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Objective: Attachment theory suggests that anxious attachment styles are associated
with risk to psychiatric disorder, especially anxiety disorders. Separation anxiety would
appear to be a core form of anxiety that is associated with anxious attachment.
Nevertheless, as yet no research has examined the relationship of attachment styles to
adult separation anxiety disorder, a condition that has only recently been fully recognized.
Method: The Attachment Style Questionnaire was used to examine attachment styles
among 83 consecutive anxiety clinic patients diagnosed with panic disorder with
agoraphobia and those re-assigned from that category to adult separation anxiety disorder.
Results: Dimensional associations showed strong correlations with scales measuring
anxious attachment and separation anxiety. Patients assigned to the separation anxiety
group scored significantly higher than those in the panic disorder group on the scales of
Need for Approval and Preoccupation with Relationships.
Conclusions: The findings finally dispel the notion that separation anxiety and anxious
attachment are relevant to panic disorder with agoraphobia, suggesting instead that that
constellation is confined to a separate group, namely that of adult separation anxiety
disorder. Possible implications for treatment are considered.
Key words: adult, object attachment, panic disorder, separation anxiety disorder.
168
Methods
Sample
The sample was recruited from a public hospital anxiety clinic in
Sydney, Australia. All patients signed a consent form approved by
the Ethics Committee for the Sydney South West Area Health
Service. The sample consisted of consecutive patients diagnosed
with PD/PD-AG according to the Structured Clinical Interview for
DSM-IV (SCID) [24].
169
Measures
Statistical analysis
SPSS was used to undertake all analyses (SPSS, Chicago, IL,
USA). Clinic patient data were compared with normative data
using a single samples t-test, while the two anxiety subgroups were
compared using independent samples t-tests. The multivariate
analysis applied a stepwise regression to examine the relationship
between the ASQ subscales and a measure of adult separation
anxiety symptoms (ASA-27). A predetermined significance criterion of p 0.01 was used throughout.
Results
Sample characteristics
Eighty-three consecutive outpatients were diagnosed with PD or
PD-AG. Seventy-four per cent (n61) were female, and 51% (n
42) were either married or in cohabiting relationships. The mean
age of the sample was 37.2 years (SD12.7). Fifty-four patients
from this group were also assigned to ASAD using a cut-off of 22
on the ASA-27. Means and standard deviations for the attachment
subscales of the ASQ for the whole sample are provided in Table 1,
showing broad comparisons with normative data provided by
Troisi et al. [28].
The mean SASI and ASA-27 scores for the sample were 3.4
(SD1.5) and 32.3 (SD18.2), respectively. SASI and ASA-27
scores were significantly correlated (r 0.56, p0.001).
170
Table 1.
ASQ subscales
Confidence
Discomfort with Closeness
Relationships as Secondary
Need for Approval
Preoccupation with
Relationships
t, df, p
NS
4.8, 82, B0.001
4.8, 82, B0.001
7.3, 82, B0.001
NS
Discussion
To our knowledge this study is the first to examine
attachment styles among patients with comorbid PD/
PD-AG and ASAD. The results showed an association between a dimensional index of adult separation
anxiety and particular attachment styles. In addition,
patients with comorbid ASAD showed more aberrant
attachment styles than those with PD/PD-AG alone.
Table 2. Correlations between the ASA-27 and the
ASQ dimensions
ASQ subscales
Confidence
Discomfort with Closeness
Relationships as Secondary
Need for Approval
Preoccupation with Relationships
ASA-27
0.35
0.43**
0.24
0.52**
0.54**
ASA, Adult Separation Anxiety Questionnaire; ASQ, Attachment Style Questionnaire.; **p 0.01.
171
t, df, p
NS
NS
NS
3.4, 81, B0.01
4.1, 81, B0.001
Conclusions
The present study suggests that anxiety patients
with comorbid ASAD-PD/PD-AG have underlying
anxious attachment styles. These enduring patterns of
attachment may be responsible in part for the
substantial disability associated with ASAD [19],
exacerbating the impact on the sufferers interpersonal relationships. As yet, persons with ASAD remain
172
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