Adult Separation Anxiety Disorder: Not Just Kids, Part 2

Adult Separation Anxiety Disorder affects almost 7 percent of the American people. Yet it was unheard of only 15 years ago.

Adult Separation Anxiety Disorder sufferers experience extreme anxiety and fear when separated from major attachment figures; avoidance of being alone; and fears that harm will befall those close to them.

Because the diagnosis is so new, there is no standard way to treat Adult Separation Anxiety Disorder. Sadly, it is hardly mentioned in the standard diagnostic manuals that mental health care professionals use.

This two-part post accompanies the posting of the reference article on Adult Separation Anxiety Disorder. The current post is the second of two. The two posts are a short version of the reference article, which has full information about the disorder. The information in today’s post falls under the following headings:

• How does Adult Separation Anxiety Disorder affect your life?
• Adult Separation Anxiety Disorder and other mental disorders
• What is the treatment for Adult Separation Anxiety Disorder?

Yesterday’s post, part 1, had these headings:

• Just what is Adult Separation Anxiety Disorder?
• How many people have Adult Separation Anxiety Disorder?
• What are the diagnostic criteria for Adult Separation Anxiety Disorder?

Who is most affected by Adult Separation Anxiety Disorder?

Relationships, education, employment are all affected

There are more women than men with ASAD. However, men are more likely than women to have the first onset of ASAD in adulthood.{{1}} Separation Anxiety Disorder, both the adult and the childhood versions, seems to run in families.{{2}}

The odds of being not married or being separated 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.{{3}}

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. {{4}}

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.{{5}}

How does Adult Separation Anxiety Disorder affect your life?

ASAD causes serious impairment to 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.{{6}} 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. As noted above, people with ASAD are much more likely not to have been married or to be divorced or separated.

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.{{7}}{{8}}

The following table shows the personal and social impairment experienced by people with ASAD:{{9}}

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

Adult Separation Anxiety Disorder and other mental disorders

Over 88% of people wit ASAD have another mental disorder

ASAD often occurs along with other psychiatric conditions, especially other Anxiety Disorders or mood disorders.{{10}} 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.{{11}}{{12}}

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.{{13}} Katherine Shear, lead author of one of the most important ASAD studies to date, says:{{14}}

I think that separation anxiety disorder is a vulnerability factor for all kinds of mental health problems.

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.{{15}} 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:{{16}}

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

What is the treatment for Adult Separation Anxiety Disorder?

There is no standard treatment for ASAD yet

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 called Stacy, whose story was told 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.{{17}}

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.{{18}}

What do you think?

We all have symptoms of ASAD sometimes

Everybody has some symptoms of ASAD from time to time, especially in dire circumstances such as a prolonged separation or a death. There are also some cultures where what might be called “symptoms” are the norm. Research is ongoing to determine what is “normal” and what is not. The full reference articles takes this subject up in detail.

The effects of ASAD in a person’s life have barely been studied. As might be expected due to the newness of the diagnosis, none of the studies of the effects of mental disorders include ASAD. But the warping of a person’s life and those about them by ASAD is very real and very painful. 

I have known several people who have had symptoms of ASAD. They were needy, clingy, or labeled “insecure” by others. Though I knew they really wanted my attention, I did my best to avoid them. Inevitably, this caused them to try all the harder to draw me into a relationship with them. I’m sure my rebuffs were painful for them, and I’m sorry now that I didn’t understand their motivations better. However, for whatever reason, this type of person seems drawn to me, and I have had to fend them off all my life!

• What do you think might be a “normal symptom” of separation that is not full-blown ASAD?
• How do you handle needy, clingy, or insecure people?

Glass figurines entitled “Separation Anxiety” created by Robert Mickelsen. Visit myglassart.org for more information.

As always, your comments are welcome!

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FOOTNOTES:

[[1]]Shear, Katherine; Jin, Robert; Meron Ruscio, Ayelet; Walters, Ellen; Kessler, Ronald. (2006, June). Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication. Retrieved April 1, 2009 from http://ajp.psychiatryonline.org/cgi/content/full/163/6/1074 Table 1 [[1]]

[[2]]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 [[2]]

[[3]]Shear, Katherine.(2006, June). [[3]]

[[4]]Shear, Katherine.(2006, June). Table 2 [[4]]

[[5]]Shear, Katherine.(2006, June). Table 2 [[5]]

[[6]]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_ [[6]]

[[7]]Shear, Katherine.(2006, June). [[7]]

[[8]]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 [[8]]

[[9]]Shear, Katherine.(2006, June). Table 4 [[9]]

[[10]]Staff of Insight Journal. (2007).[[10]]

[[11]]Shear, Katherine.(2006, June). [[11]]

[[12]]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 [[12]]

[[13]]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 [[13]]

[[14]]Szalzvitz, Maia. (2006).[[14]]

[[15]]Kirsten, Laura; Grenyer, Brin; Wagner, Renate; Manicavasagar, Vijaya. (2008, March). Retrieved April 1, 2009 from http://www.informaworld.com/smpp/35862073-66953207/content~db=all~content=a790668570~tab=content [[15]]

[[16]]Shear, Katherine.(2006, June). Table 3 [[16]]

[[17]]Szalzvitz, Maia. (2006).[[17]]

[[18]]Shear, Katherine.(2006, June). [[18]]