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Abstract

Psychotherapies focusing on relationships and separation anxiety may be helpful for adults with anxiety disorders who experienced separation anxiety in childhood. The fear extinction model of anxiety calls for desensitization to threatening stimuli and does not consider the role of earlier childhood separation anxiety disorder in adult panic disorder and other anxiety disorders. In these patients, unaddressed separation anxiety lessens the effects of both medication and psychotherapy.

Abstract

Clinically significant separation anxiety disorder in childhood leads to adult panic disorder and other anxiety disorders. The prevailing pathophysiological model of anxiety disorders, which emphasizes extinction deficits of fear-conditioned responses, does not fully consider the role of separation anxiety. Pathological early childhood attachments have far-reaching consequences for the later adult ability to experience and internalize positive relationships in order to develop mental capacities for self-soothing, anxiety tolerance, affect modulation, and individuation. Initially identified in attachment research, the phenomenon of separation anxiety is supported by animal model, neuroimaging, and genetic studies. A role of oxytocin is postulated. Adults, inured to their anxiety, often do not identify separation anxiety as problematic, but those who develop anxiety and mood disorders respond more poorly to both pharmacological and psychotherapeutic interventions. This poorer response may reflect patients’ difficulty in forming and maintaining attachments, including therapeutic relationships. Psychotherapies that focus on relationships and separation anxiety may benefit patients with separation anxiety by using the dyadic therapist-patient relationship to recapture and better understand important elements of earlier pathological parent-child relationships.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 34 - 43
PubMed: 24129927

History

Received: 14 June 2013
Accepted: 26 August 2013
Published online: 1 January 2014
Published in print: January 2014

Authors

Details

Barbara Milrod, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
John C. Markowitz, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Andrew J. Gerber, M.D., Ph.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Jill Cyranowski, Ph.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Margaret Altemus, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Theodore Shapiro, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Myron Hofer, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.
Charles Glatt, M.D.
From the Department of Psychiatry, Weill Cornell Medical College, New York; New York State Psychiatric Institute, New York; and the Department of Psychiatry, University of Pittsburgh School of Medicine.

Notes

Address correspondence to Dr. Milrod ([email protected]).

Competing Interests

Dr. Milrod receives royalties from Taylor & Francis for an academic book. Dr. Markowitz receives research funding support from NIMH and salary support from New York State Psychiatric Institute; minor book royalties from American Psychiatric Publishing, Basic Books, and Oxford University Press; and an editorial stipend from Elsevier Press; none of these constitutes a conflict of interest with the current article. Dr. Altemus has received payment for consultation from Ironwood Pharmaceuticals and Corcept Pharmaceuticals; she has also received research support from Fisher-Wallace Corporation. The other authors report no financial relationships with commercial interests.

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