Pediatric-Onset and Adult-Onset Separation Anxiety Disorder Across Countries in the World Mental Health Survey

Abstract

Objective The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Results Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th–75th percentiles]=1.4%–6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%–1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Conclusions Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

Separation Anxiety Blended with Superstitious Belief in an Adult Female: A Case Report in Bangladesh

“…Adult separation anxiety disorder (ASAD) has recently been reported in the psychiatric literature across the globe and diagnostic and statistical manual (DSM) of mental disorder omitted the age 18 years criterion for diagnosis of separation anxiety disorder (SAD) (1,2). Adult onset ASAD refers to separation anxiety disorder in an adult without a prior documented history of childhood separation anxiety disorder (3,4).…”

“…Adults with ASAD experience intense anxiety about separation from their attachment figures and engage themselves in wide ranges of activities to avoid separation and may show different emotional and behavioral disturbances that may lead to functional deterioration (1,5). Previous research revealed different factors responsible for developing ASAD, such as childhood experiences (2), environmental factors (6), genetic factors (7), over protective parenting (1,3), lack of healthy self (7), and collectivistic cultures (3). This recent recognized disorder affects multiple domains of life and is associated with different comorbidities that ultimately decrease quality of life.…”

US Veterans and PTSD: Who Are They, and How Did It Happen?

“…9,15 Insecure attachment styles and separation anxiety can increase risk of development of PTSD. [15][16][17] Reciprocally, PTSD itself can unmask/lead to insecure attachment relationships even in adulthood. 16,17 The authors note the huge public health burden of PTSD in veterans.…”

“…[15][16][17] Reciprocally, PTSD itself can unmask/lead to insecure attachment relationships even in adulthood. 16,17 The authors note the huge public health burden of PTSD in veterans. It will benefit veterans and civilians with PTSD for us to intervene rapidly and to attempt to better pinpoint risk factors around which to structure earlier interventions.…”

An Epidemiological Contribution to Clinical Understanding of Anxiety

“…The study by Derrick Silove, M.D., Ph.D., et al (1), in this issue of the Journal , on pediatric- and adult-onset separation anxiety disorder across countries in the World Mental Health Survey, an epidemiologic report of separation anxiety disorder in a sample of 38,993 adults in 18 countries, is an eye-opening study that will contribute to a better appreciation of anxiety disorders across the lifespan. Methods in this extraordinary study are clearly articulated and exemplary.…”