Childhood Separation Anxiety and the Risk of Subsequent Psychopathology: Results from a Community Study

Department of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 02/2007; 76(1):47-56. DOI: 10.1159/000096364
Source: PubMed


To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia.
The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14-24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders.
Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6-58.7), specific phobia (HR = 2.7, 95% CI = 1.001-7.6), generalized anxiety disorder (HR = 9.4, 95% CI = 1.8-48.7), obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7-66.1), bipolar disorder (HR = 7.7, 95% CI = 2.8-20.8), pain disorder (HR = 3.5, 95% CI = 1.3-9.1), and alcohol dependence (HR = 4.7, 95% CI = 1.7-12.4). Increased hazard rates for PDAG (HR = 4.2, 95% CI = 1.4-12.1), bipolar disorder type II (HR = 8.1, 95% CI = 2.3-27.4), pain disorder (HR = 1.9, 95% CI = 1.01-3.5), and alcohol dependence (HR = 2.1, 95% CI = 1.1-4.) were also found for subjects fulfilling subthreshold SAD.
Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.

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    • "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 . "
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    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.
    Journal of Affective Disorders 04/2012; 141(2-3):315-23. DOI:10.1016/j.jad.2012.03.032 · 3.38 Impact Factor
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    • "So konnten Woodward und Fergusson (2001) in ihrer Längsschnittstudie mit 1265 Kindern aus Neuseeland zeigen, dass das Vorliegen einer Angststörung im Kindesalter die Wahrscheinlichkeit erhöht, im Erwachsenenalter Angststörungen, Depressionen oder Suchterkrankungen zu entwickeln. Sowohl Schneider und Nündel (2002) als auch Brückl et al. (2007) fanden insbesondere für die Trennungsangst im "
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    ABSTRACT: Anxiety disorders are among the most frequent psychological disorders in childhood and adolescence. They are characterized by early onset, tend to remain stable over time, and act as a significant risk factor for developing a psychological disorder in adulthood. Over the last few years, research has shown that anxiety disorders in children and adolescents can be treated effectively. However, to date only cognitive behavioral therapy (CBT) has received convincing empirical support as an effective psychotherapeutic treatment. Evidence for the effectiveness of other psychotherapeutic treatments such as nonbehavioral family therapy or psychodynamic interventions is rather scant. Recent randomized controlled trials (RCT) proved CBT to be effective from preschool age onwards. Contrary to long-held beliefs, however, the involvement of parents in a treatment program does not appear to be crucial to therapeutic outcome. Issues regarding the effectiveness of disorder-specific treatments and the combination of psychotherapeutic treatments with the application of selective serotonin reuptake inhibitors (SSRIs) are increasingly being taken up in recent studies. In addition to «classic» cognitive behavioural treatment programs there are some promising suggestions for the effectiveness of novel treatment methods such as attention bias modification or computer-assisted behavioral therapy.
    Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2012; 40(1):21-8. DOI:10.1024/1422-4917/a000146 · 0.99 Impact Factor
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    • "The research has identified SAD as a specific risk factor for adult panic disorder (PD; Battaglia et al., 2009). It has also identified SAD as a general risk factor for multiple adult anxiety disorders (Brü ckl et al., 2007) and has shown that SAD may continue into adulthood (Manicavasagar, Silove, & Hadzi-Pavlovic, 1998). Despite its high prevalence and unfavorable long-term prognosis, SAD remains neglected and underresearched with respect to etiology and treatment . "
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    ABSTRACT: Separation anxiety disorder (SAD) is one of the most common anxiety disorders in childhood and is predictive of adult anxiety disorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxiety disorders with regard to psychophysiology has not been made. We expected exaggerated anxiety as well as sympathetic and respiratory reactivity in SAD during separation from the mother. Participants were 49 children with a principal diagnosis of SAD, 21 clinical controls (CC) with a principal diagnosis of anxiety disorder other than SAD, and 39 healthy controls (HC) not meeting criteria for any current diagnosis. Analyses of covariance controlling for age were used to assess sympathetic and parasympathetic activation (preejection period and respiratory sinus arrhythmia) as well as cardiovascular (heart rate, mean arterial pressure, total peripheral resistance), respiratory (total breath time, minute ventilation, tidal volume, end-tidal CO(2) , respiratory variability), electrodermal, and self-report (anxiety, cognitions, symptoms) variables during baseline, 4-min separation from, and reunion with the mother. Children with a diagnosis of SAD were characterized by elevated self-reported anxiety responses to separation and increased sympathetic reactivity compared with CC and HC groups. The SAD group also displayed greater vagal withdrawal and higher reactivity in multiple cardiovascular, respiratory, and electrodermal measures compared with the HC group, while corresponding responses were less in the CC group and not significantly different from the other groups. Separation from the mother elicits greater autonomic, respiratory, and experiential responses in children with SAD. Our findings based on brief experimental separation demonstrate differential subjective and physiological manifestations of specific anxiety diagnoses, thus supporting the validity of the diagnostic category of SAD.
    Journal of Child Psychology and Psychiatry 09/2011; 53(2):178-87. DOI:10.1111/j.1469-7610.2011.02465.x · 6.46 Impact Factor
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