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Possible Link Between Childhood Separation Anxiety and Adulthood Personality Disorder in Patients With Anxiety Disorders in Japan

Akira Osone, M.D., and Saburo Takahashi, M.D.


Objective: The aim of this study was to examine whether childhood separation anxiety symptoms associate with adulthood anxiety disorders or personality disorders.

Method: Separation Anxiety Symptom Inventory (SASI), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and Global Assessment of Functioning (GAF) were administered to 134 outpatients with anxiety disorders and SASI was administered to 176 healthy volunteers (controls) recruited in Japan from April 1999 through November 2003.

Results: SASI scores were not correlated with age or sex in controls. In contrast, SASI scores were higher in patients with anxiety disorders than in controls, especially in women. SASI showed good test-retest reliability (Pearson correlation coefficient = 0.8). One hundred thirteen patients (84.3%) had no comorbid anxiety disorder while 21 (15.7%) had any, and those with comorbid anxiety disorder tended to show higher SASI scores (p = .053). In total, 60 (44.8%) of 134 patients had at least 1 personality disorder, and the most frequent disorders were from cluster C (36.6%). The subgroup with comorbid personality disorders showed earlier onset (p < .01), higher SASI scores (p < .01), and poorer recovery of global functioning (p < .05) than the noncomorbid subgroup. Stepwise multiple regression analysis revealed that SASI scores were higher in female (p < .05) and younger (p < .01) patients and most strongly correlated with number of comorbid personality disorders in adulthood (p < .01).

Conclusion: These results suggest that there is a continuum of anxiety disorders from childhood to adulthood, the severity of separation anxiety appears to increase the risk of severe anxious-fearful personality disorders in adulthood, and those with severe separation anxiety, particularly females, may progress to suffer from comorbid adult anxiety disorders.

(J Clin Psychiatry 2006;67:1451-1457)


Received Feb. 13, 2006; accepted May 18, 2006. From the Department of Psychiatry, Tokyo Women's Medical University, Tokyo (Dr. Osone); and Saitama Kounan Hospital, Saitama (Dr. Takahashi), Japan.

Drs. Osone and Takahashi report no financial affiliations or other relationships relevant to the subject of this article.

Corresponding author and reprints: Akira Osone, M.D., Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan (e-mail: aosone@psy.twmu.ac.jp).