Hi {{ First Name | friend }}!

You’re in your 20s, in a car with friends heading upstate. Alanis Morissette plays on the radio, the early summer warmth suns your face, a long weekend’s in front of you, and you’re spending it at a free house, with a pool.

You’re lucky, and you know it. Yet, your feelings are misaligned with this reality and the wide-open joy such occasions foster. As your friends pop open beers, tell jokes, and gossip, you focus every ion of willpower to stay sure-footed atop a swinging wire thousands of feet above ground.

You are the Philippe Petit of imbalance.

One misstep and you’ll plummet into the maw of a sharp-toothed panic attack, but if you can stay propped up for just a few minutes longer, you might be spared.

You close your eyes and pretend to sleep. It’s better when no one is paying attention to you. You can focus on willing the dread away: begging, pleading, silently davening to a God you don’t believe in to remove it. 

You’re in your 30s.

You believe you’re about to die.

Newly diagnosed with a panic disorder. You’re on medication and feeling better. Your new boyfriend is cast in the European tour of Cirque du Soleil. He’ll be gone for one year. He asks you to join him, and there it is—the dread.  

You’ve experienced this familiar sense of terror your entire life, along with panic attacks. You know its name, so you hide it from those around you.

You work hard to hide it from yourself.

It’s embarrassing when your therapist confirms your self-diagnosis.

As a child, you had all the standard markers of separation anxiety: chronic excessive distress when separated from home or primary attachment, and chronic excessive distress in anticipation of separation from home or primary attachment. Persistent worry about something harming your primary attachment. Excessive worry about being lost or kidnapped.

Typically, a child outgrows separation anxiety by the time they’re 3.

You are now 33, and it’s never left. 

You say no, you can’t go to Europe with him.

Ye,s you can, he says.

You wish you could, but it’s unbearable to invite unbearable feelings into your body, when you’ve worked so hard to keep this particular horror at bay.

Everyone pushes you to go.

Then 9/11 happens, and you both leave the city for a week, and he promises to make the transition easy for you, to set up an internet connection so you can continue therapy while you’re gone. You choose to be brave and agree, you’ll go.

Before you leave, you write overwrought letters to your family members that read like suicide notes.

You travel for a year in Europe with the Cirque du Soleil. It’s the best year of your life, and when you return, you believe you’re cured of the secret thing you’ve suffered from since childhood.

You’re in your 40s. You’re on a bus to spend a month in Maine with a different boyfriend. The wash of dread and panic starts to come over you. You’re more adept now at pushing it away, at talking yourself down, but it’s still here, this childhood disorder adults aren’t “supposed” to suffer from.

Childhood Separation Anxiety is a standard and expected developmental stage. In The Diagnostic and Statistical Manual of Mental Disorders (DSM)—the handbook of criteria that clinicians use to diagnose mental health disorders and establish a consistent and common language—it’s marked by a loose start and end date: appearing around age 1 and disappearing around the age of 3.

If it doesn’t disappear by age three and lasts for longer than 4 weeks, it’s considered a disorder, which should then be treated.

But what happens if it doesn’t disappear and is never treated? 

What happens if it stays with you your entire life?

Or maybe it does end, but then it returns when you’re 23.

Until the early aughts, Adult Separation Anxiety Disorder (ASAD) didn’t exist; it was a diagnostic orphan, existing in a liminal space between patient testimonials and clinical reality.

But, in 2015, the DSM dropped the age criterion for Separation Anxiety, et Voila, millions of silent sufferers found themselves visible.

Yet, despite being a “new field of study,” it is not, in fact, only nine years old. 

It’s as old as time; it’s simply under-recognized, leaving countless adults to remain undiagnosed and untreated, to suffer silently. ASAD significantly impacts a person’s quality of life, relationships, educational achievements, career prospects and life goals.

I have it.

You might have it too.

Because it hasn’t been studied, the risk factors for developing the disorder aren’t clear-cut. 

The contours of ASAD are still being mapped. We know it shares DNA with its childhood counterpart, but with subtle mutations. Symptoms are also similar, with varying degrees of difference.

For instance, adults don't just fear separation from people; places and objects can become lifelines too. Panic attacks erupt when loved ones are unreachable; fear metastasizes into visions of emotional devastation.

In adults, the duration for diagnosis stretches from four weeks to six months.

Yet ASAD remains stubbornly under-recognized. One reason is the sufferers’ instinct to dismiss it as childish, camouflage it with coping mechanisms that mask their struggles, making it difficult for others, including mental health professionals, to identify the underlying issue.

Another reason is that the symptoms of ASAD overlap with other anxiety disorders like Generalized Anxiety Disorder and Panic Disorder, leading to misdiagnosis, underdiagnosis, or overlooked diagnosis.

ASAD is more prevalent in women, often blooming around age twenty-three. And for those with Panic Disorder (👋🏼), the percentage of ASAD comorbidity is 49.5%.

Trauma, childhood adversity, and seismic life changes are fertile soil for its roots to take hold.

Living with ASAD is like wearing an invisible leash, always taut, always threatening to yank you back. It manifests in nausea, headaches, and the sickening vertigo of panic attacks.

Research has shown that adults with separation anxiety disorder report significantly lower quality of life and greater functional impairment compared to those without the disorder.

The constant worry and need for reassurance erodes self-esteem and strains personal and professional relationships.

Career advancement often suffers, as those affected may avoid jobs requiring travel or extended time away from home. Social relationships can become strained, with individuals withdrawing from friends and activities that might separate them from their attachment figures.

Children of parents with ASAD might struggle to develop independence, potentially perpetuating the cycle of anxiety.

But recognition is the first step toward reclamation.

Cognitive Behavioral Therapy can offer a map out of the labyrinth, teaching us to challenge catastrophic thinking and face our fears incrementally. For some, medication provides a lifeline. For others, mindfulness offers grounding in the present, a bulwark against anxiety's future-oriented assault.

Those with separation anxiety need to feel connected because disconnection feels intolerable. This holds independence just out of reach. But the more we seek to identify the origin point of our fears, the easier it is to untangle their hold.

People with ASAD need to remind themselves that their need to connect isn't a weakness – it's the very essence of our humanity. With the right support, we can learn to nurture those bonds while embracing the exhilarating, sometimes frightening, freedom of independence. 

Recovery is possible, but it's rarely linear. It demands patience, persistence, and a willingness to confront what terrifies us most – separation itself. 

The invisible leash loosens. We take a step. And then another.

Are you familiar with Adult Separation Anxiety? Let me know in the comments!

Until next week, I will remain…