Adult Separation Anxiety Disorder: A New Perspective

Freya Shipley
Sep 12 · 5 min read

A young woman moving out of her parents’ house struggles with debilitating fear. A worried husband feels compelled to call his wife many times a day to make sure she’s safe.

Separation Anxiety Disorder — a pattern of irrational and overwhelming distress at the prospect of parting from a loved one — has traditionally been considered a childhood ailment. Among adults, the problem has been recognized only in cases where symptoms begin before the patient turns 18.

But over the past few years, all that has changed. Researchers have discovered that Separation Anxiety Disorder can strike at any age. Adult Separation Anxiety Disorder (ASAD) is now a formally recognized diagnosis, taking its place in the DSM-5 alongside conditions like Social Anxiety Disorder, Agoraphobia, and Generalized Anxiety Disorder.

What Are the Symptoms of Adult Separation Anxiety Disorder?

A pioneering clinician in the field, Vijaya Manicavasagar of Liverpool Hospital in New South Wales, Australia describes the experience of ASAD-sufferers as, “wide-ranging separation anxiety symptoms, such as extreme anxiety and fear, when separated from major attachment figures; avoidance of being alone; and fears that harm will befall those close to them.”

Because ASAD tends to inhibit independent activity, sufferers often have trouble completing their education, pursuing a career, and forming stable romantic attachments.

Additional symptoms may include:

  • Emotional Dependency ASAD-sufferers may be chronically dependent on an attachment figure such as a spouse or parent.
  • Compulsive checking and monitoring of the loved one’s location and well-being
  • Strict Parenting In adults whose anxiety is centered on a child, ASAD may manifest in an overly controlling parenting style.
  • Inability to Leave Unhealthy Relationships People with ASAD may find it hard to end hurtful relationships with partners, friends, or family members.
  • Avoidance of relationships, career advancement, and other commitments that encourage separation from the attachment figure
  • Feeling unable to survive without the loved one
  • Physical symptoms of chronic anxiety (headaches, digestive upsets, etc.)
  • Panic attacks
  • Suicidal thoughts

How Is Adult Separation Anxiety Disorder Diagnosed?

According the DSM-5, a diagnosis of ASAD may be appropriate if symptoms:

  • have been continuously present for at least six months
  • are severe enough to interfere with daily life
  • cannot be better explained by a different diagnosis (like PTSD)

If you suspect you may have ASAD, your first step should be to consult your healthcare provider.

What Causes Adult Separation Anxiety Disorder?

As with childhood SAD, the causes of ASAD are not yet entirely understood.

In some cases, adult-onset ASAD develops after a divorce or death, or following a significant separation like a young adult leaving home for college. ASAD seems to run in families, and it tends to co-occur with other anxiety disorders:

  • Generalized Anxiety Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Panic Disorder
  • Social Anxiety Disorder

How Common Is Adult Separation Anxiety Disorder?

A 2006 study found that in the US, about 4.1 percent of children suffer from SAD, while a conservative estimate for adults is 6.6 percent. That’s more than twenty million Americans who will struggle with ASAD at some point in their lives.

A recent international study found that across eighteen countries, lifetime rates of separation anxiety (that is, both SAD and ASAD) averaged 4.8 percent. Of that population, just over 43 percent experienced their first symptoms after age 18. Women are more likely than men to have ASAD, but men are more likely to experience initial symptoms in adulthood.

Because the adult variety of SAD has only recently been recognized and tends to co-occur with other anxiety disorders, it’s probably more widespread than we think.

What Are the Long-Term Effects of ASAD?

ASAD can be deeply disruptive to every area of life.

Dr. Katherine Shear, expert researcher and Professor of Psychiatry at Columbia University, has found that people with ASAD are:

  • twice as likely as others to be unemployed
  • twice as likely to remain relatively uneducated (completing 12 years of school or less)
  • about half as likely to maintain a stable life-partnership
  • nearly three times as likely to develop drug addiction
  • five times more likely to have an additional anxiety disorder (like Social Anxiety Disorder)
  • four times more likely to have a mood disorder (such as depression)

What Is the Treatment for Adult Separation Anxiety Disorder?

Until more is learned about the condition, ASAD is best managed using some of the same strategies that are known to be effective against other anxiety disorders:

  • Consult a counselor with expertise in treating anxiety disorders.
  • Learn and practice anxiety-management skills (physical exercise, meditation, journaling, etc.)
  • Limit caffeine and other substances that may stimulate anxiety.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a type of talk-therapy that aims to help participants identify and gain control over the thoughts that trigger anxiety.

Though CBT is known to be effective against many anxiety disorders, it seems to be less helpful in treating ASAD.

A 2008 study compared patients with panic disorder alone to patients experiencing panic disorder along with ASAD. Participants with co-occurring ASAD were 3.7 times more likely to respond poorly to CBT. A separate study found that patients getting CBT for generalized anxiety disorder were less likely to improve if they were also experiencing ASAD.

Medication

ASAD is sometimes treated with SSRI antidepressants like escitalopram (Lexapro) and anti-anxiety drugs like alprazolam (Xanax.) Medication can’t cure anxiety, but it may control the symptoms well enough to give other therapies a chance to work.

Now that ASAD has been recognized by the mental health community, it’s hoped that future research will generate more targeted approaches to prevention and cure.

Have questions about Adult Separation Anxiety Disorder? We’d love to hear from you. Call us today and make an appointment to speak with anxiety and trauma specialist Dr. Cara Engstrom.

Reference List

American Psychiatric Association (2013.) Diagnostic and statistical manual of mental disorders. Washington, DC: APA.

Arehart-Treichel J. (2006, July 7.) Adult separation anxiety often overlooked diagnosis. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.41.13.0030.

Bögels, SM Knappe, S Clark, LA. (2013.) Adult separation anxiety disorder in DSM-5. Clinical Psychology Review, 33(5), 663–74. doi: 10.1016/j.cpr.2013.03.006.

Kirsten, L., Greynyer, B., Wagner, R., Manicavasagar, V. (2008.) Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders. Counselling and Psychotherapy Research, 8(1), 36–42. doi:10.1080/14733140801892620

Manicavavagar, V., Silove, D. (1997.) Is there an adult form of separation anxiety disorder? A brief clinical report. Australian & New Zealand Journal of Psychiatry, 31(2), 299–303. doi:10.3109/00048679709073835

Shear, K., Jin, R., Ruscio, A.M., Walters, Kessler, C. (2006.) Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the national comorbidity survey replication. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.6.1074.

Silove, D. et al. (2015.) Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey. American Journal of Psychiatry,172(7), 647–56. doi: 10.1176/appi.ajp.2015.14091185

Silove, D., Marnane, C., Wagner, R., Manicavasagar, V., Rees, S. (2010.)The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC Psychiatry, 10:10–21. doi: 10.1186/1471–244X-10–21.

Freya Shipley

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Freya is a writer and editor in the San Francisco Bay Area. Come visit her at www.freyashipley.com.

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