Department of Psychiatry, Weill Medical College of Cornell University, New York City, New York.
Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York.
Depress Anxiety. 2020 Apr;37(4):386-395. doi: 10.1002/da.23003. Epub 2020 Feb 25.
Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psychotherapy (IPT) for veterans with PTSD assessed these SAD domains.
Twenty-nine veterans diagnosed with chronic PTSD on the Clinician-Administered PTSD Scale were assessed for SAD using the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and for Symptom-Specific Reflective Function (SSRF), another dysregulated-attachment marker capturing patients' emotional understanding of their symptoms. Patients received 14 IPT sessions for PTSD with assessments at baseline, Week 4 (SCI-SAS and SSRF), and termination for SAD, PTSD, and depression.
At baseline, 69% of patients met SAD criteria. Separation anxiety did not correlate with baseline PTSD severity, depressive severity, or age when traumatized; patients with and without SAD had comparable PTSD and depression severity. Patients with baseline comorbid SAD who completed IPT (N = 17) reported significantly improved adult separation anxiety (p = .009). Adult SAD improvements predicted depressive improvement (p = .049). Patients with SAD showed a stronger relationship between early SSRF gains and subsequent adult SAD improvement (p = .021) compared with patients without SAD.
This first exploration of dysregulated/insecure attachment features among patients with PTSD found high SAD comorbidity and adult SAD improvement among patients with SAD following IPT. Highly impaired attachment patients normalized attachment posttreatment: 14-session IPT improved attachment dysregulation. This small study requires replication but begins to broaden clinical understanding of separation anxiety, attachment dysregulation, and PTSD.
分离焦虑症（SAD）是依恋失调或不安全感的一个方面。尽管 SAD 会加重创伤后应激障碍（PTSD）的风险，但没有临床研究跟踪有多少 PTSD 患者有 SAD、其临床关联或对 PTSD 治疗的反应。我们对 PTSD 退伍军人进行的人际心理治疗（IPT）开放性试验评估了这些 SAD 领域。
29 名被临床医生管理的 PTSD 量表诊断为慢性 PTSD 的退伍军人使用分离焦虑症状的结构临床访谈（SCI-SAS）评估 SAD，以及症状特异性反射功能（SSRF），这是另一种失调的依恋标志物，可捕捉患者对其症状的情绪理解。患者接受 14 次 PTSD 的 IPT 治疗，并在基线、第 4 周（SCI-SAS 和 SSRF）和 SAD、PTSD 和抑郁的治疗结束时进行评估。
在基线时，69%的患者符合 SAD 标准。分离焦虑与基线 PTSD 严重程度、抑郁严重程度或创伤时的年龄无关；有和没有 SAD 的患者 PTSD 和抑郁严重程度相当。完成 IPT（N=17）的基线共病 SAD 患者报告成人分离焦虑显著改善（p=0.009）。成人 SAD 的改善预测抑郁的改善（p=0.049）。与没有 SAD 的患者相比，SAD 患者在早期 SSRF 增益与随后的成人 SAD 改善之间表现出更强的关系（p=0.021）。
这是首次在 PTSD 患者中探索失调/不稳定的依恋特征，发现 SAD 共病率高，IPT 治疗后 SAD 患者的成人 SAD 改善。高度受损的依恋患者在治疗后正常化了依恋：14 次 IPT 改善了依恋失调。这项小型研究需要复制，但开始拓宽对分离焦虑、依恋失调和 PTSD 的临床理解。
