Separation Anxiety and Actual Separation Experiences During Childhood in Patients with Panic Disorder|
Borwin Bandelow, MD1, Gabriel Álvarez Tichauer, MD2, Corinna Späth, MD3, Andreas Broocks, MD4, Göran Hajak, MD5, Stefan Bleich, MD6, Eckart Rüther, MD7
Objective: The association between separation anxiety in childhood and actual separation experiences during childhood has not yet been investigated in patients with panic disorder.
(Can J Psychiatry 2001;948–952)
Key Words: panic disorder, agoraphobia, separation anxiety disorder
For the first time in 1964, Donald F Klein observed that 16 out of a group of 32 persons with agoraphobia had suffered from separation anxiety during childhood (1). Likewise, in other studies which did not use a healthy control group, high rates of 18% to 54% of separation anxiety were reported (2–6). In most studies that compared patients with panic disorder with a control group, the incidence of separation anxiety and its severity were significantly higher for panic disorder patients than for healthy control subjects (7–11) or surgical outpatients (12,13).
Manuscript received June 2001 and accepted October 2001.
Taken as a whole, the evidence provides support for the hypothesis that early separation anxiety is an antecedent of adult panic disorder (14). We see higher rates of separation anxiety in more severely ill patients (for example, those with agoraphobia or with comorbid conditions (3,5,6,9,11,15,16).
Even so, separation anxiety during childhood does not seem to be specific for panic disorder. The rates for separation anxiety for patients with panic disorder were found to be similar to the rates in patients with depression (11,17), generalized anxiety disorder (10,11,18), social phobia (5,11), obsessive–compulsive disorder (5), or specific phobia (19,20). One study found higher rates in panic disorder than in generalized anxiety disorder or other phobic disorders (21).
These retrospective data have their limitations. Prospective studies that investigate the association between childhood separation anxiety and adult panic disorder, however, are unavailable.