Separation anxiety has long thought to be the domain of small children. The familiar developmental stage, in which the absence of a parent or loved one causes deep upset, typically kicks in during infancy.
With patience and reassurance, separation anxiety generally recedes within months or a few years without psychological treatment. Psychiatrists have long argued that its effects have ended by adulthood.
But Australian researchers have identified that separation anxiety can start or continue into adulthood. Such anxiety is typically focussed on one or two loved ones – and may even be directed at a pet.
Associate Professor Vijaya Manicavasagar, the Australian psychologist who has pioneered research into the disorder, says that as many as one in 20 adults will suffer adult separation anxiety disorder in their lifetime. Women are more likely to suffer than men.
Associate Professor Manicavasagar – working with her colleague Professor Derrick Silove – began researching separation anxiety in adults after realising that a significant number of clients seemed resistant to the conventional treatments for anxiety and panic disorder.
“We were working in a large clinic in which we were seeing many hundreds of patients. Yet there were a significant number who did not benefit as much as they should from cognitive behaviour therapy, which is the evidence-based treatment for panic disorder.”
On close examination, Associate Professor Manicavasagar, who is the Director of the Black Dog Institute Psychology Clinic, carefully studied the individual cases of this cohort. She was able to identify that these patients were united by a deep reliance on the presence of a loved one.
Dr Manicavasagar said that sufferers are often busy, high achievers with an understanding that their behaviour is not the norm. Many manage the symptoms of the disorder by curtailing their daily activities, such as declining to travel for work.
Technology masks the problem
She said: “Technology can mask the existence of the disorder. Text messages and video calls give sufferers the means to be in constant contact with the object of their attention in a way that is socially acceptable.”
Problems occur when separation from the loved one causes such anxiety that quality of life seriously suffers. Symptoms can include headaches, nausea, difficulty sleeping and nightmares. It may even prompt panic attacks which, unaddressed, may lead to panic disorder and can be mistaken for agoraphobia.
Fellow mental health professionals were at first sceptical of the new diagnosis. Work conducted over the course of almost 20 years – some of it with a research team based in the US led by Dr Katherine Shear – has since confirmed the existence of ASAD.
The pioneering work of the Australian researchers was recognised when the disorder was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM5), one of the key references for psychiatric diagnosis. Previously this maintained that separation anxiety disorder was experienced only by the young.
Research for a treatment
Recognition of the disorder is now improving, as knowledge among mental health professionals grows. A world-first study, led by Associate Professor Manicavasagar, is now underway at the University of New South Wales to establish an evidence-based treatment for ASAD.
Further research may examine the factors that contribute to the development of adult separation anxiety disorder. Some researchers suggest it may be connected to loss or grief, but more research is required.
For those finding that an irrational desire for constant contact with a loved one is affecting their life, Associate Professor Manicavasagar recommends consulting an appropriate psychologist. An experienced professional will be able to use cognitive behaviour therapy to examine the thoughts underpinning the concern. They will help suffers build skills to manage anxiety and its symptoms.