Adult separation anxiety disorder in DSM-5

Abstract

Unlike other DSM-IV anxiety disorders, separation anxiety disorder (SAD) has been considered a disorder that typically begins in childhood, and could be diagnosed only in adults "if onset is before 18." Moreover, SAD is the only DSM-IV anxiety disorder placed under "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" whereas most anxiety disorders typically start--and are diagnosed--in childhood. Therefore, adult SAD may have been under-recognized and under-diagnosed. A literature review was carried out on behalf of the Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders DSM-5 workgroup to explore the evidence for SAD in adulthood, focusing on potentially relevant clinical characteristics and risk factors. The review revealed that SAD in adulthood is prevalent, often comorbid and debilitating. The DSM-IV age-of-onset criterion was not supported as a substantial portion of adults report first onset in adulthood. Research on putative risk factors is limited to childhood SAD: SAD runs in families, albeit patterns of familial aggregation and heritability estimates indicate low specificity. Tentative evidence for biomarkers and biased cognitive processes exists, again pointing to moderate SAD-specificity only. Further research on the epidemiology, etiology, and treatment of ASAD, using DSM-5 criteria, is needed, and particularly prospective-longitudinal studies to understand the developmental trajectories of separation anxiety disorder from childhood to adulthood.