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Separation anxiety disorder from the perspective of DSM-5: clinical investigation among subjects with panic disorder and associations with mood disorders spectrum

Published online by Cambridge University Press:  23 February 2015

Camilla Gesi ,
Marianna Abelli ,
Alessandra Cardini ,
Lisa Lari ,
Luca Di Paolo ,
Derrick Silove  and
Stefano Pini
Camilla Gesi*
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
Marianna Abelli
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
Alessandra Cardini
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
Lisa Lari
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
Luca Di Paolo
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
Derrick Silove
Affiliation:
Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia Centre for Population Mental Health Research, South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia
Stefano Pini
Affiliation:
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy
*
*Address for correspondence: Camilla Gesi, Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, via Roma 67, 56100 Pisa, Italy. (Email: camillagesi@hotmail.com)
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Abstract

Objective/Introduction

High levels of comorbidity between separation anxiety disorder (SEPAD) and panic disorder (PD) have been found in clinical settings. In addition, there is some evidence for a relationship involving bipolar disorder (BD) and combined PD and SEPAD. We aim to investigate the prevalence and correlates of SEPAD among patients with PD and whether the presence of SEPAD is associated with frank diagnoses of mood disorders or with mood spectrum symptoms.

Methods

Adult outpatients (235) with PD were assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Panic Disorder Severity Scale (PDSS), the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and the Mood Spectrum Self-Report Instrument (MOODS-SR, lifetime version).

Results

Of ther 235 subjects, 125 (53.2%) were categorized as having SEPAD and 110 (46.8%) as not. Groups did not differ regarding onset of PD, lifetime prevalence of obsessive compulsive disorder (OCD), social phobia, simple phobia, BD I and II, or major depressive disorder (MDD). SEPAD subjects were more likely to be female and younger; they showed higher rates of childhood SEPAD, higher PDSS scores, and higher MOODS-SR total and manic component scores than subjects without SEPAD.

Discussion

SEPAD is highly prevalent among PD subjects. Patients with both PD and SEPAD show higher lifetime mood spectrum symptoms than patients with PD alone. Specifically, SEPAD is correlated with the manic/hypomanic spectrum component.

Conclusion

Our data confirm the high prevalence of SEPAD in clinical settings. Moreover, our findings corroborate a relationship between mood disorders and SEPAD, highlighting a relationship between lifetime mood spectrum symptoms and SEPAD.

Keywords

Comorbiditymood disordersmood spectrumpanic disorderseparation anxiety
Type
Original Research
Information
CNS Spectrums , Volume 21 , Issue 1 , February 2016 , pp. 70 - 75
Copyright
© Cambridge University Press 2015 

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Footnotes

This work was supported by grants from the Italian Ministry of University and Scientific Research (PRIN 2005: prot. 2005069159) and Fondazione IDEA (Institute for Research and Prevention of Depression and Anxiety).

References

1. Manicavasagar, V, Silove, D, Curtis, J. Separation anxiety in adulthood: a phenomenological investigation. Compr Psychiatry. 1997; 38(5): 274–282.Google Scholar
2. Fagiolini, A, Shear, MK, Cassano, GB, Frank, E. Is lifetime separation anxiety a manifestation of panic spectrum? CNS Spectr. 1998; 3(4): 63–72.Google Scholar
3. Dell'Osso, L, Carmassi, C, Musetti, L, et al. Lifetime mood symptoms and adult separation anxiety in patients with complicated grief and/or post-traumatic stress disorder: a preliminary report. Psychiatry Res. 2012; 198(3): 436–440.CrossRefGoogle ScholarPubMed
4. Wijeratne, C, Manicavasagar, V. Separation anxiety in the elderly. J Anxiety Disord. 2003; 17(6): 695–702.Google Scholar
5. Manicavasagar, V, Marnane, C, Pini, S, et al. Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep. 2010; 12(4): 290–297.CrossRefGoogle ScholarPubMed
6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
7. Shear, K, Jin, R, Ruscio, AM, et al. Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. Am J Psychiatry. 2006; 163(6): 1074–1083.CrossRefGoogle ScholarPubMed
8. Manicavasagar, V, Silove, D, Curtis, J, et al. Continuities of separation anxiety from early life into adulthood. J Anxiety Disord. 2000; 14(1): 1–18.CrossRefGoogle ScholarPubMed
9. Manicavasagar, V, Silove, D, Marnane, C, et al. Adult attachment styles in panic disorder with and without comorbid adult separation anxiety disorder. Aust N Z J Psychiatry. 2009; 43(2): 167–172.CrossRefGoogle ScholarPubMed
10. Pini, S, Abelli, M, Shear, KM, et al. Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Acta Psychiatr Scand. 2010; 122(1): 40–46.Google Scholar
11. Silove, D, Marnane, C, Wagner, R, et al. The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC Psychiatry. 2010; 10: 10–21.CrossRefGoogle Scholar
12. Kossowsky, J, Pfaltz, MC, Schneider, S, et al. The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry. 2013; 170(7): 768–781.Google Scholar
13. Pini, S, Abelli, M, Mauri, M, et al. Clinical correlates and significance of separation anxiety in patients with bipolar disorder. Bipolar Disord. 2005; 7(4): 370–376.Google Scholar
14. Toni, C, Perugi, G, Frare, F, et al. The clinical-familial correlates and naturalistic outcome of panic-disorder agoraphobia with and without lifetime bipolar II comorbidity. Ann Gen Psychiatry. 2008; 7: 23.Google Scholar
15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
16. Cyranowski, JM, Shear, MK, Rucci, P, et al. Adult separation anxiety: psychometric properties of a new structured clinical interview. J Psychiatr Res. 2002; 36(2): 77–86.CrossRefGoogle ScholarPubMed
17. Cassano, GB, Dell’Osso, L, Frank, E, et al. The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999; 54(3): 319–328.Google Scholar
18. First, MB, Spitzer, RL, Gibbon, M, et al. Structured Clinical Interview for DSM IVAxis I Disorders. New York: New York State Psychiatric Institute; 1996.Google Scholar
19. Dell'Osso, L, Armani, A, Rucci, P, et al. Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002; 43(1): 69–73.CrossRefGoogle ScholarPubMed
20. Frank, E, Cassano, GB, Shear, MK, et al. The spectrum model: a more coherent approach to the complexity of psychiatric symptomatology. CNS Spectr. 1998; 3(4): 23–34.Google Scholar
21. SPSS Inc. SPSS for Windows. Rel. 16.0. Chicago: SPSS; 2007.Google Scholar
22. Perugi, G, Akiskal, HS. The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatr Clin North Am. 2002; 25(4): 713–737.Google Scholar
23. Miniati, M, Calugi, S, Rucci, P, et al. Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: the role of adult separation anxiety. J Affect Disord. 2012; 136(3): 675–679.Google Scholar
24. Aaronson, CJ, Shear, MK, Goetz, RR, et al. Predictors and time course of response among panic disorder patients treated with cognitive-behavioral therapy. J Clin Psychiatry. 2008; 69(3): 418–424.Google Scholar