I , and many others I have come to know in the past several years, are “written off” so easily because we have suffering that is not so cut an dried like a “broken bone” which has a clearcut cause, and often a clearcut solution that works in a relatively short period of time.
Thank you for your research and publication about it re: Adult Separation Anxiety Disorder. I will be saving your article for my own reference. Sincerely, K.
I have never actually been diagnosed with ASAD but I am pretty sure I am struggling with it. I was often quite left alone as a child considering the fact that my mother was a single parent working late nights. She finally got remarried and her husband legally adopted me when I was 7 years old so we could all be a happy family. I grew a strong relationship with this man because I had never had a male figure in life before and now I did.When I was about 16 years old, they had gotten a divorce and the worthless piece of dirt so called “father” decided that he could basically devorce me too. He decided to lose all contact with me and go on his way. He met a new woman and had his first biological child with her and I have not seen or heard from him in about 3 years. This brutally turned my world upside down. Shortly after the devorce, I met my (current) boyfriend who I have been with ever since and things are not going too good. I am not inlove with him and I do not want to be with him anymore. But everytime I go to leave him, I get the worst panic attacks. Even if I’m away from him for more then 5 hours, I feel the anxiety start to over come me. Usually I get 2 types of anxiety , 1 is I either get chest pains or stomach pains or hot flashes and feel like something is wrong with my body or I get really dizzy and start cying and hyperventilating all accompanied by confussion. I always find myself questioning why my body is doing this to me or what is happening or whats wrong with me when the second type happens. I do not want to be with him anymore do the fact that we have our differences. Also I want to be a mature independant woman. I do not want to depend on him for my security anymore. I feel like this happens to me because he was the first male figure to walk into my life when my father walked out. I REFUSE any type of medications or drugs or pills or anything like that. Also I been to hypnotherapy before for other reasons and it did not help at all. Can someone please give me advise? It’s really hurting an depressing me. I don’t want to waste my life with someone I do not love all because my mind is not in the right place. Please email with any advice please! mustangJESS831@aol.com
I am dealing with this upsetting ASAD! It is completly ridiculous that I have to go through this. My Husband is Active Duty Infantry for the US Army! He barely joined and is doing his training in another state. I get these overwhelming feelings everything thats said in the article about the ASAD is exactly what I have!!!! I just get to the point were I want to jump on a plane an go to wherever it is that he is at & drag him outta there. which I know cant happen. Im trying to deal with realizing he is not coming back until his training is done. but I cant seem to get that through my head. I never though it was going to be this hard. I get extreme anxiety attacks and panic attacks along with hot flashes and a feeling that makes me think im dying when really its just a separation for the mean time & he will be back. Why cant I just deal with this. Its really making my days seem long and dreadful! How do you OVERCOME ASAD??
is it just me or do all spanish women suffer from asad? Seriously
I was first diagnosed with Depression with Anxiety and Obsessive Compulsive Personality. My father left my mother and I when I was young. Growing up my mom and step-dad used drugs and we were homeless most of my young adult years. I was very close to my mom (since she is clean), my step-dad, and my best friends. My step dad who I loved as my father blew me off the moment he found a new girlfriend and didnt attend my wedding to walk me down the isle. Even after I forgave him for all the stuff he put me through growing up. About a year ago, my newly-wed husband and I moved to opposite side of the US because he is in the military. I have been a wreck since we left home. I have trouble sleeping (talking/screaming in my sleep, nightmares, restlessness) when he is home and when he has duty I dont sleep at all. I have gained over 30 pounds in the last year because I am eating obsessively (especially if he is not home) and I never feel satisfied. I cry all the time and I get regular headaches. I have morbid thoughts of the people I love getting hurt or dying and I am so afraid that I will not be there for them. I have been taking Paxil now for a few months. It has offered some relief. I am still not great though. How do I overcome all of this ASAD? I should be happier. This is supposed to be the best time of my life.
I don’t know if this is what I am suffering from, but would be happy with input from others that may have the same experience. I moved to another country, nearly half way around the world, from my children eleven years ago. My children are all grown in their own relationships, one with children. We have been unable to visit due to my husband’s health. He has been unable to work for some nine years now, and I have needed to stay at home with him to help him. This low income we now have has made it impossible to visit my four children. In eleven years, we went back for a short visit once, three years ago. This separation has now become such a depressive issue for me, I am finding it hard to cope. I feel anxious and depressed all the time, and feel in despair about the future. I wake up a lot at night with nightmares that something has happened or may happen to my children. I cannot talk about this to my husband (I remarried) because he has had no children of his own and he feels it is his fault we are unable to visit due to his illness. He just gets upset about it and I don’t want to upset him. I cannot see any way forward at the moment. You feel as if your heart is breaking and you are crying inside all the time. My youngest daughter is now on her own, struggling with her two little ones, in trying to work and arrange care for them. I feel I need to be there for them, but cannot. How do I handle this?
I read the posts above and am pretty shocked to see “tomtom” having the identical problem that I’m having. The major difference is that it’s with my wife. I must know where she is at all times. I cannot let her go out alone to a store or anywhere unless I accompany her. She had to leave her job a while back partially because of my ASAD. When I am at work, I must call her frequently and if she doesn’t pick up, I’ll panic immediately. She may be in bathroom, but I assume she left the house or someone broke in and took her. When she worked, I nearly had a heart attack often! If I could not catch her on cell phone going to train, I thought I’d never hear from her again. Maybe she was hit by car, etc. She once went out to help old lady with packages. I entered room and I saw the door open and she was gone and I freaked out. Thought I’d never see her again. When I found her, I went from this out of control person in fear to euphoric relief.
When I used to not be able to reach her(on train, cell phone problem), I would pray hard. I would want to tear my insides out.
She is luckily ok with staying at home all day. When I am home which is often, we take long walks, watch tv, and talk. She would rather work, however and I hope she never demands to return.
Besides this ASAD and other general moderate panic, I am a normal person I believe.
If someone would like to discuss this issue with me(jbbc72@gmail.com) I would be glad to, but please realize that I would like to discuss only this exact problem described above. That is, having to be able to contact and know exactly where my wife(or other person – mother, father, friend, etc) is at all times. If I do not respond, please don’t be offended. It may be due to my panic. Thank you.
H20 – it was very enlightening to read your post – the symptoms you detail seem to be exactly the same as mine, including the inevitable but self-evidently irrational headlong rush to an unshakeable certainty that ‘no answer’ = ‘kidnapped/dead/lying injured’ and so on, and then the euphoric relief of finding they’re okay. I truly feel for you, knowing exactly what you’re going through.
I’m not a psychiatrist, but I do think I can detect more than one ‘type’ of what we’re calling ASAD right now: one appears to me to be based upon a general feeling of anxiety and depression which is ongoing when the sufferer is separated from the object of attachment, even if the sufferer hasn’t been trying and failing to contact them (some but not all of the above posts), while the other (mine and H20’s included, if I might be so bold as to assume I understand his symptoms fully) is a pattern of triggers relating to an inability to establish contact at a specific point in time and a subsequent catastrophic anxiety event that’s instantly extinguished when the attachment figure is relocated. For my part, I feel little general anxiety when I’m separated, so long as I’m satisfied in my own mind that there’s ‘nothing wrong’; when things are ‘wrong’, eg when there’s no answer on the phone or when the attachment figure is too long at the store, then the anxiety is all-consuming, like an obsessive madness. It’s pretty much all or nothing, but the effort of maintaining the ‘nothing’ spells is in itself a matter of great mental stress, occupying so, so much of the time between the ‘panics’.
I do also detect a deal of what might be termed (by a layman such as myself) obsessive compulsive elements in many of these stories (mine included): it seems that there might be similarities between these unconquerable compulsions to check up on attachment figures and the classic unconquerable compulsions of hand-washing etc in OCD. Pandering to the compulsion does lead eventually (as, objectively speaking, it almost inevitably always will) to a resolution of the anxiety (ie the checking is sooner or later ended by the reappearance of the attachment figure), but with of course the intervening panic state. Once the compulsion has been sated (the attachment figure relocated; the hands washed) the sufferer gets the ‘reward’ of relief but then the cycle inevitably starts again, and therein lies the problem, almost like a pathological state of uncertainty and an inability to be assured that things will be okay.
H20 – I don’t have a private email address that I can use to chat with you about these shared symptoms, but I do think it might be good for both of us to compare notes on what strategies we’ve found that might help, when I’ve a way of writing directly. For my part, I’ve found that giving up alcohol (a known depressant) has had a noticeable effect on my underlying mood (though I no longer have it as a self-medicating aid to lower anxiety), while when I was taking an SSRI a few years ago for generalized anxiety I found that my ASAD symptoms were greatly reduced, as I simply found it harder to maintain that state of anxious compulsion.
Thank for the quick reply. I agree with the obsessive compulsive element in my own situation. However, I exhibit none of the classic OCD behaviors, such as frequent hand washing, etc. I do obsess over situations, some that an average person would obsess over as well albeit with more intensity. If I’m given a new assignment at work that involves travel, I will worry about it. I also have a low self-confidence problem. I’ll immediately think to myself “I can’t handle this,” regarding the new assignment.
If I’m driving alone and get lost, I will totally lose it. I feel I’ll never get home, see my loved ones, etc. Therefore I do not drive anywhere alone where there’s a possibility of getting lost.
I also have this notion that my wife is helpless. That she couldn’t survive without me. She has done some things that strengthen this belief, such as getting stranded in a major snowstorm where she faced a near-death experience as she doesn’t focus on things such as weather warnings, crime, etc.
This anxiety coupled with obsessiveness is probably deep rooted in my psyche. But I honestly feel that I would need a new brain for me to truly be able to change! BTW I am full of feelings of guilt. When I am enjoying myself playing sports I have to cut out early often to get home to make sure she’s ok and also I feel it’s not fair for me to enjoy myself so much when she might be unhappy.
You mentioned you’ve given up alcohol. That’s great.
I have not tried alcohol or SSRI’s. Too scared to try these things. I’ve heard of side effects of SSRI’s and I feel they won’t cure me.
My mother suffers from depression, but mostly anxiety. She has taken xanax, which works for her, but only when she’s really nervous. I wish I was like my father. Calm as a cucumber; not depressed. Happy watching tv, doing exercise, traveling, etc. If my mother took the car somewhere, he does not worry. Plain and simple. She on the other hand will worry if my father is late or something. But not to extent of my panic. He has displayed complete competence his whole life. Always on time, dependable in all situations. This is why it’s hard to worry about him as it’s so likely that where ever he may be , he is fine.
I’m curious about your mom. As a child, did you ever experience a time when she left and you thought she might never return? For example, maybe she had argument with your dad and she walked out and you got so worried thinking you may not see her again? Sorry to ask, but I’m trying to see any similarities with my mom and me. Take care. Hope to see your post again.
H20- My therapist told me about Obsessive Compulsive PERSONALITY. It is in the same family as Obsessive Complsive DISORDER but it is very different. Check this out on the web. Very Interesting.
H20 – interesting that you should talk about a feeling that the object of your separation anxiety is helpless: I can very much sympathise with this, since much of the grinding detail of my worries come down to a conviction that she’s not able to keep herself from harm, from falling down the stairs and so being unable to reach the phone, from extricating herself from the people who’d be trying to kidnap/kill her, from crossing the road without being run over etc etc etc. So, when she doesn’t answer the phone, my mind automatically assumes such a reason. Despite my mother being a perfectly capable 63-year old who raised two children and now lives just down the street from other members of her (very large) family in south London after surviving a divorce from her husband of 25 years, something instinctive in me is convinced that she’s helpless, and perhaps that it’s up to me to ‘protect’ her. I’ve thought about whether there was ever an incident where I felt she’d been taken away and wouldn’t come back, but I can’t pinpoint anything. There’s a memory of my parents arguing once and my father walking out, but I can’t honestly say I think that that was any kind of trigger. My younger sister once almost got lost aged just 5 or 6 when walking home from school one winter in the snow, when the school had closed early and my mother wasn’t there to meet her, and I think that that incident might have more to do with my being sensitised to possible loss. As with your case, she and my father are very matter of fact and competent – or should I say I perceive them as such, since my mother is just a normal person in this regard, if a little prone to tripping over things when out about town – and I hardly worry about them at all.
As with your case, too, my mother does have an anxious streak to her personality, which can be attributed to her childhood with a father who suffered from various mental illnesses and was at times extremely violent, though not directly physically violent to her. I’m sure that a lot of my anxiety is a case of me ‘copying’ anxious thought patterns that I’ve learned from her (“Will you be safe?” / “Do you really need to go to XXX after dark? Isn’t it dangerous?” / “What if something happens?” etc etc). To be fair, my anxieties have an effect on her, too, and I often find myself asking her if she’ll be safe going to the shops, or reminding her not to be murdered if she’s at home alone (!!)
One thing I might suggest, just since it’s looking like it might be having a calming effect on me personally: you mentioned that you pray that your wife will be okay (but I suspect that you’re still thinking that it makes no difference to how anxious you feel in practice, which might make you think that either (a) God isn’t listening or (b) you’re not praying hard enough, and that your faith’s at fault). Very recently I started looking into meditation, Christian meditation specifically in the tradition of earlier Christian mystics, and I’m now practising it once a day for about 20 minutes, starting with something tried and tested called ‘palms up, palms down’ (I’m sure you can Google it!) then moving on to visualising Gospel stories, and ending with thanks. I’m using a book called Celebration of Discipline by Richard Foster, which has a variety of Christian practices of meditation, prayer, silence and so on. I might find that tomorrow I fall back into a pit of nerves, but for now I do genuinely feel calmer in myself, as though the knot of anxieties has eased, and that destructive carousel of negative thoughts has slowed. Just a suggestion. Don’t know if anybody else out there has tried.
By the way, I wouldn’t necessarily shut the door to modern drug treatments for these problems: if you’d got a ‘physical’ disease I presume you’d be happy to take effective drugs even though they have side-effects? Yes, I did find that SSRIs had a tendency to make me a bit yawny at first, but once I’d been using them for a few weeks the world genuinely looked a less frightening place, more ‘real’, and less the product of my neuroses. I was taking a low dose, much lower than for clinical depression, and I weaned myself off after a year by very slowly reducing the dose (actually by opening each capsule and removing more and more of the grains each day!), until I was totally off them with no withdrawal effects at all. The effect of the drugs even after then was very pronounced, as my mind had had time to readjust itself to looking at the world in a different way.
Do post again if you want to know anything more or let off steam about your thought patterns. Tomtom
Pieface- I checked out what you mentioned. I don’t think that I possess all of the characteristics of that disorder. Maybe a few. Thanks for pointing it out though.
TomTom-
Please tell me. When you took the SSRI’s and let’s say you couldn’t reach your mother, did you panic on the ssri’s? Was it better? Was it sustainable? Did you ever try a tranquilizer? I really do not want to take ssri’s or tranquilizers, but I may have to. Do these things really work well? Strongest thing I ever took was benadryl or ambien for sleep.
Wow! The incident involving your younger sister certainly may have traumatized you. It’s interesting that when my father was a kid, his mother had a very frightening ordeal with him. He and his brother and mom were waiting for a subway train. My father was playing around when a train arrived(not the one they were waiting for!) and he suddenly jumped into the train just before doors closed. His mother couldn’t catch him in time. I don’t remember the story of how she was able to finally get him. I believe the train was ordered to stop and wait at the next station. His mother, even after this near tragic event, has never experienced anxiety, worry or simple nervousness. It’s amazing. This would have rattled my nerves forever. Some people are lucky in that they just do not worry or panic about things, even something like what I described. For example, when I fly, I almost always threaten to cancel the trip due to fear(plane crash, plane delays, etc.). I now only fly with my wife next to me, even on business. I grip her hand so tightly when the plane takes off. And when there’s turbulence, forget about it. I constantly ask her, isn’t this turbulence too severe? Aren’t you the least bit nervous? Answer- it’s nothing and no. Meanwhile, I am in a state of mental agony.
I’ve got to do something to “cure” myself of this terrible panic which has lead to obsessiveness over her. Life is not as fun as it used to be. If I’m not worrying about her, I’m worrying about something else. Guess what? The future. Will we have enough money to live on? Should I change careers? It’s really messed up.
All this is really difficult to discuss in writing. I can’t even talk about it as I don’t know where to start. One thing that puzzles me is that years ago I did not display any panic over my wife. She might have been late, not reachable, etc. I would simply look out the window if I heard a noise and if it was the wind, I’d go back to whatever I was doing. This panic slowly grew.
I am not a religious person, but when I could not reach her those many, many times, I would pray with every fiber of my being. It did not ease my mind, but I thought to myself there is absolutely nothing else I can do. I began calling a relative during the episodes when I couldn’t reach her. It was a miracle that each time I did this, I would eventually reach her. What a huge relief. My relative would hear me breathing like I had just run a marathon. I couldn’t focus on anything she told me to do. But I always thanked her for trying to calm me down. Maybe it worked a little.
Well, I guess that’s all for now.
H20 – I’ll keep posting my thoughts for all to see, as I think perhaps there might be points for others to consider, or perhaps others might have some observations or input.
To start with specifics, I went to my GP to ask for Venlafaxine XR (extended release), aka Effexor (actually an SNRI, it seems). I was on a very low dose of 75mg/day (which is the lowest you can get to without taking the capsules apart!), and apart from a bit of yawning at the outset had no side effects personally. As the weeks went by I found it much harder to focus on the thoughts that had become obsessively worrisome: if I couldn’t reach my mother by phone my first reaction was not one of panic but a more mellow one of kind of shrugging and thinking ‘I’ll try again later…’ In general, before there’d been enough failed attempts to get in touch to push me into panic, the situation would have resolved itself by her ‘reappearance’. In that sense, the drug definitely worked. I eventually decided to slowly come off it, grain by grain as I said before, after a year, as I was getting married, was planning a long trip in the developing world, and didn’t want to be tied to a GP’s prescription. I had no side effects whatsoever coming down so slowly from such a low dose. Of course, the fact that I’m sat here now writing on an anxiety forum would hint that, having taken them, found them useful, and then come off them, doesn’t of itself leave me cured! The engrained thought patterns and behavioural reactions didn’t change much, though that could be down just as much to the fact that the drug did what I wanted it to do and so I never strived to change my underlying mental approaches to the world. After I stopped the drug, they’ve slowly crept back, but to be honest I’d be happy to go back on them to get the same relief.
Now, as to what on earth we should all be doing about this… It strikes me, and I’d like to see if anybody has any thoughts on this, that a (and perhaps the) dominant ‘contour’ of our problem is that our thoughts are focussed obsessively and negatively upon the future. That might seem an obvious point, but I’ve been thinking about all this for a long time now, and you might need to indulge me with this stream of consciousness into its implications for a moment:
When we phone and it rings but nobody answers, or when we get home and it’s empty, or when, in your case (personally I love flying!), you’re on an aircraft, our thinking goes something like… “she isn’t answering the phone now, so therefore she will not be okay” “she isn’t in the house now, so she will be dead” “I’m flying now, so there will be a problem with the flight”. If I think about every time I’m anxious, it’s because there’s an assumption in my conditioned thought processes that there will be some awful future event (perhaps in the imminent future, perhaps a bit further away) whose certainty has been proved to me by the fact that something in the present is happening, e.g. no answer, nobody home, I’m on a plane… The consciousness of the future certainty of bad events could be understood as what we’re afraid of. If, for the sake of argument, we imagine that we simply did not have the ability to conceive of the future in any way, we would not be able to get anxious about the things we instinctively imagine will happen. I think some psychologist referred to all these kinds of anxious disorders and obsessive/compulsive spectrum behaviours as disorders of ‘pathological doubt’, which seems to me to sum up a lot of our problem.
The upshot of my thinking along these lines is that if we could retrain our brains to stop focussing upon the ‘certain future negative outcomes’ of what to any ‘normal’ person is simply neutral evidence of the present, then we might be able to interpret present stimuli/evidence in a healthy, ‘normal’ way: “she isn’t answering the phone right now” “she isn’t in the house right now” “I’m flying right now”. Of course, ‘normal’ people start to get concerned at some point, but only after a lot more past- or present-tense evidence: “she hasn’t answered the phone for two days now, when she said she’d be at home, so it’s possible that there’s a bad reason for that” “she hasn’t been home all evening, when the note she left said she’d back at noon, so perhaps I should start to call her friends” “Those engines were definitely not alight when we took off!”
When you mentioned that you start praying as though your life depended upon it when your triggers have been set off, I took it that you were a religious person falling back on prayer, rather than a not-very-religious person doing anything he could to stop the panic – I can absolutely sympathise with either, and don’t have any judgment to make on either score. Personally I’m a very questioning Christian with all kinds of doubts about received teaching and ‘Biblical truth’; I have found that praying sometimes helps, but to be honest, when you’re mentally and physically beside yourself with terror it’s nigh impossible to think, let alone pray. But… I have found that the meditation has helped calm me considerably, even in just a couple of weeks, and here’s my thinking as to why: it’s generally recognised, once the pseudo-religious or mystical aspects of it have been stripped away, that regular meditation retrains your brain/mind to focus upon the present rather than the past or future – it’s sometimes called ‘mindfulness’, I believe, though I think that this can also refer to a specific meditational practice that doesn’t go as deep as I’m thinking, but I’m no expert. Something about alpha and beta waves… If I apply my musings on how we’re stuck in a feedback pattern of thoughts that ‘obsess’ about future certainties with only the very very scantest of present evidence, then it follows that retraining our brains to spend time mostly in the present ought to refocus our thinking and ‘short-circuit’ our anxieties. In any case, 20 minutes of meditating some time each day leaves me feeling so much calmer, and that calmness seems to be accumulating and rubbing off on my anxieties: yesterday, can you believe it, I actually dialled my mother’s number even when she’d previously called to warn me she was going out to the store, so that I wouldn’t worry if I called and she wasn’t in (of course, this normally makes me even more worried, as previously I hadn’t known she was going out! – you see how we both subconsciously ‘encourage’ each other’s anxiety, even if only with the best of loving intent?). Normally I’d’ve been terrified to call, in case she didn’t answer (“she will have been hit by a car!”), but this time I managed it almost unthinkingly, and even remember my thoughts as it rang: “if she doesn’t answer, she’s just not back yet – you can try later”. I’m sure you’ll appreciate what a big first step that is!
I’m lucky that, living in England, I can go to my GP any time and ask to be referred to a community psychiatric nurse who can pass me on to specialists in things like Cognitive Behavioural Therapy or even meditation, all for free on the National Health Service. Drugs, too, such as Effexor, are free if you qualify and cheap if you’re in work and have money, so there’s no bar there to asking to be prescribed them and hence my blithely deciding to take them. I’m assuming from your vocabulary that you’re in the US (perhaps Canada, but I can’t hear your accent!), so I don’t know how things work over there. I do know that people generally say that meditation is best learned from a practitioner rather than a book; over here there are various informal classes where groups meet in a church hall etc, or more formal arrangements where you pay for an instructional day course or a longer retreat.
But I’ve been writing for 45 minutes now, and I’m clearly not addressing people who aren’t perfectly capable of working out these things for themselves, what with the internet and stuff!
Keep me/us posted.
It’s nice to know a proper name exists for this horror I’ve been through. Ironically, I write this as I’m to be left for four days while my grandparents go on holiday.
I’m not sure I can cope so may show them this page and ask them to work with me on it slower…
Is this diagnosis going to be considered in the DSM? I could only find it related to childhood disorders but I can tell you, I am 40 and no doubt have this. It was like a light went off in my head! I had recently fallen in love with someone and would have panic attacks with crying that I had done something to make this person angry or that they were hurt or that he needed something and was afraid to ask. It was all consuming. At least now I know I am not alone.
I knew about codependency so have been reading up on that. But there was another element to it that I couldn’t put my finger on…until I found this. It was an aha! moment.
I am sure this all stems from unresolved childhood trauma living with a single alcoholic parent who would leave me alone for most of the day while he went out to the bar. We lived in a very rural area so there was no people other than me around and no phone. SO I would spend my days worrying that something happened to my father who would eventually show up intoxicated.
My coping mechanism up to this point was not allowing myself to fall in love with someone. Sure I love people in my life, but not in love so to speak. But then someone special just sort of plopped down right in front of me. Well, needless to say all those negative unresolved issues came back with no mercy. So I called all the time. Cried alot. Mind just raced thinking I was going to lose this person either to something I did or said or to someone else or to illness or accident. I think I may have really lost them now because I smothered them with all this. I didn’t know what was wrong with me. Now I do.
Hopefully, I can get help with this. I did find a CoDA meeting so that my help. However, with this being a diagnosis that isn’t in the DSM. How many people would be good at treating this?
Someone Help Me!
I dont know if I have ASAD but I am so attached to my kids! If they are not around me I get panic attacks. I think my husband thinks I’m going crazy and I sometimes think so too. I quite often get really bad panic attacks because I always think something bad will happen to my kids or the people close to me. I have shut myself out from anything negative…I cannot watch the news..I never wanna hear anything negative or i just go into a panic…I need serious help!
To: Tom Tom and others here:
I think I would like to try an experimental brain treatment if one was available. If medical science could minimize feelings of panic, anxiety, obsessiveness, guilt, etc. without impairing any other cognitive function with some sort of stem cell brain “adjustment,” I would give it a shot. I just do not want to take the standard meds available now. It sounds like you, Tom Tom, have had pretty good results on a low dosage of a SNRI. I am afraid that on ssri’s or snri’s I would change so that I might lose control of situations and let things happen that I normally would not. I am going to speak with an MD soon to see what the best drug for me is. I’ve read horror stories about many of them, such as weight gain, dreams of all sorts, etc. But eventually I will need to take these as my condition gets worse day by day. I also should find a cognitive behavioral doctor as I’ve heard that they might help. Problem is they’re hard to find. Another issue is that the few md’s I’ve talked to(not CBT’s) were horrible. Standards in the field of psychiatric medicine need to be overhauled . In the U.S. the “good ones” often don’t accept insurance plans and then you may wind up paying thousands over time. However, for all other fields of medicine, most doctors do accept insurance.
Once, when I couldn’t contact my wife for hours, I went to the ER of a hospital. It was chaotic. There was absolutely no help. I needed someone to talk to and reason this thing out until my wife contacted me. Instead, they treated me like a car that had just come in for service. In other words, like a diagnostic evaluation. This was not the proper time for that. The psych. area was full of screaming patients, who seemed out of control. I wanted to get out of there, but they wouldn’t let me! They needed to make sure I wouldn’t hurt myself or anyone else. This really increased my panic. I had to lie and play it cool and tell them that I feel better now. When they let me go, I really did feel better that I was free of them. My panic was reduced as I felt like I at least had control of myself again. When I reached my wife, I felt so relieved, like I took some magic pill. Anyway, she couldn’t believe that i did this. She tries but cannot fully understand the depth of my panic and worry. She’ll always say, what are worried about?
I feel bad for everyone on this board who suffers from some type of ASAD. People who don’t have it can’t really sympathize. Why? because when the one(s) that you are separated from have returned to you, the panic is GONE! So they may rarely or never see you in that state of total panicked loss of control. Mywife has seen elements of it when I worried deeply over other stuff.
I simply cannot take this anymore. Yet I feel when I am not in panic mode, that I actually am pretty happy with life. Got a decent job, have interests, good physical health. These elements though, are all seriously affected by the great illness called ASAD.
Some One Out there!
I am reading these post and My mouth falls to the ground and I feel that little turn in my stomach that I get when I start to drift into what Everyone has my whole life has called(homesickness)! My Heart aches for everyone that is suffering. I don’t know if ASAD is the illness that I have but it sure sounds a lot like it .. I am 27 years old and I have been dealing with this my whole life .. I couldn’t stay over at a friends house .. I tried girl scouts once and I was fine until time for bed and when I knew it was about time to go to sleep I drifted into a panic to where I really thought I was dying at a estimated age of 11 or so.. I can remember a scout leader so worried about me that she took me to a E.R and called my parents to meet me there.. and my parents got to the point of being mad because I wanted to spend the night with a friend and do what the other kids were doing but as soon as I realized I wasn’t home and the fun was dying down I went into panic mode and they had to pick me up.. so eventually they quit letting me go… I missed 1mth of school in 5th grade and almost the school really hammered my parents …still no help from a doctor.. I went through school some days I was ok and some not in high school I couldn’t go on a date and made up lies and excuses because I was ashamed of my illness .. no one understood me It just got brushed off as me not letting go of my “mommy and daddy” today I have been married several times and they have ended in divorce… I married young because for the first time I was able to get in a car with a guy by myself without throwing up or having to call someone to come and get me so I thought this must be the one because I didn’t get sick .. I didn’t call my parents much because I was afraid that if I did It would trigger my attack because I would miss them so I almost tried to make my brain forget about them.Finally I slipped into my attacks once again and I wish I knew why but I got to a point where my parents had to come to my house just to get me to go to sleep .. of course this wasn’t good for the marriage and the ex didn’t know how to deal with this and we eventually split. I am married now and we live with my parents….!! We have a child and it’s the hardest thing I have ever had to go through my husband tries to understand but he just doesn’t , I would love to get my own place but I am afraid of the attacks.. my attacks have gotten worse and It’s hard for me to even go shopping, go see my in-laws, go on vacation.. This illness has taken control of my life and I want it back I just don’t know where to turn or what to do! I am afraid I will lose my Husband to this he is dealing but he isn’t going to live with my Parents for forever and I know that.. I just can’t seem to let go.. I want to be normal.. and when I watch people on t.v or hear about friends getting married and buying houses together and going on vacation .. I start to feel anxiety because I can’t do that..I am worried about our child and the emotional support that she recieves because of what I am going through … I just don’t want to keep hurting the people I love anylonger .. I need a fix for this … Thanks for letting me vent.. and I am here for anyone who wants someone to talk to … It’s so nice to hear from someone who can relate to one another ! I pray for everyone here for some relief!
Dee – yes, it does sound as though what you’ve been going through for years is somewhere on the spectrum of what we’re calling ASAD. I can especially sympathise with the not-calling-people as a means of avoiding a panic: I’ve had all kinds of avoidance behaviours over the years, and in themselves I know that they can cause subsequent guilt as my mind recognises that I’m avoiding people I love, as though I don’t care about them, when in truth it’s the exact opposite. Crystal too, seems to be suffering terribly from what to others is irrational, all-consuming anxious attachment.
John – you sitting as a child at home all day anxiously waiting for a parent to come back does seem to be a good spark for a later fear of emotional attachment, and for a fear of losing people you love. The way those fears are expressed seems to be internally directed as well as external, with you thinking that you personally might in some way be responsible for them leaving, while for H20 and me it all seems to be external threats.
H20 – you’re quite right to note that people who don’t actually suffer from these panics can’t understand, especially if they’re actually the ‘attachment object’. My wife has seen me in a panic, and she’s not the one I worry about, so she has an inkling of what I’m going through but that’s as far as she can get. I might be at the point of trying to tear my brain out of its case with panic, but then ‘they’ pick up the phone or walk through the door and it’s as though nothing had happened. They just see a slightly flustered version of my normal self. It sounds like Dee’s husband is in this position of wanting/trying/needing to understand but being unable, though I’m not sure from Dee’s post exactly how much her symptoms are of this kind of ‘Jekyll and Hyde’ variety where the removal of the source of the panic = instant and total relief, or whether there’s always a free-floating anxiety that you (?) and I don’t seem to have. I can utterly sympathise over the panicky ER escapade – it’s as though you’ll do anything, no matter how objectively ridiculous or embarrassing, to get some relief. Ever tried stopping random strangers on the street outside to ask if they’ve seen your mother, who’s a moment late back from the store? As a grown man, that’s pretty embarrassing, and feels at the time like a true moment of madness. If I didn’t laugh about it I’d have to cry! Of all the posts I’ve read, H20, I think your symptoms are closest to mine in their details, down to the feeling that other than in this aspect of our life we’re in good shape, but that this aspect is all-consuming and we can’t go on like this.
Now, I have no axe to grind for or against drugs, CBT, meditation, brain-stem transplants etc. My personal observations are this: Brain-stem transplants, though desirable, are still a while off (!). In the meantime… Cut out caffeine totally – it increases anxiety symptoms generally. While stopping it might seem like ‘p*ssing into the ocean’ as we say in England, and won’t solve our problems we could all do with making sure we don’t do anything that unnecessarily increases our basic anxiety level.
I’ve also found that giving up alcohol has without doubt reduced my underlying tendency to depression/negative thoughts which was giving my panic a more fertile space to flourish. I was drinking really quite heavily, as I found that having a drink made the world make sense – the panic was greatly, greatly reduced after a pint or two, but you can’t spend your life half drunk to avoid things that you really shouldn’t be feeling in the first place!! (I read Allen Carr’s ‘Easy Way to Control Alcohol’, which I’d recommend to anybody who’s already at the stage of knowing they drink too much but can’t seem to get off the treadmill.)
As to CBT – I tried it but didn’t find that it effectively addressed the complexity of my thought processes. That said, it did at least allow me see that my thoughts were irrational and gave me a strategy. It strikes me that it might be interesting for somebody to try exposure therapy, in the same way that OCD-sufferers or phobics can be treated. How about starting off, in a supportive, safe environment, calling up when we know the person will not answer (perhaps because they’re out, driving, the phone’s off, etc). Exposure to what we most fear could be gradually lengthened before we get relief, in the hope that we’ll start to lose the immediately catastrophic assumption of disaster. Just a thought.
The thorny topic of medication. It’s easy to find horror stories online of people who’ve had all kinds of side-effects from SNRIs and SSRIs and who legitimately feel hard done by, but it seems to me that far fewer of the people who find themselves genuinely happier using them ever bother to log on to talk about their experience. I found (and I think it’s a general observation on these drugs) that the anxiolytic effects start at quite low doses compared to their use in depression, where one finds more of the problematic side-effects. Several people have posted that they’ve got to the stage where they know they simply can’t carry on with things as they are. I fully sympathise, though right now I’m a decent way above that depth of despair. When it comes to it, if any of us were told we could get relief from (if not a cure of) that despair by taking a pill, but that, yes, there definitely were side-effects like dry mouth, constipation, weight gain, odd dreams, would we decide we’d prefer to go on suffering? I got to the stage where no possible side-effects (of what are after all highly regulated medications sold in Western democracies with strong legal systems and consumer protection laws) could have been worse than what I was going through, and so I took the plunge and don’t regret it one iota. If the side-effects aren’t worth the benefits or are in themselves too much, we can always just tail off the dosage and stop the meds. Nothing lost. (I need to add here that, on reflection, I did get other minor effects on Effexor XR, such as constipation, dry mouth, tooth-grinding, but they all petered out after a few weeks as my system got used to the drug, and with time my system soon readjusted to its pre-drug norm).
Meditation. I mentioned before that I’ve been trying meditation (Christian-centred specifically, but only for personal reasons – other forms are based on Hindu or non-religious thought) for a couple of weeks now, and that it’s been having a good effect. Let me roll back my thought process a bit… At it’s most basic level, I think we’re all suffering from / living in a kind of permanent anxiety state which, for complex reasons that differ in their teetering pile of details for all of us, tends to be triggered by associations with people we love and have attachments to. Fear of permanent loss seems to be a common theme. Now, we seem to be stuck in rapidly destructive ever-decreasing circles of thoughts that take an otherwise objectively neutral stimulus and turn it into a catastrophic conclusion. We might begin to fear the conclusion itself and the extreme physical symptoms of anxiety that go along with it, and develop complex avoidance behaviours which are in the end ineffective when the stimulus is met. We all (I assume) live in Western democracies with competent and effective emergency services (no matter how cynical I am about British policing!) and strong civil societies which don’t just let people get hurt or die on the streets without all kinds of alarms and sirens, both literal and metaphorical. But we still feel that our attachment figures are constantly in mortal peril or just going to vanish. They’re not. Objectively, there’s nothing to support these catastrophic conclusions. H20 – if I was at your house and your wife didn’t answer her phone I wouldn’t be in the least worried; Dee – if I was staying at your home I would be able to get to sleep perfectly well; Crystal – if your kids didn’t answer when I called them in I wouldn’t panic, I’d just shout louder or pop out to look for them; John – I wouldn’t spend all the time calling your partner worrying about them. You all know, of course, that I’m writing this with the best possible of intentions, and that I’m well aware that none of you would be remotely panicked if you were here at my house and my mother unexpectedly didn’t answer her phone. My obvious point is that our anxieties, though very real to us both mentally and physically, are objectively absolutely baseless. They exist only in our individual heads, and this is why I think that it’s vital for us to find a way to break out of subjectively catastrophic thought-cycles which focus very unhealthily upon possible future events.
Where was I? Ah, yes – meditation. Like I said, I’ve no axe to grind – I’m just passing on what thoughts I have and what I’ve found / am finding effective. There have been lots of proper scientific studies (I’m contrasting them rather arbitrarily with new-age pseudo-scientific studies – please indulge me) into how regular meditation has a measurable and long-term influence upon thought-patterns, tending to give practitioners a calmer outlook on life, reduced incidence of depression etc etc. (I don’t want to bang on about the British National Health Service as most of you seem to be in the US and so it’s not really relevant, but there are moves here to have more GPs recommend people with depression etc for meditation programmes, as they’ve been shown to be good at reducing relapses and the need for medication.) There’s an enormous psychosomatic element to our problems (and by that I mean that our thoughts have a real effect in physical symptoms, not that we’re imagining we have a problem), and I think that if we can address the anxiety side of things we might be able to ‘undermine’ the other negative thoughts; or to put it another way – if when we tried to call but got no answer, or (insert particular stimulus here), and there was no hint at all of that gut-wrenching feeling of doom / nausea / racing heart and so on, we could ignore the little nagging thought that something is wrong or that something bad is bound to happen, or could drown it out or replace it with whatever we were doing up until the point that the stimulus hit us.
I’ve been spending 20 minutes or so each day meditating in silence, and it leaves me feeling very calm. The effect seems to be cumulative, and I’ve started to have moments in the past couple of weeks, like brief glimpses of feeling positive about these ASAD thoughts, like little spots of light – ‘actually, if she didn’t answer now, I don’t think I’d panic’ or ‘wow, I’d normally have obsessive thoughts about where she is around this time of day, but I’ve forgotten to worry’. That kind of thing. I’m going to carry on with the meditation. I’ve found it takes me out of myself for a while each day, and allows me to focus beyond my anxieties. When I’ve finished, it seems a little easier each day to look back at myself from the outside, as it were, and to realise that my thoughts are like a mental prison. Hey, I might find that tomorrow I relapse horribly and the meditation is back to square one, but so far it’s a great help. If anyone wants to try it there are a million and one online resources. I don’t think any of us have anything to lose by devoting half an hour each morning to something that might work, is free, has a proven track record, and which we can ditch if it does nothing after a month or two.
Don’t despair, everyone – we were once free of this anxiety, everybody else is free of it all the time, and there’s no reason why we can’t find our way back to where we once were and where everybody else still is.
Hi All -
I was so happy to stumble across this article. I mainly feel like I suffer from this in terms of romantic relationships. I cannot stand to be away from my significant other. Now that I am older, and thinking about getting married – I’m realizing that it needs to come to an end or else the guy I’m with is going to think I’m crazy. I have always had trouble controling my emotions… but at this point, it’s at it’s absolute worst. There are times when I am at work, and instead of going to dinner with my boyfriend, or seeing him after work – he’ll want to do something else, which lead to me going home for a couple hours by myself without anyone. Not even exaggerating – AT WORK, I cannot control my bursting tears from the thought of this. I feel like I want and NEED to be with him ALL the time. I have to go to the bathroom and cry. He gets frusturated with my about my feelings, and so then he’s upset which then makes me more upset on top of it. There’s no reason that he can’t grab a bite to eat and I can be at home for 2 hours without him. But there mere thought of it makes me so nervous I want to cry. I always try to set up plans with him for the week so he can’t do anything else… and if he wants to I can be upset that he’s canceling on me. I have avoided talking to anyone about this because it is brushed to the side… maybe they think I don’t have a good relationship, or I’m just young and don’t trust him. I have a great relationship, with a fantastic guy. I just can’t stand overreacting anymore when I know I shouldn’t. Like someone else said – they will drive over to the person’s house or try to find them if they are not answering their phone. I am afraid that my actions will result in him being so fed up that he won’t want to continue the relationship. I have also found that talking to a therapist does not help. Maybe I haven’t found the right one, but I’m tired of spending money trying. I have emotional control problems regardless.. most likely depression – I have always been on meds. for that (citalopram) – but this “seperation anxiety” is the only problem that continues no matter what. The medication has always made me feel better… but this is the only thing that will not go away. Is there anyone out there that mainly experiences this with a relationship?
I think that I might have ASAD. I am 18 yrs old and have been with my current boyfriend for the past 2 years. I always feel anxious when i know that i am going to be apart from him even if its only for a few hours. We are very much in love with each other but i thought that these feelings were normal until they got worse. I now go to school in the same city as him just so we can be close and i can see him but its gotten to the point where i have a hard time being away from him, i find it hard to concentrate, study or do anything productive because i am constantly thinking about how i want to be with him. I am afraid that i am getting worse and that i am going to ruin our relationship. Just the thought of loosing him makes me so scared. Please help!
Oh my gosh!!! I can’t believe there are more people out there like me! I’ve suffered with this for years, and I just thought it was me. It’s not something you just casually bring up with other people, everyone else just looks at you like what’s the big deal? Everything I’ve ever read about talks about generalized anxiety and on and on, but I know what I have is very specific. I’m generally a very happy person, but this one area plagues my life. I’m fine as long as I know where my husband is, but the same as mentioned above, as soon as he doesn’t answer his cell phone, I’m sure he’s dead. The problem is too, he travels a lot and travels alone, driving for long distances. The description above (either tomtom or H2O) was exactly on…terrible panic and dread, for me including crying and praying, until I finally get a hold of him, and then it is a huge euphoric relief. I hate this about myself. I wish with all my heart I could change it. I know the event that happened in my childhood that started this, but how do I ever get over it? I hate medication, but what are the alternatives? Anyone found anything that helps?
I have been reading all of the comments on this website and I felt so relieved I burst into tears. I have been suffering with ASAD since I feel in love with my boyfriend, and it has ruined my life so far. I have been diagnosed with panic disorder and GAD, but the symptoms can’t be fully explained by anything other than ASAD WITH panic disorder.
My parents broke up when I was young, and this has triggered real abandonment issues for me. I had no trouble until I met my boyfriend, and as we got closer, I started to get panic attacks when he was going to leave me, and so badly that he would stay to look after me. I phoned his college in hysterical tears because I thought I would die without him and was told I belong in hospital by a teacher, which made me feel like I was going crazy… We live a long way from each other now, due to his university commitments, but I don’t want to do anything without him, and I hate leaving when I visit, I often can’t do it and stay for days and days until he’s annoyed. I think something bad is going to happen or that he will not want me anymore, so I cling on tighter to make sure he wants me. I get really jealous of certain other girls in his life, even though I trust him completely, and I want him to spend all his time with me, as if that keeps him safe. He can’t go to the gym or anything for a couple of hours in the evening without me going crazy.
It’s ruined my life and now my relationship- my boyfriend can’t take it anymore and doesn’t want to be together. I feel so alone and so desperately unhappy, I think about him all the time. I am 20 years old- these are supposed to be the best years of my life but they’re the worst so far! Can anyone offer some help…?
Some of the more recent posts seem to have added a new element to the mix of what we’re calling ASAD – alongside the overriding symptom which H20, Dani and I have (i.e. we’re basically fine and level-headed until we find that we can’t reach a specific attachment figure and then we’re straight into a blind, crying panic until they turn up again and we’re euphorically happy), there are others whose main symptom seems to be that they’ve additionally (or perhaps solely?) got a disablingly anxious need to remain with the person, which isn’t what I personally (and H20 and Dani?) have a problem with (okay, I’m horrifically oversimplifying from the basis of a few lines). EJ, for example, you say “I am constantly thinking about how I want to be with him”, which seems to be the other side of the coin from H20, Dani and me (and to a lesser degree Saz). Jamie, too, seems to be able to sympathise with the extreme panic symptoms, but I don’t get the impression that panicking when temporarily unable to contact your boyfriend (e.g. because you’re then convinced he’s dead/kidnapped etc) is paramount (I might be wrong here). EJ and Saz too seem to have similar complexes of insecurities and anxieties attached to persistent and intrusive thoughts that anticipate the loss of, or abandonment by, a partner, and perhaps you three ought to swap email addresses and have more of an exchange of exactly what form your symptoms take, to find some common details that might shed light on how to move forward. I can imagine exactly what the anxious anticipation is like for you, but personally I feel very emotionally secure and wouldn’t really know how best to empathise with what appears to be a different set of fears. (Having now written a lot below on how possibly to challenge and analyse thought processes, it might be possible to tailor those suggestions to your own anxious reactions?).
One thing I might suggest is some way of thinking rationally (it’s clearly missing somewhere along the line for all of us, else we wouldn’t be here!) about what exactly it is that we’re afraid of, and testing those unquestioned but clearly undesirable and persistent thoughts against “reality”. Here’s an example of how this might work for, say, Dani (but only because you only mention one trigger, so it’s a little easier):
Your husband travels a lot (and presumably is away for some time, perhaps overnight in some other city?), and so come the evening you want to call him up, ostensibly to chat but also because you need to calm that growing and insistent feeling of anxiety. If he answers, fine, but if not then you’re straight into our catastrophic downward cycle of panic, leading to worse anxieties, and so to more panic. If you’re like me, then the bodily feeling of panic in itself creates a certainty that “something dreadful has happened”, like a self-fulfilling prophecy. Up until the point when you tried to call you were pretty much together mentally, if perhaps a little anxious, but you weren’t thinking “he is dead”. The unanswered call has made all the difference. But if you think about it, if you weren’t thinking he was definitely dead before the phone call, the fact that he hasn’t answered the phone hasn’t suddenly made him certainly dead, it’s your reaction to the fact that he hasn’t answered that’s made you instantly reason it out that he must be dead. That might be a blindingly obvious point, but let me try to think on the hoof through the implications of it…
Your belief that “unanswered call = husband dead” isn’t (obviously!!) a rational reaction to that unanswered call. Neither is my belief that “unanswered call = mother dead or kidnapped” a rational reaction. If we challenge your evidence for your belief, it’s very weak – could you make a list of other explanations for your husband not answering? Off the top of my head there are: he didn’t hear the phone; the phone’s out of power; the phone’s out of range of a signal; he’s turned it off because he’s driving/in a meeting/in a restaurant; he left it in his room/car/jacket pocket… I could go on, but you see my point? These are all much more likely explanations, and if only they can be placed at the head of your mind’s list of explanations for “the evidence” of his death (i.e. he didn’t answer) then your mind/gut instinct should find it harder to instantly assume it has resolved the evidence into a “reasonable” explanation.
Then comes my next thought process – my mind has instantly jumped yet again from the evidence of the unanswered phone to (say) the certainty of death, but it’s forgotten to assimilate past experience, as though we’ve got a complete blind spot for previous outcomes of the exact same situation: what happened last time I called and he didn’t answer? I couldn’t get him for a minute/an hour/five hours, but then I did get through and found out that the reason he hadn’t called was X (see reasons above, or add one I haven’t thought of). How about keeping a strict written record, coldly factual and impersonal of what you’re doing, and of what the ultimate outcome is? For example, yours might read “Date/time: X didn’t answer; called again X minutes later (if this was me it’d be every few seconds!!) and no answer; called at X o’clock and X answered: he hadn’t picked up before because…”. After a while you’ll build up a truthful picture of the reality of the evidence without your mind being able to play tricks on you by “forgetting” what happened (i.e. he was okay, and there was a perfectly normal reason for his not answering) or by distorting the past. You’d be able to see that, for example, on average he doesn’t answer two times before he eventually does answer, or that when he last didn’t answer on a Saturday morning it was because XYZ, but he was okay and there’s no reason to think he’s dead, because this has happened before.
Would you be able to remain calm enough before a call to run through that reasoning and make it stick? E.g. “I’m now going to call. He might not answer. If he doesn’t answer then these are the best explanations to account for that fact…”. If he then doesn’t answer, try going through that process in your mind again, perhaps with physical relaxation techniques or some other practice aimed at removing your obsessional thoughts and replacing them with some other distraction. Remember that all of these anxieties are in your mind, not an objective reality. If you can change your perspective and look at your thought processes from outside, their irrationality might become clearer.
Okay, your obvious objection to this fund of proven past precedents for the best way to perceive the evidence is to say that there is a possibility that he’s e.g. died in a car crash. True, but you’ve no objective reason to believe that: I’m assuming you’re in the US – don’t the police call round when people’s relatives are involved in car crashes? (I’m not being hard-hearted here, only practical – trust me, I’m going through or have been through exactly the same emotions and my stomach churns at these thoughts). Surely no police at the door = no evidence of a car crash involving X? No news is good news (that is to say, if you haven’t heard anything bad, assume the best), but we seem to reason instinctively that exactly the opposite is true.
Next thought – what’s the worst that could happen? Okay, we all know what our worst fear is for these people, but every one of us is capable of surviving the death of a loved one if, God forbid, it ever actually happened as we fear. We all know people who’ve gone through that and worse and survived, or even flourished as a result of that terrible experience.
Another thing – aren’t we all subconsciously refusing to allow these people we’re anxious about the respect that they deserve as competent adults? I know for my part that I suspect somewhere just below the surface that my mother isn’t capable of fully looking after herself, that she’ll walk out in front of a bus or something. But she’s a perfectly capable woman of 63 who’s brought up two children, gone through a divorce, and has survived years growing up and living in south London (far from a rural English village, for all you Americans out there – think the British equivalent of the rough end of the Bronx!), while it’s me who’s the one with the anxiety problem. If anything it’s her that’s the capable and strong one, and me who needs people to worry about me!
I’m still doing the meditation, specifically Christian-centred as I feel that this better suits my background and is more likely to fall on fertile ground, as it were, and I do feel that my overall background anxiety level is lower than before – I’m further away from panicking, and so the triggers that cause the panic need to be worse or more consistent for me to hit those lows I used to. There are lots of resources for techniques that make you calmer online – mental relaxation regimens etc – and some of you might fancy trying the hardcore Buddhist meditation techniques that have proven scientific effects on mood – I’d be interested to hear if anybody’s tried them and found a positive effect on GAD or similar.
Sorry for the very, very long post. Hope somebody has thoughts on all that lot to throw into the pot!
This article was the “aha!” for me also. I have read all the comments here & it’s nice knowing that I’m not alone! My separation anxiety is mostly directed toward my husband. I used to get severely panicked knowing that he had a long commute to work…I would spend the whole day convinced that he was dead on the side of the road somewhere, & if I couldn’t reach him, that of course just added to my panic. But we fixed that specific issue by having him call me when he arrives, just to let me know that he’s made it okay. This has helped significantly!! However, I still feel panicked whenever he leaves the house, as I am convinced something will happen & he won’t come back (yes, I know, it’s completely irrational!!). But on top of it, I have milder feelings of anxiety in general whenever we are apart at all.
I also can’t stand to be home alone at night. I literally will sit, feeling somewhat panicked, in one room of my house (upstairs, where I can see from the window if anyone is coming) & I stay there until my husband gets home. If it is an overnight trip, I stay in that one room until bedtime & feel panicked right up until I fall asleep. Also, I know, completely irrational, but I’m just so scared unless he is there! I even feel anxious if we don’t go to bed at the same time. I don’t feel comfortable until he is in the bed with me, even if I know he is just in the room next door checking his e-mail!!
I’m also very smother-y. I hate for him to leave home without me, for fear of something bad happening. I even get hurt or offended sometimes if he is gone too long, as I want him to be with me all the time! I even burst into tears sometimes just thinking about the fact that we are aging & getting older by the day (we are only in our 20’s!!) & some day, he will die. Even if he lives to be 90, he will still die. For me, it’s not so much an issue of simply being alone, but being without HIM, and even not being married to him any longer. I am a Christian & I believe in Heaven, so you would think that in those times I could just reassure myself that even if he does die some day, I’ll see him again. Well, no, because the Bible says that there is no marriage in Heaven. So while Heaven will be great & yes I will see him, we won’t be married & it won’t be the same as it is now. This also makes me (at times) want to avoid physical intimacy with him, because that only strengthens my feelings of love for him, making the coming “dooms day” an even more painful thought. I hate that I’m putting him through this, but he is very supportive & kind about all of it.
We had our first child several months ago, & I cried for weeks at the thought that we wouldn’t have as much time together as before, & that there was someone else in our little family now, rather than it just being the two of us (& I love my son, & it was a very planned pregnancy, etc!!)
I am breastfeeding & we hope to have more children, so even though I have taken meds in the past I don’t really want to go down that road again for now. I feel like for me anyway, I really need to focus on the spiritual aspect right now. Somewhere along the line I’ve come to depend solely on my husband to meet all my emotional needs & ensure that I feel safe. I need to figure out how to put that dependence on God instead, because He is the only one who will NEVER leave me, ultimately. Saying this is of course easier than really doing & believing it!! I also read an interesting article on the connection between mental/emotional problems & nutrition & am going to alter my diet a bit & try to get in more exercise.
My parents divorced when I was very young- 2 years old. I didn’t get to see my dad much, so that could be the root of some of my abandonment fears. But then my mom convinced me that I should hate my dad, and I listened to her. I would cry & scream & grab onto things, refusing to leave for my visitation with him. I didn’t want to leave my mom. Then by the time I was 5-6 years old, I can actually remember sitting in my room crying because I was afraid my mom was going to die. Even when convinced that she was perfectly healthy, I continued to cry just based on the thought that she would eventually die some day.
It’s been so nice to type this all out, as it would generally be considered “taboo” to talk about it in most of my circles, & only my husband knows what I go through (& even he can’t relate, but he’s there for me & is understanding). Thanks!
I have read this article and my heart goes out to everyone who posted comments. As all of you I too suffer from some form of adult separation anxiety. It has become worse since my father died 4 years ago. Consequently my marriage ended at the same time. Now I’m in a relationship looking to getting married in a few months and continue to struggle with the clinginess, neediness, etc. I don’t have to go into detail since you all know what i’m talking about. Although, my struggles revolve around my partner they also include my mother in some way. I have also noticed that therapy hasn’t really help because perhaps we are not targeting the right symptoms. I have tried medication only for panic attacks but are now thinking that i should try something else. Some of the things I try to focus on like someone else said is mediation, especially during the panics. Itunes has a wide selection of meditation podcasts that are downloadable for free. Also, try on working on stopping the irrational thoughts as soon as they begin. Do not indulge them or they take a mind of their own. Although that doesn’t work too well at times. Instead of playing that negative tape player try replacing it with a positive thoughts and play that thought over and over again. I know it’s not much help but sometimes it stops my anxiety…for a moment.
Hello All-
After finding this artical on the internet a sense of ease came over me. I no longer felt like I was CRAZY! I have always had a problem letting go of male figures in my life because my father passed away when I was 4. My mother remarried several times each time her husband would walk out on my mother and my family. Growing up I always had to have a main guy friend. It just seemed to come natrually since i had not had a male figure in my life. I would say that I started to become obcessed (not in a homosexual kind of way. (Not that there is any thing wrong with that) but I would always have the fear of them going out of my life. It is not until about 1 year ago that I realized that I had a problem. Not only did experience anxiety with the separation, I also experienced jealousy, depression, and mood swings. Not only do I become over obsessive with the necessity to be close to my friends I became overly protective of them putting myself in danger. With this clingy and needy behavior and the fear of losing my friend I have seemed to push them away more than keep them close. After reading this artical I am happy to say that I will be making an appointment with my doctor as soon as possible so that I can come as close to some kind of recovery as I can. I hope that every one on this page finds the answer that you are looking for. Good luck to all.
jm
I’m seeing that most females that have posted comments here – have an anxiety associated with their husbands (as the subject of attachment) and they have father issues from childhood. My father personally abandon me and I now suffer from ASAD and believe that it’s because of the childhood separation my father (the male figure). I’m curious if anyone has sought treatment or formally been diagnosed. I feel very embarassed about this problem and it is effecting my husband as he feels like a prisoner. My attachment is to my husband, and oddly enough, I was married and divorced once before and didn’t have this problem with my previous marriage.
My counselor today told me that I suffer from separation anxiety disorder. I did some research and found that I probably experienced it in childhood and adulthood. I researched the childhood separation anxiety and had flashbacks to my early and middle childhood – more so than my nightmarish adolescence. In my case separation anxiety is exacerbated by my parents’ emotional abuse. The effects of separation anxiety have been devastating for my life. I cannot hold a job in any office or company. I am not able to pursue my original dream of becoming a professor of history or political science. I am in my mid-30’s living in my grandmother’s house underemployed and never married. I now understand why I can’t hold a job or get married. It makes me very sad, but at least it makes sense to me why this has happened to me and why my life has turned into a nightmare and my dreams have been dashed against the rocks. Thanks to the writer for this important article. I am female too. I felt like this article was talking about me all the way. At least I know why my life outcome has been so devastating.
It’s funny how much clearer things seem when a definite label has been attached to one’s problems.
I have several anxiety disorders – gosh, I hate talking about it in this way, because it makes me sound like a container for a number of diagnoses. Most people who meet me don’t for a moment assume that I have severe mental problems or, in fact, any. I appear normal, but in fact my life is utterly painful.
I am, basically, someone who is always afraid. And have been for as long as I can remember. I’ve been in therapy, and I use meds. I’ve heard many different explanations for what is wrong with me, from Prost Traumatic Stress Disorder (by the psychiatrist I saw for years, and to whom I owe much in terms of personal development, if unfortunately not in terms of significant anxiety relief) to, somewhat upsettingly to me, borderline personality disorder.
I don’t think I’ve ever felt so bad about my psychological problems as on that occasion – when the psychiatrist in question (who did not know me very well, incidentally) suggested I was a borderliner. For one thing, it’s a diagnosis that carries great social stigma. For another, his main argument was that I had separation anxiety. I told him I didn’t seem to exhibit any of the other traits: no self- harming behaviour, no suicide attempts, no tempestuous relationships, no substance abuse, no impulsivity. (Far from it, in fact.) But he wouldn’t budge (and was, in fact, quite irritated by my anxious reaction. Even though I was perfectly polite, he at some point said he would not continue our conversation if I didn’t listen to him better, etc.)
What I’ve always felt, myself, was that the main factor in all my anxiety and mood troubles, was: loss. Mainly of people, but also of places I had been attached to. (Such as home, in my childhood.) In spite of years of therapy with an excellent and caring psychiatrist, I’ve never been able to make significant inroads on the problem.
What I have been able to do, thank God, (and learned to do thanks to this psychiatrist) was to build a strong relationship with my loving husband, in spite of the separation anxiety and its potentially disastrous effects on relationships. Of course it is terribly annoying for a partner to have to deal with clinging behaviour, and with restrictions that one might want to impose on them. I’m not sure I would like that very much, myself.
He and I reached a simple agreement: I was allowed to express my anxiety, and he would understand that it was a problem I had no control over, and would not be cold or punishing. In return, I would not try to restrict his actions, and would let him free to enjoy a normal life. So, he would go away for a week to the mountains, and in the prior days I’d suffer debilitating anxiety. He would comfort me when he felt like it, and not when he didn’t. I would tell him how worried I felt, but in no way try to persuade him not to go. He would not be cold, I would not be accusing.
It worked. It worked wonderfully well. We each let the other be who we were, and I can honestly say that whereas my severe anxiety disorders greatly harmed my life, they did not harm my relationship. Which meant, of course, that I had to deal with a lot of anxiety without trying to ‘act’ on it. But, in truth, even if you do try to restrict your partner, not only do you run the risk of ruining the relationship, but it doesn’t really help, anyway, does it. It’s a stopgap solution to anxiety, but it works for only very short whiles. You can try to keep someone from going out without telling you, or from going abroad by himself, but it won’t make your life happier in the long run. Not at all.
So, I dealth with the anxiety. Apart from all other anxieties, throughout the many years of our marriage I was terrified my husband would die. Almost every hour of every day, with only short intervals of relenting of the fear. Yet he was young, and in perfect health. My feelings of “co-morbid” depression were almost entirely caused by the fact that I’d envision how I would be alone after his death, pacing the house and crying. People would tell me to ’stop worrying’ about that. Needless to say, if that was an option, I would have done it long ago.
Much probably had to do with my mother being ill when I was a small child. She was taken to hospital regularly and for long periods. I think the repetition of such loss was more damaging even than her eventual death, when I was 8 years old.
One year ago, on the same day my mother died decades ago, I came downstairs in the morning and found my husband dead on the floor. It was probably a heart attack, the doctors think, despite the absence of risk factors. Because he was so fit and healthy, I always thought that a car accident was the big danger to watch out for. Not so. It is surreal, now, to be pacing the empty rooms of my house exactly as I visualised throughout all those years of anticipatory anxiety.
And have I learned a lesson from this? Some people have suggested that I have now seen that “worrying doesn’t help”. That’s true. But sadly, my worries about losing the very few people I still have attachments to have only intensified. I don’t see myself ever getting over this Separation Anxiety, whether with (yet more) therapy or (yet more) medication. In fact, I avoid seeing my beloved father these days, because it’s so unbearable to be with him and all the time visualise how I will have to be without him soon, probably within some years.
The fact that we had no children leaves me quite lonely, of course. But one of the reasons I decided not to have them (given that my husband wasn’t awfully keen on having children, anyway) was that I knew my life would be hell for worrying about Something Happening To Them. Which I didn’t think would be a nice way for them to grow up. Just one of the many ways in which ASAD impacts one’s life.
Oh, just one more thing. Many people have talked about it already. It’s this simple thing: even more painful than debilitating anxiety is the lack of understanding in other people, and suggestions that one is “weak”. Utterly, utterly painful.
I’ve just finished reading the many comments and yes I can relate to many. Most comments here seem to be women, perhaps not many men are willing to ‘open up’? Anyway, i’m a 28yr old male and I have similar anxieties though not so much with people or a specific person as in most of the other posts but with home. I think I read somewhere in these comments that a girl was unable to go to sleep-overs due to panic attacks. This was the case with me as a child and I think as a result I am now very reluctant to go to friends in nearby towns as I don’t want to be away from home and when I do go I constantly think about what I would be doing if I was at home surrounded by all my comforts and knowing me and my family are safe. I have tried to go on holiday 3 or 4 times but once there all I can think about is coming home. I completely lose my appetite and can’t even force myself to eat as my mouth is so dry. I find myself frequently being sick and as a result feel weak and tired. This last holiday I slept an average of 15 hours a day, obviously because I was so tired but also because I knew when I woke up I would be closer to going home. I did calculations in my head of how long had gone and how long was to go.
If it wasn’t for the thought of leaving my gf and 2yr old child behind for the remainder of the trip I would certainly have got an early flight home, regardless of the cost.
My thought patterns were so irrational that when on the hotel balcony I thought ‘if I were to fall off here they would have to fly me back home to hospital’, at least then I would not have to face the embarresment, and explaining to people why i had caught an early flight…again’.
I don’t like thinking too much about that moment, it makes me sound suicidal which I really aren’t, it was just a momentary feeling of desperation of going home.
Once I arrived home I felt fantastic, within minutes of touching down my appetite was back and I felt completely back to myself!
The problem now is how can I possibly contemplate spending hundreds on going on holiday if the same thing is going to happen again, does this mean I can never go on holiday again???
Thanks for listening, any advice would fall on very welcome ears!
Hi everyone,
I have found it a little more comforting knowing im not alone in this….i am only 19 years old and suffer from this greatly. one of my friends when i was 16 was murdered and since tht day i have not been the same. i have a wonderful loving caring boyfriend who knows abour my disorder and he helps me greatly. Tonight is a night that i cant sleep due to nightmares about loosing him i know it sounds irrational and that at 2:30 in the morning id expect to hear his voice when i called in a panic but i didnt and now it is 430 in the morning and i am still up writing this comment crying because of the fear that i lost him. i love my boyfriend with all that i have and im just so scared someone or somthing will take him from me how they took my friend from me. i tell myself i know he is ok tht his beautiful face is sound asleep but yet i can never truely believe myself until i hear his voice comforting me telling me hes ok. i mean again i know it is irrational but tonite he took allergy medicine. can you even overdose on that? and in my mind im freaking out that u can and tht he has i cant help but have tears pouring from my face while writing this. i know i need help and i want help i want to go backto the way i was before i lost my friend to murder. i want to be able to sleep well at nite knowing my boyfriend is ok and that he will be here in the morning. i dont want to cry anymore i just want to get better because i cant take this anymore. please any advice would be greatly appericated. i know this all sounds so irrational but this is my life and i want to be ok.
Hi J and everyone else!
I’m so sorry to hear about your fear and upset- it is irrational, but everyone on this page knows that just because we know it’s irrational, it doesn’t make the feelings any better! I suffer from agonizing ASAD from my boyfriend too, and I know how terrible it is and how needy and clingy you can get. I’m starting to see now however, that this behaviour was only pushing him away. I realised that I WOULD lose him if I didn’t get better and stop the feelings- my boyfriend is wonderful and very understanding, but after a while it does get a bit much for them.
I am trying CBT at the moment- my doctor is giving me one to one sessions once a week to help me, and I am also on the waiting list for a new NHS service called “Let’s Talk”. It’s free CBT and is actually Increased Access to Psycho Therapy. CBT is great for me- I still have the feelings that I had before, but I can control them much better now. I am also using Diazepam for emergencies, but as they are a tranquiliser, I try not to use them too much.
Look up CBT on the internet- it’s basically breaking unwanted habits and vicious circles. It might really help you.
I really hope you start feeling better, and let us know of your progress!
Saz x