title: The relationships among separation anxiety disorder, adult attachment style and agoraphobia in patients with panic disorder.
abstract: Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy. Electronic address: stefano.pini@med.unipi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pini
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Abelli
authors.affiliation: Department of Neurosciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Troisi
authors.affiliation: Department of Neurosciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Siracusano
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, via Roma 65, I-56100 Pisa, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Cassano
authors.affiliation: Columbia University, Department of Social Work, School of Social Work, Columbia University, New York, NY, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Shear
authors.affiliation: Department of Psychiatry, University of Southampton, Faculty of Medicine, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Baldwin
mesh_terms: D000328:Adult; D000367:Age Factors; D000379:Agoraphobia / Q000523:psychology*; D001010:Anxiety, Separation / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D001523:Mental Disorders; D009769:Object Attachment; D016584:Panic Disorder / Q000523:psychology*; D011788:Quality of Life; D012737:Sex Factors
keywords: Adult attachment style; Agoraphobia; Panic disorder; Separation anxiety disorder