The DSM-5 Dimensional Anxiety Scales in a Dutch non-clinical sample: psychometric properties including the adult separation anxiety disorder scale.

With DSM-5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM-5-based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM-5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM-5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED-A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM-5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

Adult separation anxiety disorder: a disorder comes of age.

This article explores accruing evidence supporting the occurrence of an adult form of separation anxiety disorder (ASAD), a category yet to be recognized by international classification systems. ASAD can have its first onset in adulthood, although in a portion of cases, it represents a persistence or recurrence of the childhood-onset type. Recent large-scale clinic studies have suggested that ASAD is associated with high levels of disability. In addition, the presence of ASAD in individuals with anxiety disorders seems to signal a poor outcome to cognitive-behavioral therapy. The existing evidence suggests possible grounds for removing the childhood-onset requirement for the category of separation anxiety disorder, thereby allowing for first onset in adulthood. There is a pressing need to design and test appropriate treatments for ASAD and to educate clinicians to identify and manage the condition.

Separation anxiety in adulthood: dimensional or categorical?

Recent evidence suggests that a clinical form of separation anxiety can be observed in adults. An important question of relevance to defining the construct of adult separation anxiety is whether there is discontinuity between that constellation and other forms of anxiety. In the present study, 2 taxometric procedures - Mean Above Minus Below a Cut and Maximum Eigenvalue - were used to assess whether adult separation anxiety conformed primarily to a categorical or a dimensional pattern. The data were derived from a separation anxiety symptom questionnaire completed by 840 consecutive adult patients attending an anxiety disorders clinic. Although some results of the analysis were ambiguous, the overall findings suggested a dimensional pattern. The relevance of the finding to the status of adult separation anxiety is discussed.

Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: evidence for distinctions between DSM-IV subtypes.

OBJECTIVE: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. METHOD: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. RESULTS: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. CONCLUSIONS: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.

Subpopulations of early separation anxiety: relevance to risk of adult anxiety disorders.

BACKGROUND: The present study aims to examine whether discrete subpopulations can be identified according to their levels of early separation anxiety (SA), and if so, whether such a typology of SA influences risk to particular adult anxiety disorders. METHODS: Mixture analysis was applied to early SA scores provided retrospectively by a composite group (n=1800) of adult community and patient samples. The distribution of adult anxiety diagnoses across the SA categories was assessed in a community (n=136) and a clinic (n=74) sample. RESULTS: The mixture analysis yielded two subpopulations according to SA scores. Odds ratios for assignment to the high SA category for the various anxiety disorders ranged from 3.6 to 6.7. A logistic regression analysis revealed that when comorbidity was taken into account, the panic disorder-agoraphobia (PD-Ag) group was the only anxiety disorder to be associated with the high SA category. CONCLUSION: Assignment to a high early SA category appears to increase risk to adult anxiety disorders, particularly PD-Ag. Several possible pathways may account for such a risk including the persistence of separation anxiety disorder into adulthood. LIMITATIONS: Assessment of early SA was made using a retrospective measure and the samples included groups which were known to have high SA scores. CLINICAL RELEVANCE: Only a subpopulation of anxiety sufferers may have elevated levels of SA. Identification of this group may be important for early detection and intervention.

Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports.

BACKGROUND: The advantages and disadvantages of lay-administered structured interviews and self-administered problem checklists for estimating prevalence and associated features of childhood psychiatric disorder have attracted little comment. This article compares the scientific adequacy of these 2 instruments for classifying DSM-III-R categories of childhood psychiatric disorder in general population samples. METHODS: Study data are from parental assessments of 251 children aged 6 to 16 years participating in a 2-stage measurement evaluation study. Reliability and validity were compared between the Diagnostic Interview for Children and Adolescents (the structured interview in the study) and the revised Ontario Child Health Study scales (the self-administered problem checklist used in the study). RESULTS: Reliability estimates based on the kappa statistic were comparable for the 2 instruments and ranged from 0.21 (conduct disorder) to 0.70 (depression) on the lay interview and from 0.17 (depression) to 0.61 (oppositional defiant disorder) on the self-administered checklist. Validity coefficients tended to favor the checklist categories, but only marginally. CONCLUSIONS: On balance, differences in reliability and validity were small between the 2 instruments. These differences would appear to have no discernible impact on the knowledge about prevalence and associated features of disorder generated by use of such instruments in general population surveys.

Separation anxiety in adulthood: a phenomenological investigation.

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

[Anxiety and anxiety disorders in childhood]. / Angste und Angststörungen im Kindesalter.

Anxiety disorders in children are common. The current international classification systems--DSM and ICD--have increased the reliability of the diagnostic classification of anxiety disorders among children, too. The clinical picture of separation anxiety disorder of childhood, the phobic anxiety disorder of childhood, the social anxiety disorder of childhood, and the overanxious disorder of childhood will be described. The paper will conclude with a description of the diagnostic procedure. A case study will serve to illustrate the diagnostic and therapeutic procedure.

[Panic attack and panic disorder in the child and adolescent]. / Attaque de panique et trouble panique chez l'enfant et l'adolescent.

In the light of the current interest in the development of this disorder in adults, a number of recent studies have been devoted to the condition in children and adolescents. These papers include retrospective studies of adults suffering from the disorder, clinical reports on children or adolescents with the same problems, epidemiological studies of children and adolescents consulting psychiatrists, epidemiological studies of the general population, family studies, and studies of chemotherapeutic treatments. The conclusion from these papers is that many children and adolescents who present with physical symptoms are suffering from a panic disorder which has not been identified as such at the time. Other studies have analysed the age of onset of the first attack. All these studies are now in agreement in confirming that adolescence is the preferential age of onset of panic disorder. There even appears to be a correlation between the stages of puberty (Tanner) and the onset of panic attacks in young adolescents. At each successive stage of puberty, C. Hayward et al. (1992) found a progressively higher rate of panic attacks. "Panic disorder" thus preferentially develops in adolescence, more commonly in girls than boys, particularly in subjects who are prone to anxiety or show traits of the "avoiding personality", but who also have a depressive tendency. A number of studies also suggest that pathological separation anxiety developing in childhood represents a risk factor for the development of "panic disorder" and/or agoraphobia during adolescence or adult life. The natural history of Panic Disorder in adolescence is still little known. The greatest risk appears to be chronic anxiety, but the progressive establishment of panic disorder, its development in the direction of depressive disorder, and self-medication and/or abuse of psychotropic drugs, also give cause for concern. Finally, a number of psychopathological considerations have raised the possibility that the onset of a panic disorder may be a danger signal of an underlying depressive personality.

Anxiety among widowed elders: is it distinct from depression and grief?

The purpose of this study was to test the validity and utility of distinguishing symptoms of anxiety from those of depression and grief in recently spousally bereaved elders. We also examined pathways from baseline (six months or less post-spousal death) to follow-up (12 and 18 months post-death) levels of anxiety, depression and grief-related symptoms. Baseline and follow-up data were available from 56 recently widowed elderly subjects recruited for an investigation of physiological changes in bereavement. Confirmatory factor analyses indicated that a model in which anxiety was specified as a third factor, apart from depression and grief factors, fit the data well and significantly better than either the one or two factor models. Path analyses revealed that both baseline severity of grief and anxiety had significant lagged effects and predicted follow-up severity of depression. Symptoms of anxiety appeared distinct from those of depression and grief, and the anxiety, depression and grief factors differentially predicted subsequent symptomatology. These findings suggest a need for more specific identification and treatment of anxiety, depression and grief symptoms within the context of late-life spousal bereavement.

Construct and content validity of the Separation-Individuation Test of Adolescence: a reply to Levine.

The purpose of this commentary is to respond to Levine's (1994) critique of our earlier article (McClanahan & Holmbeck, 1992). We agree with Levine's argument that changes in the subscales of the Separation-Individuation Test of Adolescence (SITA; Levine, Green, & Millon, 1986) should be made based on both theoretical and statistical considerations. On the other hand, we also argue that attention needs to be paid to the content and construct validity of the SITA in future revisions of the measure.

Coping with security distress: the Separation Anxiety Test and attachment classification at 4.5 years.

The hypothesis that the same organization of attachment that can been seen in reunion with mother following a separation would be revealed in the child's responses to separation pictures was upheld. This supports the construct of an internal working model of attachment. Children classified as secure in reunion, compared to those classified as insecure, were more emotionally open to appropriate negative feeling, without being over-expressive, and showed a greater ability to tolerate security distress aroused by the separation pictures without raising defences against it. Responses of avoidant, ambivalent and controlling groups showed elements of the same organization revealed in reunion behaviour. These data support the validity of the Separation Anxiety Test (SAT) as an attachment instrument, but are not strong enough to suggest using it as an alternative to classifications.

[Separation anxiety: a new category of anxiety disorders in children?]. / L'angoisse de séparation: une nouvelle catégorie de troubles anxieux chez l'enfant?

The separation anxiety disorder is defined as an excessive anxiety when the child is separated from significant persons. It needs however to be distinguished from normal development separation anxiety because of the later age at onset, its persistence and general impact. We shall discuss the clinical aspects of this disorders, its complications and the issues raised by its outcome. The interesting characteristics of separation anxiety disorder are its frequency and different treatments available.