Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-17T21:41:02.486Z Has data issue: false hasContentIssue false
  • English
  • Français

Separation anxiety disorder in adult patients with obsessive-compulsive disorder: Prevalence and clinical correlates

Published online by Cambridge University Press:  15 April 2020

A.P. Franz ,
L. Rateke ,
T. Hartmann ,
N. McLaughlin ,
A.R. Torres ,
M.C. do Rosário ,
E.C.M. Filho  and
Y.A. Ferrão
A.P. Franz
Affiliation:
Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, sala 109, Porto Alegre, Rio Grande do Sul90050-170Brazil
L. Rateke
Affiliation:
Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, sala 109, Porto Alegre, Rio Grande do Sul90050-170Brazil
T. Hartmann
Affiliation:
Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, sala 109, Porto Alegre, Rio Grande do Sul90050-170Brazil
N. McLaughlin
Affiliation:
Butler Hospital, Alpert Medical School of Brown University, 45, Prospect Street, Providence, RI02912United States
A.R. Torres
Affiliation:
Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University, Avenue Prof. Montenegro Bairro, Distrito de Rubião Junior, s/n, Botucatu, SP, 18618-970Brazil
M.C. do Rosário
Affiliation:
Child and Adolescent Psychiatry Unit, Department of Psychiatry, Federal University of São Paulo, Rua Sena Madureira, 1.500, 1° Andar, Vila Clementino, São Paulo, SP, 04021-001Brazil
E.C.M. Filho
Affiliation:
Institute and Department of Psychiatry, University of São Paulo School of Medicine, R. Dr. Ovídio Pires de Campos, 785, São Paulo, SP, 05403-903Brazil
Y.A. Ferrão*
Affiliation:
Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, sala 109, Porto Alegre, Rio Grande do Sul90050-170Brazil
*
*Corresponding author. Tel./fax: +55 (51) 3346 1077. E-mail addresses: ygoraf@ufcspa.edu.br (Y.A. Ferrão).
Get access

Abstract

Objective:

Individuals with obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) tend to present higher morbidity than do those with OCD alone. However, the relationship between OCD and SAD has yet to be fully explored.

Method:

This was a cross-sectional study using multiple logistic regression to identify differences between OCD patients with SAD (OCD + SAD, n = 260) and without SAD (OCD, n = 695), in terms of clinical and socio-demographic variables. Data were extracted from those collected between 2005 and 2009 via the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders project.

Results:

SAD was currently present in only 42 (4.4%) of the patients, although 260 (27.2%) had a lifetime diagnosis of the disorder. In comparison with the OCD group patients, patients with SAD + OCD showed higher chance to present sensory phenomena, to undergo psychotherapy, and to have more psychiatric comorbidities, mainly bulimia.

Conclusion:

In patients with primary OCD, comorbid SAD might be related to greater personal dysfunction and a poorer response to treatment, since sensory phenomena may be a confounding aspect on diagnosis and therapeutics. Patients with OCD + SAD might be more prone to developing specific psychiatric comorbidities, especially bulimia. Our results suggest that SAD symptom assessment should be included in the management and prognostic evaluation of OCD, although the psychobiological role that such symptoms play in OCD merits further investigation.

Keywords

Obsessive-compulsive disorderSeparation anxiety disorderComorbidityAnxietyDiagnosisEpidemiology
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 1 , January 2015 , pp. 145 - 151
Copyright
Copyright © European Psychiatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Tel.: +55 (51) 3303 9000; fax: +55 (51) 3303 8810.

2

Tel.: +1 401 863 1000.

3

Tel.: +55 (14) 3811 6000.

4

Tel.: +55 (11) 3385 4101.

5

Tel.: +55 (11) 2661 6972.

References

Albert, U, Venturello, S, Maina, G, Ravizza, L, Bogetto, F. Bulimia nervosa with and without obsessive-compulsive syndromes. Compr Psychiatry 2001;42(6):456–460.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC, USA: American Psychiatric Press Inc; 2000[Text Revision (DSM-IV-TR)].Google Scholar
Atli, O, Bayin, M, Alkin, T. Hypersensitivity to 35% carbon dioxide in patients with adult separation anxiety disorder. J Affect Disord 2012;141(2–3):315–323.CrossRefGoogle ScholarPubMed
Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56(6):893–897.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J, et al.An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.CrossRefGoogle ScholarPubMed
Becker, CB, Deviva, JC, Zayfert, C. Eating disorder symptoms among female anxiety disorder patients in clinical practice: the importance of anxiety comorbidity assessment. J Anxiety Disord 2004;18:255–274.CrossRefGoogle ScholarPubMed
Bolam, JP, Hanley, JJ, Booth, PA, Bevan, MD. Synaptic organization of the basal ganglia. J Anat 2000;196:527–542.CrossRefGoogle ScholarPubMed
Coffey, BJ, Miguel, EC, Biederman, J, Baer, L, Rauch, SL, O'Sullivan, RL, et al.Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different?. J Nerv Ment Dis 1998;86(4):201–206.CrossRefGoogle Scholar
Costello, EJ, Copeland, W, Angold, A. Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults?. J Child Psychol Psychiatry 2011;52(10):1015–1025.CrossRefGoogle ScholarPubMed
de Mathis, MA, Diniz, JB, Hounie, AG, Shavitt, RG, Fossaluza, V, Ferrão, Y, et al.Trajectory in obsessive-compulsive disorder comorbidities. Eur Neuropsychopharmacol 2013;23(7):594–601.CrossRefGoogle ScholarPubMed
Ferrão, YA, Shavitt, RG, Prado, H, Fontenelle, LF, Malavazzi, DM, de Mathis, MA, et al.Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: an exploratory study of 1001 patients. Psychiatry Res 2012;197:253–258.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBStructured clinical interview for DSM-IV Axis I disorders: clinical version (SCID-CV). Washington, DC: American Psychiatric Press; 1997.Google Scholar
First, MBStructural clinical interview for DSM-IV-TR impulse control disorders not elsewhere classified (SCID-TCIm). New York, NY: Biometrics Research Department; New York State Psychiatric Institute; 2004.Google Scholar
Fontenelle, LF, Cocchi, L, Harrison, BJ, Shavitt, RG, do Rosário, MC, Ferrão, YA, et al.Towards a post-traumatic subtype of obsessive-compulsive disorder. J Anxiety Disord 2012;26(2):377–383.CrossRefGoogle ScholarPubMed
Godart, NT, Flament, MF, Perdereau, F, Jeammet, PFacteurs prédictifs de l’inadaptation sociale chez les patients anorexiques et boulimiques. Encephale 2003;29(2):149–156.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, et al.The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989;46(11):1006–1011.CrossRefGoogle ScholarPubMed
Gorman, JM, Kent, JM, Sullivan, GM, Coplan, JDNeuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry 2000;157(4):493–505.CrossRefGoogle ScholarPubMed
Graeff, FGSerotonin, the periaqueductal gray and panic. Neurosci Biobehav Rev 2004;28:239–259.CrossRefGoogle ScholarPubMed
Graeff, FGSerotonina, matéria cinzenta periaquedutal e transtorno do pânico. Rev Bras Psiquiatr 2003;25(2):42–45.CrossRefGoogle Scholar
Graybiel, AM, Aosaki, T, Flaherty, AW, Kimura, MThe basal ganglia and adaptive motor control. Science 1997;265:1826–1831.CrossRefGoogle Scholar
Hong, JP, Samuels, J, Bienvenu, OJ, Cannistraro, P, Grados, M, Riddle, MA, et al.Clinical correlates of recurrent major depression in obsessive–compulsive disorder. 3rd Depress Anxiety 2004;20:86–91.CrossRefGoogle ScholarPubMed
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, et al.Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36(7):980–988.CrossRefGoogle ScholarPubMed
Kendall, PC, Compton, SN, Walkup, JT, Birmaher, B, Albano, AM, Sherrill, J, et al.Clinical characteristics of anxiety disordered youth. J Anxiety Disord 2010;24(3):360–365.CrossRefGoogle ScholarPubMed
Kopec, JA, Esdaile, JMBias in case-control studies. A review. J Epidemiol Community Health 1999;44(3):179–186.CrossRefGoogle Scholar
Kossowsky, J, Wilhelm, FH, Roth, WT, Schneider, SSeparation anxiety disorder in children: disorder-specific responses to experimental separation from the mother. J Child Psychol Psychiatry 2012;53:178–187.CrossRefGoogle ScholarPubMed
Leckman, J, Walker, DE, Cohen, DJPremonitory urges in Tourette's Syndrome. Am J Psychiatry 1993;150:98–102.Google ScholarPubMed
Lewinsohn, PM, Holm-Denoma, JM, Small, JW, Seeley, JR, Joiner, TE Jr., et al.Separation anxiety disorder in childhood as a risk factor for future mental illness. J Am Acad Child Adolesc Psychiatry 2008;47:548–555.CrossRefGoogle ScholarPubMed
Manicavasagar, V, Marnane, C, Pini, S, Abelli, M, Rees, S, Eapen, V, et al.Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep 2010;12(4):290–297.CrossRefGoogle ScholarPubMed
Manicavasagar, V, Silove, D, Curtis, J, Wagner, RContinuities of separation anxiety from early life into adulthood. J Anxiety Disord 2000;14(1):1–18.CrossRefGoogle ScholarPubMed
Manicavasagar, V, Silove, DIs there an adult form of separation anxiety disorder? A brief clinical report. Aust N Z J Psychiatry 1997;31(2):299–303.CrossRefGoogle ScholarPubMed
Matsunaga, H, Kiriike, N, Miyata, A, Iwasaki, Y, Matsui, T, Fujimoto, K, et al.Prevalence and symptomatology of comorbid obsessive-compulsive disorder among bulimic patients. Psychiatry Clin Neurosci 1999;53(6):661–666.CrossRefGoogle ScholarPubMed
McCloskey, LA, Walker, MPosttraumatic stress in children exposed to family violence and single-event trauma. J Am Acad Child Adolesc Psychiatry 2000;39(1):108–115.CrossRefGoogle ScholarPubMed
Mghaieth, S, Othman, S, Bouden, A, Halayem, MBÉtat de stress post-traumatique chez l’enfant: sémiologie et comorbidité. Encephale 2007;33(4 Pt 1):598–602.CrossRefGoogle Scholar
Miguel, EC, Ferrão, YA, Rosário, MC, Mathis, MA, Torres, AR, Fontenelle, LF, et al.The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results. Rev Bras Psiquiatr 2008;30(3):185–196.CrossRefGoogle Scholar
Mink, JWBasal ganglia dysfunction in Tourette's syndrome: a new hypothesis. Pediatr Neurol 2001;25:190–198.CrossRefGoogle ScholarPubMed
Mink, JWThe basal ganglia: focus selection and inhibition of competing motor programs. Prog Neurobiol 1996;50:381–425.CrossRefGoogle Scholar
Mroczkowski, MM, Goes, FS, Riddle, MA, Grados, MA, Bienvenu, OJ, Greenberg, BD, et al.Separation anxiety disorder in OCD. 3rd Depress Anxiety 2011;28:256–262.CrossRefGoogle ScholarPubMed
Muris, P, Merckelbach, H, Clavan, MAbnormal and normal compulsions. Behav Res Ther 1997;35:249–252.CrossRefGoogle ScholarPubMed
Nestadt, G, Addington, A, Samuels, J, Liang, KY, Bienvenu, OJ, Riddle, M, et al.The identification of OCD-related subgroups based on comorbidity. Biol Psychiatry 2003;53(10):914–920.CrossRefGoogle ScholarPubMed
Nestadt, G, Samuels, J, Riddle, MA, Liang, KY, Bienvenu, OJ, Hoehn-Saric, R, et al.The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med 2001;31(3):481–487.CrossRefGoogle ScholarPubMed
Ollendick, TH, Lease, CA, Cooper, CSeparation anxiety in young adults: a preliminary examination. J Anxiety Disord 1993;7:293–305.CrossRefGoogle Scholar
Pallister, E, Waller, GAnxiety in the eating disorders: understanding the overlap. Clin Psychol Rev 2008;28:366–386.CrossRefGoogle ScholarPubMed
Perugi, G, Deltito, J, Soriani, A, Musetti, L, Petracca, A, Nisita, C, et al.Relationships between panic disorder and separation anxiety with school phobia. Compr Psychiatry 1988;29:98–107.CrossRefGoogle ScholarPubMed
Petter, T, Richter, MA, Sandor, PClinical features distinguishing patients with Tourette's syndrome and obsessive-compulsive disorder from patients with obsessive-compulsive disorder without tics. J Clin Psychiatry 1998;59(9):456–459.CrossRefGoogle ScholarPubMed
Roberson-Nay, R, Eaves, LJ, Hettema, JM, Kendler, KS, Silberg, JLChildhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis. Depress Anxiety 2012;29(4):320–327.CrossRefGoogle Scholar
Rosario, MC, Prado, HS, Borcato, S, Diniz, JB, Shavitt, RG, Hounie, AG, et al.Validation of São Paulo Sensory Phenomena Scale: initial psychometric properties. CNS Spectr 2009;14(6):315–323.CrossRefGoogle Scholar
Rosario-Campos, MC, Leckman, JF, Mercadante, MT, Shavitt, RG, Prado, HS, Sada, P, et al.Adults with early onset obsessive-compulsive disorder. Am J Psychiatry 2001;158(11):1899–1903.CrossRefGoogle ScholarPubMed
Rosario-Campos, MC, Miguel, EC, Quatrano, S, Chacon, P, Ferrao, Y, Findley, D, et al.The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry 2006;11(5):495–504.CrossRefGoogle ScholarPubMed
Ruscio, AM, Stein, DJ, Chiu, WT, Kessler, RCThe epidemiology of obsessive–compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2010;15:53–63.CrossRefGoogle ScholarPubMed
Salkovskis, PM, McGuire, JCognitive–behavioural theory of OCD. In: Menzies, RG, de Silva, P, editors. Obsessive–compulsive disorder: theory, research, and treatment. Sussex, England: Wiley & Sons; 2003. p. 59–78.Google Scholar
Sallet, PC, de Alvarenga, PG, Ferrão, Y, de Mathis, MA, Torres, AR, Marques, A, et al.Eating disorders in patients with obsessive-compulsive disorder: prevalence and clinical correlates. Int J Eat Disord 2010;43(4):315–325.Google ScholarPubMed
Salum, GA, Isolan, LR, Bosa, VL, Tocchetto, AG, Teche, SP, Schuch, I, et al.The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings. Rev Bras Psiquiatr 2011;33(2):181–195.CrossRefGoogle ScholarPubMed
Samuels, J, Nestadt, G, Bienvenu, OJ, Costa, PT Jr., Riddle, MA, Liang, KY, et al.Personality disorders and normal personality dimensions in obsessive–compulsive disorder. Br J Psychiatry 2000;177:457–462.CrossRefGoogle ScholarPubMed
Saxena, S, Rauch, SLFunctional neuroimaging and the neuroanatomy of obsessive-compulsive disorder. Psychiatr Clin North Am 2000;23:563–586.CrossRefGoogle ScholarPubMed
Scher, A, Blumberg, ONight waking among 1-year olds: a study of maternal separation anxiety. Child Care Health Dev 1999;25:323–334.CrossRefGoogle ScholarPubMed
Shear, K, Jin, R, Ruscio, AM, Walters, EE, Kessler, RC, et al.Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. Am J Psychiatry 2006;163(6):1074–1083.CrossRefGoogle ScholarPubMed
Silove, D, Manicavasagar, V, Curtis, J, Blaszczynski, AIs early separation anxiety a risk factor for adult panic disorder? A critical review. Compr Psychiatry 1996;37:167–179.CrossRefGoogle ScholarPubMed
Silove, D, Momartin, S, Marnane, C, Steel, Z, Manicavasagar, VAdult separation anxiety disorder among war-affected Bosnian refugees: comorbidity with PTSD and associations with dimensions of trauma. J Trauma Stress 2010;23(1):169–172.Google ScholarPubMed
Torres, AR, Ramos-Cerqueira, AT, Ferrão, YA, et al.Suicidality in obsessive-compulsive disorder: prevalence and relation to symptom dimensions and comorbid conditions. J Clin Psychiatry 2011;72(1):17–26.CrossRefGoogle ScholarPubMed
Troisi, A, Di Lorenzo, G, Alcini, S, Nanni, RC, Di Pasquale, C, Siracusano, ABody dissatisfaction in women with eating disorders: relationship to early separation anxiety and insecure attachment. Psychosom Med 2006;68(3):449–453.CrossRefGoogle ScholarPubMed
Troisi, A, Massaroni, P, Cuzzolaro, MEarly separation anxiety and adult attachment style in women with eating disorders. Br J Clin Psychol 2005;44:89–97.CrossRefGoogle ScholarPubMed
Verduin, TL, Kendall, PCDifferential occurrence of comorbidity within childhood anxiety disorders. J Clin Child Adolesc Psychol 2003;32(2):290–295.CrossRefGoogle ScholarPubMed
Ward, A, Ramsay, R, Treasure, JAttachment research in eating disorders. Br J Med Psychol 2000;73:35–51.CrossRefGoogle ScholarPubMed
Ward, A, Ramsay, R, Turnbull, S, Benedettini, M, Treasure, JAttachment patterns in eating disorders: past in the present. Int J Eat Disord 2000;28:370–376.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Ward, A, Ramsay, R, Turnbull, S, Steele, M, Steele, H, Treasure, JAttachment in anorexia nervo a transgenerational perspective. Br J Med Psychol 2001;74:497–505.CrossRefGoogle Scholar
Zitrin, CM, Ross, DCEarly separation anxiety and adult agoraphobia. J Nerv Ment Dis 1988;176(10):621–625.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.