A three-generational presentation of separation anxiety in childhood with agoraphobia in adulthood.

School phobia belongs to a family of childhood anxiety states that appear to be related to adult forms of anxiety disorders, particularly to panic disorder with agoraphobia. School phobia appears to affect at least 5 percent of elementary school children and 2 percent of middle school children. Many of these children would be classified under the current DSM-III-R system of nomenclature as suffering from separation anxiety disorder. The present study is related to the elaboration of a three-generation family presentation of separation anxiety disorder manifesting itself as school phobia in childhood, which evolves toward panic disorder with agoraphobia in young adulthood and diffuse anxiety with hypochondriacal features in later life. All 13 genetically related members of the family investigated have been afflicted. The children with separation anxiety disorder and school phobia in this family who have been treated with imipramine have shown a resolution of anxiety symptoms that has allowed their successful return to school. The information from this family would fit into a model that describes a spectrum of anxiety disorders that present with different manifestations of overt psychopathology throughout the life cycle. We hope to follow this family prospectively over the next 30 years.