Separation anxiety: universal condition or psychopathological dimension?

The DSM officially contemplated separation anxiety as a condition that occurs in both adults and children only after the publication of the fifth edition. Separation anxiety is a common developmental phenomenon characterized by excessive fear or distress concerning detachment from an attachment figure. Separation anxiety disorder is highly prevalent in the general population and is characterized by a large array of manifestations. These include dependent and overprotective behaviors, anger or occasional aggression toward someone who is forcing separation, demanding, intrusive, and in need of constant attention manners, periods of exacerbation and remission, strong interdependence among family members, and suicidal attempts. Adult separation anxiety disorder is often comorbid with other mood and anxiety disorders and results in a worse clinical outcome, more significant impairment in role functioning, and reduced treatment efficacy, regardless of modality and a primary diagnosis of mood or anxiety disorder. Both adult and childhood separation anxiety may be considered manifestations of a more comprehensive panic diathesis called the "panic spectrum." Other studies discerned separation anxiety to strongly correlate with categorical borderline personality disorder criteria, particularly with fear of abandonment. The relationship between separation anxiety and autism spectrum is also particularly intriguing. In both conditions, early interactions are thought to shape emotional, social, and cognitive development throughout life. Efforts need to be directed at the disentanglement of common and specific risk factors, pathways, and mechanisms underlying separation anxiety disorder by probing its neurobiological underpinnings in individuals belonging to different psychopathological domains but with predominant attachment dysregulations.