Separation Anxiety Disorder in Adults

Medical Reviewer

Ask most people what they know about separation anxiety and they'll maybe offer examples that involve children or pets. In fact Adult Separation Anxiety Disorder (ASAD) may be even more prevalent than childhood separation anxiety, yet surprisingly little is known about this. It's fair to say that ASAD is a comparative newcomer in terms of a recognized and specific form of anxiety disorder. Although identified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) there is really no more than a passing reference to the fact that adults can have a similar condition to children. However, the last DSM was published in 1994 and some interesting findings about ASAD have been published since then.

During child development it is quite normal for a toddler to feel separation anxiety when out of reach of a parent. Separation anxiety is different to ASAD. ASAD is a psychological condition where the person feels acute and excessive anxiety if another person, usually a spouse or partner, is out of contact with them. From the outside looking in, we might view this person as excessively clingy, needing to know where their partner is, what they are doing, always needing to be with them even in activities they personally dislike. Equally, this isn't to be confused with jealousy or paranoia, the key ingredient is the person's own level of anxiety when separated. For the sufferer the costs are high in terms of daily torment, sleepless nights, obsessive thinking, worry and fear.

M. Katherine Shear M.D. is Marion E. Kenworthy Professor of Psychiatry at Columbia University School of Social Work. Her research into ASAD puts the lifetime estimate of the condition at a staggering 6.6 percent, that's over 20 million American adults affected at some point in their life. From what is understood, more women than men are affected. Childhood separation anxiety disorder seems to increase the risk in adulthood and people with less education are also more susceptible. Many people with ASAD seem unable to hold down a job although the relationship between employment status and the disorder isn't clear.

There are a variety of reasons for the possible onset of ASAD, which may help to explain the suggested high numbers. An extension of childhood separation anxiety into adulthood is one. Traumatic situations that cause separation, for example during an armed conflict, or a marital or partnership break up, or the death of a loved one are others.

ASAD is often associated with other anxiety conditions and mood disorders. The cruel irony of such a condition is that it can become unbearable for the person who is the focus of attention. The need to provide constant reassurance and be with the person whenever possible can reach a point where the relationship breaks down.

There is no standardized treatment for ASAD. Professor Shear has successfully used a combination of antidepressant medication and cognitive behavioral therapy, but as she says, most people with ASAD remain untreated, even though they may be receiving treatment for some related condition like anxiety or depression. Whether the newly revised DSM, due out in 2012 will include ASAD, remains to be seen.