LAUSR

Consolidation of early cognitive capacities, emerging independence, and an ability to interact with the world characterize Margaret Mahler's separation–individuation phase. This phase represents a critical developmental process that subserves the development of individual identity (Mahler, 1974). Separation-individuation is well known to child and adolescent psychiatrists and refers to individual development in the infant; however, the process aptly describes the process for the “new” anxiety disorder—adult separation anxiety disorder. Recently, against a backdrop of increased understanding and reconceptualization of separation anxiety disorder, two important shifts occurred in the transition from DSMIV to DSM-5: (1) moving separation anxiety disorder from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the Anxiety Disorders section and (2) recognition that separation anxiety disorder exists in adults. Separation anxiety disorder represents a significant and common anxiety disorder in children and adolescents and potentially affects 3–8% of children annually (Beesdo-Baum & Knappe, 2012; Kessler, Avenevoli, & Costello, 2012). Once considered to rarely persist into adulthood (Beesdo-Baum & Knappe, 2012), longitudinal studies suggest that separation anxiety disorder may continue into adulthood, and, in some cases, emerges during adulthood. Importantly, this condition is poorly characterized in treatment-seeking adults and treatment studies—whether psychopharmacologic or psychotherapeutic—are brutally lacking for adults. Compounding this dearth of data related to separation anxiety disorder in adults, some practitioners have considered separation anxiety as a temperament type, a personality feature, or a symptom of specific personality pathology (e.g., dependence or fears of abandonment in dependent or borderline personality disorders). Thus, the recent recognition of separation anxiety disorder as a condition afflicting adults has multiple clinical and research implications and underscores the need to understand its pathophysiology and treatment in adults. As the crucial first step in this process, this issue features the inaugural randomized controlled trial of pharmacotherapy separation anxiety disorder in adults. In this study, Schneier and colleagues (2017) remind us that, despite the prevalence of separation anxiety disorder in adults, in particular, adults with treatment-resistant anxiety disorders, the condition is rarely diagnosed “outside of research settings.” Schneier et al. completed the first randomized controlled trial of adults with a primary diagnosis of separation anxiety disorder, comparing treatment effects of vilazodone, a selective serotonin reuptake inhibitor (SSRI) and serotonin 1A (5-HT1A) receptor partial agonist, with placebo. While response rates at the 12-week endpoint of the study did not differ significantly between vilazodone-treated patients and those receiving placebo, patients receiving vilazodone had greater decreases in the Structured Clinical Interview for Separation Anxiety Symptoms (p = 0.026) and on the Quality of Life Enjoyment and SatisfactionQuestionnaire (p=0.011) compared to those receiving placebo and trended toward having greater global improvement (p=0.064) (Schneier et al., 2017).However, the value of this study extends beyond the observed treatment effects. The authors meticulously characterized the patient sample, contextualized the separation anxiety symptoms, and described the functional impairment of these patients. This investigation highlights several important questions for clinicians and researchers: