COM­MEN­TARY

Deal­ing with adult sep­a­ra­tion anx­i­ety

The Covington News - - HEALTH & WELLNESS -

Most grow out of it, but not all. Clas­sic movie ex­am­ples might in­clude “Casablanca” where Ilsa (In­grid Bergman) clings to Rick (Humphrey Bog­art) shortly be­fore they part for­ever and even the fright­en­ingly bizarre Hol­ly­wood thriller “Psy­cho” where Norman Bates (An­thony Perkins) sleeps next to his mother long af­ter she has died.

But, adult sep­a­ra­tion anx­i­ety can per­sist from child­hood into adult­hood or even be­gin in adult­hood. Ac­cord­ing to an ar­ti­cle in the Jan­uary 7, 2007, is­sue of the Har­vard Men­tal Health Let­ter, one na­tional sur­vey found that 2 per­cent of the Amer­i­can adult pop­u­la­tion had suf­fered from sep­a­ra­tion anx­i­ety in the pre­vi­ous year. The sur­vey’s re­searchers es­ti­mated that in a third of th­ese cases, child­hood sep­a­ra­tion anx­i­ety per­sisted into adult­hood, while oth­ers had late on­set, ap­pear­ing first in late teens or early 20s and of­ten much later adult­hood.

An ear­lier study (part of a na­tional co­mor­bid­ity study) con­ducted by pro­fes­sor of psy­chi­a­try at Columbia Univer­sity, Kather­ine Shear, M.D., and pub­lished in “Psy­chi­atric News” 2005 found that ap­prox­i­mately 7 per­cent of adult Amer­i­cans had suf­fered from sep­a­ra­tion anx­i­ety at least once in their lives, an even greater preva­lence rate than that of child­hood sep­a­ra­tion anx­i­ety dis­or­der, which is es­ti­mated by the sta­tis­tics pub­lished by the Of­fice of the Sur­geon Gen­eral to be 4 per­cent.

Ado­les­cents and adults with sep­a­ra­tion anx­i­ety may worry about leav­ing some­one close or go­ing away on a trip. They may be anx­ious when un­able to speak reg­u­larly to some­one on the tele­phone with whom they feel close. They may feel ex­tremely anx­ious about events that might sep­a­rate them from peo­ple close to them, have night­mares about be­ing away from home, find it dif­fi­cult to sleep alone and de­velop other psy­cho­log­i­cal and phys­i­cal symp­toms that over­lap with other mood and anx­i­ety disor­ders, es­pe­cially panic dis­or­der. By and large, symp­toms mir­ror those found in child­hood sep­a­ra­tion anx­i­ety dis­or­der dis­closed in the first ar­ti­cle of this se­ries.

Trau­matic or com­pli­cated grief may also be re­lated to sep­a­ra­tion anx­i­ety. Symp­toms may in­clude ob­ses­sive yearn­ing af­ter the per­son no longer with you, imag­in­ing of feel­ing his or her pres­ence, ru­mi­nat­ing about the events sur­round­ing the loss and blam­ing one­self or oth­ers for the loss. A per­son who has al­ways been anx­ious about part­ing is at in­creased risk for trau­matic or com­pli­cated grief. Best treat­ment prac­tices

The most widely used treat­ments for sep­a­ra­tion anx­i­ety dis­or­der are be­hav­ioral and cog­ni­tive ther­a­pies. Ex­po­sure ther­apy grad­u­ally ac­com­mo­dates the adult or child to in­creased dis­tance from sig­nif­i­cant oth­ers or par­ents. Cog­ni­tive ther­apy teaches both how to iden­tify and then how to re­sist un­re­al­is­tic fears by re­struc­tur­ing them into a more as­sertive and adap­tive frame­work. Re­lax­ation train­ing helps with phys­i­cal symp­toms and, fi­nally, con­tin­gency man­age­ment — re­wards, praise and oc­ca­sion­ally loss of priv­i­leges — some­times proves ef­fec­tive (for adults as well as chil­dren).

Par­ents and/or sig­nif­i­cant oth­ers can be ed­u­cated about the prob­lem and trained in how to fa­cil­i­tate a loved one’s re­cov­ery from over­whelm­ing fears. If fam­ily trou­bles are one source of the anx­i­ety or serve un­wit­tingly to re­in­force fears or the adult or child is em­u­lat­ing an anx­ious sig­nif­i­cant other or par­ent, joint fam­ily ther­apy may be help­ful. Stud­ies have found that in­di­vid­ual and group cog­ni­tive be­hav­ioral ther­a­pies are ef­fec­tive as is added fam­ily in­volve­ment.

No drugs are ap­proved for sep­a­ra­tion anx­i­ety in chil­dren. Se­lec­tive sero­tonin re­up­take in­hibitors (Prozac and its cousins), the stan­dard drug treat­ment for adult anx­i­ety dis­or­der, may be help­ful, but lit­tle is known about the longterm risks and ben­e­fits in chil­dren. Physi­cians may be re­luc­tant to pre­scribe an­tide­pres­sant or anti-anx­i­ety med­i­ca­tion for chil­dren be­cause of con­cerns about the po­ten­tial for in­creased sui­ci­dal ideation and be­hav­ior.

Phar­ma­co­log­i­cal ther­a­pies should be con­sid­ered for use in an ad­junct man­ner when the level of func­tional im­pair­ment is se­vere. For a child with se­vere sep­a­ra­tion anx­i­ety and/or de­pres­sion, con­ser­va­tive and closely mon­i­tored use of a pre­scribed med­i­ca­tion by a li­censed med­i­cal pro­fes­sional may be help­ful.

Peggy Nolen

Colum­nist

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