The authors examined the relation between retrospectively reported childhood separation anxiety disorder and adult DSM-III-R anxiety disorders in 252 outpatients at an anxiety disorders research clinic. The prevalence of childhood separation anxiety disorder was significantly greater among patients with two or more lifetime adult anxiety disorder diagnoses than it was among patients with only one anxiety disorder, suggesting that childhood separation anxiety disorder may be a risk factor for multiple anxiety syndromes in adulthood.
"This was also noted by others, e.g., Faravelli and Pallanti (1989), Kaunonen et al. (2000), Milrod et al. (2004). We noted that " [p]atients highly comorbid for multiple anxiety disorders are particularly likely to recall childhood SAD (Lipsitz et al., 1994) " , and that " [c]laims that separation anxiety equivalently antecedes other anxious states (van der Molen et al., 1989) may be due to diagnostically ambiguous limited symptom attacks and the unreliability of the questionnaire method " . We concluded that " in the only controlled, long-term, direct, blind, clinical interview follow-up of separation-anxious, school-phobic children, the only significant finding was an increased PD rate " (Preter and Klein, 2008). "
[Show abstract][Hide abstract] ABSTRACT: The present paper is the edited version of our presentations at the “First World Symposium On Translational Models Of Panic Disorder”, in Vitoria, E.S., Brazil, on November 16–18, 2012. We also review relevant work that appeared after the conference.
Suffocation-False Alarm Theory (Klein, 1993) postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. The expanded Suffocation-False Alarm Theory (Preter and Klein, 2008) hypothesizes that endogenous opioidergic dysregulation may underlie the respiratory pathophysiology and suffocation sensitivity in panic disorder. Opioidergic dysregulation increases sensitivity to CO2, separation distress and panic attacks. That sudden loss, bereavement and childhood separation anxiety are also antecedents of “spontaneous” panic requires an integrative explanation. Our work unveiling the lifelong endogenous opioid system impairing effects of childhood parental loss (CPL) and parental separation in non-ill, normal adults opens a new experimental, investigatory area.
"Authors commented that CSAD might represent an antecedent to adult-onset PD. However, further research has revealed mixed findings, and prospective follow-up studies confirmed that CSAD – compared to those with other anxiety diagnoses – was related to more anxiety disorders in general and distinct psychiatric disorders, but not specifically to PD (Aschenbrand et al., 2003; Brückl et al., 2007; Lipsitz et al., 1994; Silove et al., 1993a). Thus, inconsistencies on the specificity between CSAD, and adult PD are still bearing an unresolved controversy . "
[Show abstract][Hide abstract] ABSTRACT: Adults with panic disorder (PD) and children with separation anxiety disorder (CSAD) show higher reactivity to CO(2). Our hypothesis was patients with adult separation anxiety disorder (ASAD) would show similar hypersensitivity to CO(2). In the present study, we determined whether sensitivity to CO(2) was enhanced in adult patients with separation anxiety disorder with no history of panic attacks.
Patients with PD (n=38), adult separation anxiety disorder (ASAD) patients with no history of panic attacks (n=31), and healthy subjects (n=40) underwent a 35% CO(2) inhalation challenge procedure. Baseline and post-inhalation anxiety were assessed with the Acute Panic Inventory, Visual Analog Scale, and Anxiety Sensitivity Index-3 (ASI-3).
As hypothesized the rate of CO(2)-induced panic attacks was significantly greater in PD and ASAD patient groups (55.3% and 51.6% respectively) than healthy comparison group (17.5%). Nine (69.2%) of 13 patients in PD group who have ASAD concurrent with PD had a CO(2)-induced panic attack. ASI-3 total scores were not different between PD and ASAD groups and both were significantly higher than controls. However, anxiety sensitivity did not predict the occurrence of panic attacks.
The researchers were not blind to the diagnosis and there was no placebo arm for comparison. Besides, parameters of respiratory physiology were not evaluated.
ASAD was associated with CO(2) hypersensitivity quite similar to PD. This finding partly unfolds the complex relationship of 'CSAD, PD, and CO(2) hypersensitivity' and indicates that CO(2) hypersensitivity and separation anxiety extend together beyond childhood.
"Some studies confirm the association between separation anxiety in childhood and panic disorder (PD) in adulthood (Capps et al., 1996; Pine et al., 1998). The results from other studies did not confirm a specific link between these two kinds of disorders (Lipsitz et al., 1994; Silove et al., 1996). Some researches consider that a history of SAD identifies a particularly heritable, early-onset form of panic disorder (Battaglia et al., 1995). "
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