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There is a need to explain the high level of comorbidity between separation anxiety disorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To examine whether separation anxiety disorder (SAD) in childhood is a risk factor for panic disorder and agoraphobia in adulthood., Method: Patients (n = 85) who had completed treatment for SAD, generalized anxiety disorder, and/or social phobia 7.42 years earlier (on average) were reassessed using structured diagnostic interviews., Results: Subjects with a childhood diagnosis of SAD did not display a greater risk for developing panic disorder and agoraphobia in young adulthood than those with other childhood anxiety diagnoses. Subjects with a childhood diagnosis of SAD did not more frequently meet full diagnostic criteria for panic disorder and agoraphobia, generalized anxiety disorder, social phobia, or major depressive disorder in adulthood than subjects with childhood diagnoses of generalized anxiety disorder or social phobia, but were more likely to meet criteria for other anxiety disorders (i.e., specific phobia, obsessive compulsive disorder, posttraumatic stress disorder, and acute stress disorder)., Conclusions: These results argue against the hypothesis that childhood SAD is a specific risk factor for adult panic disorder and agoraphobia.

Introduction: Choking phobia has been rarely described in the literature and its prevalence has not yet been determined. Because of its clinical picture (female predominance, avoidance or refusal of certain foodstuffs, secondary weight loss, associated obsessive-compulsive symptoms), it is often misdiagnosed as anorexia nervosa., Case Report: The authors describe the case of an 11-year-old girl, hospitalised for anorexia, who actually had choking phobia. Following a long history of anxiety disorders (including separation anxiety, social phobia, obsessive-compulsive disorder), the choking phobia had been triggered by a traumatic choking episode occurred in her grandfather. The disorder was successfully treated by cognitive-behavioural techniques associated with an antidepressant therapy., Conclusion: This typical case questions the relationships between choking phobia and the other anxiety disorders of childhood and adolescence. According to data from the literature, the authors conclude that choking phobia may be regarded as a non developmental specific phobia, whose occurrence is facilitated by the presence of pre-existing anxiety disorders. The disorder is usually improved by cognitive-behavioural treatment.

The relationship between selective mutism (SM) and childhood anxiety disorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxiety disorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxiety disorder or a variant of a specific anxiety disorder. The conceptualization of SM as an anxiety disorder is helpful in effectively treating afflicted children. There is enough evidence in the current literature to challenge the current classification, from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of SM as an Other Disorder of Infancy, Childhood, and Adolescence.

Objective: This research investigates personality variables--aggression and disorders of conduct, depression, and separation anxiety--mediating suicidal behavior in psychiatrically hospitalized urban minority adolescents., Method: Four matched groups of 26 subjects (N = 104) participated: suicidal adolescents with, and suicidal adolescents without, a conduct disorder diagnosis, nonsuicidal adolescents with a conduct disorder diagnosis, and a nonpsychiatric control group. Subjects were assessed with three dimensions from the Epigenetic Assessment Rating System (EARS), the Children's Depression Inventory (CDI), and the Separation Anxiety Test (SAT)., Results: A conduct disorder diagnosis was related to lower modal EARS scores. The EARS and the CDI each identified a different subset of suicidal adolescents. Adolescents with lower modal EARS scores exhibited greater reactivity to separation experiences on the SAT., Conclusion: Relying on depressive symptomatology to identify suicidality overlooks a majority of at-risk adolescents. Structural personality variables as measured by the EARS identify and distinguish subsets of suicidal adolescents.

Objective: To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence., Method: Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents., Results: On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each., Conclusion: After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.

Objective: To investigate the frequency and phenomenology of clinical, subsyndromal, and subthreshold phobias in young adolescents., Methods: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 487 mother-child pairs., Results: Prevalence rates of clinical, subsyndromal, and subthreshold phobia were 2.3%, 14.5%, and 22.2%, respectively. One-year incidence rates were 0.4%, 8.0%, and 16.9%, with 43.0% of phobic subjects categorized at the same or a more severe level after a year. Females, blacks, subjects not living with both biological parents, and older adolescents were more likely to meet the diagnostic criteria for clinical phobia. The majority (77%) of subjects with clinical phobia experienced multiple phobias. Subsyndromal (52%) and subthreshold (74%) phobics were more likely to experience simple phobias only., Conclusions: Phobic symptoms are relatively common at a moderate level and in the majority of adolescents are somewhat transitory in nature. Characteristic symptomatology and comorbidity may facilitate earlier identification of subjects at risk of persistent symptomatology and in need of treatment.

72 infants delivered normally were observed for 2 h after birth. In the separation group (n = 34), the infant was placed on the mother's abdomen immediately after birth but removed after about 20 min for measuring and dressing. In the contact group (n = 38) contact between mother and infant was uninterrupted for at least 1 h. After about 20 min the infants began to make crawling movements towards the breast; the rooting reflex soon came into play, and at an average of 50 min after birth most of the infants were sucking at the breast. More infants in the contact group than in the separation group showed the correct sucking technique (24/38 vs 7/34). 40 (56%) of the 72 mothers had received pethidine during labour; the infants were also sedated and most of them (25/40) did not suck at all. It is suggested that contact between mother and infant should be uninterrupted during the first hour after birth or until the first breast-feed has been accomplished, and that use of drugs such as pethidine should be restricted.

The characteristics of anxiety-based school refusal were examined in 63 school refusing children and adolescents referred to an outpatient anxiety disorder clinic. Patients were assessed on sociodemographic, diagnostic, and personality variables, as well as familial history of school refusal. Results suggest that there are two primary diagnostic "subgroups" of school refusers--separation anxious and phobic. Phobic school refusers had a later age of onset and showed more pervasive (severe) school refusal than separation anxious school refusers. By contrast, separation anxious school refusers were more likely than phobic school refusers to have mothers who had a history of school refusal problems. The implications of these findings are discussed.

A pragmatic approach to the prevention of eating disorders involves the study of individuals at high risk for the development of these disorders. A clinical survey of 14 adolescent exchange students who were diagnosed as eating disorder patients confirms our hypothesis that several of the predisposing or precipitating factors mentioned in the literature must be present for the disorder to occur. It is concluded that the prevention of eating disorders among the high risk population of exchange students should focus on an early detection of adolescent identity problems, relational difficulties and an accentuated sensitivity to weight issues.

This paper reviews a number of treatment strategies utilized in the treatment of a 6-year-old boy with a history of multiple parental separations. When the patient presented to the child psychiatric clinic, he had a history of not speaking in the preceding four months, following the arrival of a stepmother in the household and a move to a new house in a new locality. Developmental and psychometric assessments are presented and their utility in early diagnosis and later prognosis are discussed. Reluctant speech is differentiated from, and compared with, elective mutism.The management of elective mutism is often complicated by these children not speaking to anyone in certain environments, and very frequently the persons with whom they do speak are not available for participation in treatment programs. Consequently, if a child does not speak to anyone who can participate in the early mapping of treatment modalities, the use of treatment strategies such as stimulus fading is impossible. Suggestions for future management to overcome this difficulty are presented and discussed.