Sam came into couple’s therapy with his wife Leah kicking and screaming all the way. “I’m fed up,” Leah said. “We may be home together all day, and if I’m watching television or doing something around the house without him, he pops in to say he misses me. If I go out to run errands for a couple of hours, he calls me two to three times to find out how I am. And, if I don’t come home in a time frame that he thinks is reasonable, he calls to say he’s worried about me.
But, what really gets me riled is when he calls to ask if something’s wrong that he thought I’d be home by now. You’d think I was gone for a day rather than 2 hours. Heck, even the police won’t begin to look for you unless you are gone for over 24 hours. My friends think he’s just being attentive and sweet and wish their husbands were like Sam. If it is just this, then why do I feel suffocated by him? ”
Leah and Sam have been married for 35 years. Sam’s “changed” Leah says, since their youngest son died in a motorcycle accident seven years ago. Sam was never very social, a little neurotic, and always preferred being with Leah than other people. But, the meaning of being-with-her has taken on new meaning in their relationship. Leah described Sam as becoming more needy over the past few years than her children when they were 2-years of age.
What’s wrong with Sam?
Sam has adult separation anxiety disorder (ASAD). To most of us, separation anxiety is what happens to young children separating from their parents on the first day of school. They cry, cling and voice strong opposition to having to separate from their parents for a short while.
But some adults also experience anxiety and fear of being separated from their loved ones. Bereavement and other traumatic situations that cause loss and separation (illness, marital or partnership breakup, prolonged military service) seems to activate the disorder in adults, as it did in Sam (Relationship between separation anxiety disorder and complicated grief; Separation-Anxiety?). People with ASAD become anxious, worried and afraid that something bad might happen to themselves, and the people they love, just like young children do. But, now, the ghosts and monsters of childhood have become vehicular accidents, illness, or any other threatening event that may take away the people they depend on most for their happiness, support and well being.
Additionally, some studies show that adulthood separation anxiety is an extension of a dysfunctional style of the attachment bond (Anxious or Avoidant Attachment Style) to primary caregivers established in early childhood that makes one vulnerable to adult separation issues as adults, especially in times of high stress (Attachment, Panic Disorder and ASAD; Adult Separation Anxiety & Attachment Style). This connection between early attachment style and adulthood separation disorder may explain its high rate of occurrence in the United States (6.6% or 20 million people).
Childhood experiences that raise children’s fear of the unknown, potential for harm, and uncertainty of circumstance can make them anxious and fearful. This is especially the case in families that have a high level of financial and social stress, emotional difficulties, or drug or alcohol addiction. These types of stressful preoccupations can lead parents to neglect their children, which makes children anxious about the stability of their parents’ attention, care and love. In contrast, parents may overprotect their children, as a result of such pressures that increases children’s anxieties about all of the bad things that can happen to them.
Take Sam, for example. Sam was the youngest, only male child of three. His parents came from Greece to the United States through Ellis Island, when Sam was just 2-years-old. They didn’t speak English and lived with relatives until they had enough money to live on their own.
Sam doesn’t recall many childhood times that he wasn’t with family and relatives. He was not allowed to go on school camping trips or slumber parties with friends and playing outdoors was ill-advised, as the family lived in a rough neighborhood. Although his childhood was happy, there was always an undercurrent of fear related to financial and social stress. His parents, especially his mother, had a heightened concern about negative consequences of the family separating. On family outings, she’d continually shout out, “Stay together.” She was preoccupied with worst-case scenarios that Sam carried forward into his adult life.
ASAD FACTS
People vary in terms of how adult separation anxiety disorder presents in their lives and in the intensity of symptoms. But, research shows that:
- ASAD tends to present more in female than male adults.
- Cultures that have a lower tolerance for physical and emotional separation of family members may have higher rates of ASAD within their populations.
- The most common co-occurring mental disorders that appear with ASAD include major depressive disorder (40.8%), generalized anxiety disorder (16.1%), specific phobias (35.8%), social anxiety disorder (34.5%), post-traumatic stress disorder (23.7%), panic disorder (14.8%), agoraphobia without panic (5.8%), and obsessive-compulsive disorder (9.9%).
- For some persons, early childhood separation anxiety disorder can extend into adulthood.
- Symptoms of ASAD most usually show up after bereavement (especially of the complicated type) and traumatic loss. But, positive and negative life transitions (e.g., change in relationship, job or lifestyle status) can also activate symptoms in some people.
- ASAD has periods of activation and remission.
- Symptoms of ASAD include a persistent worry about losing loved ones to death, illness, accidents or some other disaster; nightmares stemming from these fears; grieving-related behaviors that include social withdrawal, sadness, nervousness and an inability to concentrate, avoidance of sleeping away from loved ones, also
- The rates of the disorder in the population show that separation disorder occurs more frequently in adults than in children. (DSM V Changes in Anxiety Disorders and Phobias).
Recent changes in the leading psychiatric diagnostic manual (Diagnostic Statistical Psychiatric Manual, DSM V) now includes adults as well as children as capable of having a separation anxiety disorder (ASAD). In the past, patients presenting with separation anxiety difficulties tended to be misdiagnosed as having either an adjustment, depression, agoraphobia, generalized anxiety or social anxiety disorder.
I’ve treated adults throughout the years who present with symptoms of ASAD. It is not easy to spot, at first, as ASAD shares some of the symptoms of the above-mentioned mental health conditions. Studies that have shown bereavement and traumatic loss as main precipitants of ASAD are helpful in establishing the diagnosis and its treatment.
Treatment of ASAD
The treatment of ASAD is only in its infancy. At this time, treatment for ASAD relies on treatments for the other Anxiety Disorders, as well as the expertise of psychiatrists and psychologists to tailor treatment approaches to the individual needs of their patients.
ASAD is a serious disorder. The symptoms of ASAD can be quite disabling, negatively affecting people’s work, social, and relationship life. Antidepressant and anxiety medication in combination with cognitive behavioral therapy and support groups are the main focus of treatment.
1. Medication. The selective serotonin reuptake inhibitors (SSRI’s) are the first line of medication treatment. They increase the feel good nerve transmitter (serotonin) throughout the brain and body, which lowers depression, anxiety, and fear-related behaviors. Patients feel more calm and overall happiness and stop avoiding situations that have led to their dysfunction. The SSRI medications include: Fluoxtine (Prozac®), Fluvoxamine (Luvox®), Paroxetine (Paxil®), Sertraline (Zoloft®), Citalopram (Celexa®), and Escitalopram (Lexapram®).
Many people would like to avoid taking medication, if possible. But, with conditions like ASAD, physiology cannot be ignored, especially at first. People with anxiety conditions tend to have overly sensitive nervous systems that sensitize them to perceiving harm and threat. To adequately treat the symptoms of ASAD, the body has to become desensitized to separation threat. Only then, can persons with the disorder learn that their worst separation fears will not be confirmed. A calm mind and body also allows patients to benefit more from the coping skills and support that they get in psychotherapy. Additionally, medication benefits more than symptom reduction. A large body of genetic research shows that sufficient levels of brain serotonin helps the brain to repair and regenerate its neurons. SSRI medications increase the brain’s serotonin level to normal levels.
2.Cognitive Behavioral Treatment. ASAD cognitive behavioral psychotherapy should emphasize a restructuring of thinking that increases separation anxiety and fears, like the thought, separation always brings disaster. Sam’s son left the house and never returned home again, for example. To him, leaving home equated with actual death. His disaster-type thoughts excited his body, which worsened his symptoms. Psychotherapy helped Sam to become aware of the relationship between his negative thoughts and his anxiety and to counter these extreme ideas with rational thinking.
Additionally, cognitive-behavioral techniques increase patients awareness of their bodies. They learn to sense subtle increases in body tension that can lead to anxiety and fear. Through techniques, like muscle relaxation, deep breathing and mindfulness, they learn how to lower brain and body arousal to stop their anxieties from taking them over. With enough practice, people can retrain their bodies to be less responsive to threat and harm, which can help them to lower their medication or completely get off it.
3. Support Groups. Attending an ASAD support group is a very important aspect of treatment. It helps to know that other people have walked in your shoes and appreciate first-hand your anxieties and fears. Support systems should always include a licensed professional who is able to work with the individual with ASAD to develop coping tools to reduce their burden upon their loved one. It is also important for each person in the relationship to have their own support system of family and friends.
I hope you liked today’s post. If so, please let me know by selecting the Like icon that immediately follows. You can also Tweet and Google+1 today’s article to let your friends know about it. Warm regards, Deborah.
The featured Art called Separations is by Margaret Dolinksy of Indiana University.
Dr Deborah, I rear and re read this article. It is very well written and I felt it answered questions I have had for many years.
As usual, very helpful
Thank You
Amy Green
Hello Amy, thank you. I really enjoy helping people understand and putting some questions to rest. Warm regards my friend. Deb!
it is very informative read….all thanks to u for rendering such valuable service.
Hello Maaz. Thank you for your kind words. I’m glad it was informative. Good to see you here and looking forward to seeing you here again. Warmly Deborah.
Very interesting article Deborah I have been a magnet for a few of these types. Is that because they chose someone who may ultimately reject them ?
Hi Kathleen, thank you. That’s any interesting question. It certainly can work this way, especially if the relationships don’t have a lot of history or other reasons for working through the problems. But, most definitely, if the person doesn’t get help for the problem it can push their mates away in some way. Hope all is well with you. Warm regards Deborah.
Dear Dr. Deborah Khoshaba, ur post is very informative and valuable. I have been suffering from General Anxiety Disorder since 3 years. I want to have sessions of cognitive behaviour therapy. Kindly suggest some good psychologist in Pakistan.
Hello Syed, I’m glad the article was helpful. I hope you took a look at my article on Generalized Anxiety Disorder as well. Here’s a link to it, just in case you have not: http://www.psychologyineverydaylife.net/2012/05/06/living-with-chronic-worry-you-may-have-a-generalized-anxiety-disorder/
I will get back to you with some names. Warm regards Deborah.
I believe m suffering from ASAD..I am the eldest daughter n was always attached to my mom..even till now she is my best friend. .I recently got married n it was hard to leave my mother n go to another country but I did n my husband was the reason I managed fine..but as he is also very caring, I feel protected with him n now even if I have to go to visit my parents..I feel insecure n depressed. ..n strange fobias surround me.n I cant stop crying. .my mother feels so bad n even my family thinks that I only love my husband n not them n that’s why I m behaving like this..my husband is also worried. .
.I dnt wana torture my sweet family. .they all are worried bcz of my behavior. I dnt kw wt to do..plz help me..
Hello Sana, I hope I’m understanding correctly. So when you leave your husband you feel anxious and upset? I think this is what you are saying here. Sana, I’m sure you tell your family that your upset is not because you don’t love them but because you feel anxious leaving your husband. It does sound like you are having some separation anxiety. Sana this reaction to going away from him may be temporary because you recently got married and moved away to live with him. You have to see if over time this goes away and it persists to really know what is happening. At this point, it just may be that the marriage is so new to you and you are very much in love that it’s just very hard to separate from him. I’m hoping this changes over time for you. I don’t want to recommend anything clinical for you because I think this may be a result of the newness of your relationship. The best thing you can do is remind yourself that you are just having anxiety over leaving your new husband, so you don’t build it into anything more serious in your mind which will worsen your symptoms. Let me know how it goes. And, congratulations on your loving relationship to your new husband. Warmly Deborah.
Hello Dr. Deborah Khoshaba I came to know about you via your facebook page. I am suffering from sort of similar situation you wrote about. But the difference is its not about being a couple, rather its about friendship. I might not be able to disclose the complete situation here but the main question is what should we do when we are asked to choose one (among the two friends) when both of them are equally important and valuable. Pretty much tense…awaiting your reply and thanks for the article.
Hello Wagas, I’m glad you came across my blog and me through Facebook. First, I’m sorry for the late response. I understand you’d like to feel less anxiety about all of this. Yes, we can have separation issues with friends who have been in our lives for sometime and who we are very emotionally attached to. Now, I don’t know why you have to choose between two friends–if it is because they don’t like each other or they both want more than a friendship with you? So, my answer is not going to exactly address your question. I’m going to assume that you are in a situation in which both friends want a romantic relationship with you. If this is the situation, you have to sort out which friend is really best for you, romantically. Sometimes we are attracted to a persons personality and physical features but they don’t always fit that well with our true nature and needs. You can start by examining this question. Which friend is really better suited for my personality and for what I need long term to find lasting fulfillment in a romantic relationship. I hope this helps a bit.
I’m sorry my answer could not be more specific. I’m glad to see you here today and look forward to your comments in the future. Warmly Deborah.
Thanks a lot Dr. for your time. Now again coming toward the main point, I think I should be open to you if I want to get rid of all these problems. There is no such drama, we call “Love” it’s a simple and pure friendship. It’s a bad habit of mine that I am too much sensitive. How can I control my sensitivities? And please I want your personal opinions if you were in the similar sort of situation what would you have chosen? It’s worth mentioning here that if I choose one friend other one is almost over. Both are mad I must say. Once again waiting for your precious comments.
I believe I am surfing from ASAD
Dear Doc,
em glad to read this post and it’s really helpful regarding many stressing points. Many thanks for giving such a help and guiding people as well.
Thank you emayel. I’m always so pleased to learn that the points in my articles helped someone. I’m glad you follow my blog and look forward to your comments again. Warmly Deborah.
i am a patient since i lost my mother in law 10 years before i am going through different treatments from then that i lost my loved ones and suffering form anxiety as it genetically in my mothers family i am taking depex and ativan for sleep when i leave medicine i go through same condtions so medicine is part of my life but i want to be confident and need power to live as it shatters down by the time i wan to live happy not crying to much when depress…
Hello Fayza, I’m sorry about all of the loss you have experienced. One death after another is very very hard on us, emotionally and physically. Medication does help with the anxiety. But, therapy to help you cope better with the loss is needed to begin to live more healthier and free again. If you have not gotten psychological help as well, you may think about it. I understand that you want to be happy again. You deserve this. Warm regards to you Fayza. Deborah.
Hi Deb,
As always I find your explanations clear and understandable. I don’t know much about this but I can surely sympathize with the wife in this case. I would be smothered also! Glad he received the help he needed.
Hi Rita, how nice to say hello to you here. I think many of us would feel smothered. Thank you my friend. Warmly Debbie 🙂
Dr. Deborah, thank you for this article. I have recently discovered that what I thought was just GAD is in fact ASAD. It is making me sick and I do not want to live like this any longer. I would love to find a counselor or support group nearby (Denver / Boulder, Colorado. Do you know of any resources for this type of help?
You are very welcome Nicole. You may want to contact the following agencies to see if they can help. Also, there are psychological associations in Denver that list psychologists/psychiatrists and their specialities. I would do a search for the Denver Psychological Association and go from there. But, in the meantime, these are National Agencies that can help. You take good care. Warm regards Deborah.
Anxiety Disorders Association of America (ADAA)
8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Phone: 240-485-1001
Fax: 240-485-1035
Email: information@adaa.org
http://www.adaa.org
National Institute of Mental Health (NIMH), Public Information & Communication Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
Toll Free: 1-866-615-6464
TTY: 301-443-8431
TTY Toll Free: 1-866-415-8051
Fax: 301-443-4279
Email: nimhinfo@nih.gov
http://www.nimh.nih.gov
Hi, after many years of being told I suffer from depression I read this and everything clicked into place. I am 44 years old and have suffered like this since my Dad died suddenly when I was 8. This has blighted my whole life and cost me two marriages. I am a first year psychology student and this prompted me to delve further into my problems. I am about to approach my GP with this but as I live in Scotland I do it hold out much help of support in any way. Do you know of any self help material I could use?
Kindest regards
Julie
Hello Dr.Khoshaba,
Your article was wonderfully put! I was diagnosed with ASAD a couple of years ago and haven’t been able to find any articles that explains ASAD well enough to educate and help my family and friends understand what ASAD is, what I go through and why I do the ridiculous things I do! I think this article might help!
I do have a more complicated situation that I was hoping you could give me some suggestions or even make it a topic of your next article!
My complicated situation with ASAD is that I’m in a relationship with an abusive narcissist!
I hate everything about the relationship and I hate that I know in my head he could kill me, I know I deserve to have a man who treats me better I know there is someone better out there for me, but I can’t leave him. I know wanting and needing to be with this man is absurd! I have tried several times but I just end up going back because I can not handle being away from him! I get too sick from my ASAD! Any suggestions would be greatly appreciated!
Thank you for this wonderful article!
Kristina
Hello, I am overly anxious in the fact that my two boys are getting older. I can’t bear the thought of seeing them leave the house one day, even though I know it is totally normal. How can I prepare myself for this and stop feeling as if the hours are counted? Thanks for your kind help!!