In a groundbreaking study published in BMC Psychiatry, researchers have delved deep into the complex relationship between Panic Disorder (PD) and Adult Separation Anxiety Disorder (ASAD), shedding new light on the psychological mechanisms that intertwine these two often co-occurring conditions. The investigation specifically targeted the potential mediating role of attachment styles—a foundational concept in understanding human relational patterns—offering nuanced insights into how early life bonds may or may not influence the onset and progression of these anxiety disorders.
Panic Disorder, characterized by sudden and recurrent panic attacks accompanied by intense fear and physiological symptoms, has long been recognized as a debilitating condition negatively impacting quality of life. Meanwhile, Adult Separation Anxiety Disorder, historically considered a childhood ailment, is increasingly acknowledged as significant in adults, manifesting as excessive fear or distress concerning separation from loved ones. Despite clinical observations of frequent co-occurrence, the underlying pathways linking these disorders have remained ambiguous—until now.
The study’s cohort consisted of 76 individuals diagnosed with Panic Disorder, recruited consecutively from the Psychiatry outpatient clinic at Rize Recep Tayyip Erdoğan University Training and Research Hospital over an eight-month window in 2023. To establish a comparative baseline, 79 healthy control participants were also assessed. The researchers employed validated psychometric instruments: the Panic Agoraphobia Scale (PAS) to quantify panic severity, the Adult Separation Anxiety Questionnaire (ASA) to measure separation anxiety symptoms, and the Relationship Scales Questionnaire (RSQ) to evaluate attachment patterns.
Results from this methodologically rigorous inquiry revealed a striking discrepancy in the prevalence of ASAD between the two groups. Specifically, a significant 66% of patients with PD exhibited clinically relevant separation anxiety symptoms compared to just 34% in the control group. This statistical disparity underscores the high comorbidity and suggests ASAD may be more than an incidental finding in panic psychopathology. Importantly, the findings emphasize the need for clinicians to screen for and address separation anxiety symptoms when treating panic disorder.
Intriguingly, when the researchers constructed a mediation model to ascertain whether attachment styles influenced the relationship between PD and ASAD, the anticipated mediating effect was absent. Contrary to some theoretical frameworks suggesting that insecure attachment—marked by anxious or avoidant relational schemas—might facilitate or exacerbate anxiety disorders, this study found no significant direct or indirect mediation by attachment patterns. This challenges prevailing assumptions and invites a re-examination of the role of early relational factors in adult anxiety disorders.
Nevertheless, the analysis identified a direct effect of ASAD on the development of Panic Disorder, indicating that separation anxiety symptoms may act as a precursor or risk factor for the onset of panic attacks. This linear relationship highlights an avenue for early intervention targeting separation anxiety as a possible preventative strategy for subsequent panic pathology. Understanding this dynamic offers a paradigm shift in how treatment protocols might be prioritized or combined in clinical settings.
Beyond clinical implications, these findings prompt a reflection on the complexity underlying attachment theory in adult psychopathology. Attachment styles, often rooted in early caregiving experiences, influence emotional regulation and interpersonal functioning. However, this study suggests that while attachment insecurity and anxiety disorders co-occur, the pathway linking separation anxiety and panic may be mediated by different or additional neurobiological, cognitive, or environmental factors yet to be fully elucidated.
The use of validated self-report measures in this study ensures robust data; however, future research incorporating longitudinal designs and neuroimaging could offer deeper causal insights. Exploring the neurocircuitry shared by PD and ASAD, particularly in brain regions governing fear processing and emotional regulation such as the amygdala and prefrontal cortex, might illuminate shared pathways that attachment styles alone do not explain.
Furthermore, this research spotlights the vital importance of comprehensive mental health assessments that move beyond symptom checklists. Integrating evaluations of attachment alongside anxiety symptoms can help tailor psychotherapeutic approaches. For instance, treatments emphasizing emotion regulation and interpersonal effectiveness might still benefit PD patients with underlying insecure attachment, even if these styles do not mediate PD and ASAD comorbidity.
Given the clinical burden and often chronic trajectory of panic disorder, these results advocate for clinicians to maintain vigilance for separation anxiety symptoms in adult patients. Early detection and targeted cognitive-behavioral therapies specifically addressing separation fears may reduce the progression or severity of panic episodes and improve overall therapeutic outcomes.
This study also serves as a call to action for mental health professionals and researchers to reconceptualize how related disorders are linked. While attachment theory remains a cornerstone of developmental psychology, its role in adult anxiety disorders may be more complex and less direct than previously posited. Multidisciplinary approaches bridging psychological theory, neurobiology, and social context are essential to unravel these intricate relationships.
Ultimately, the research contributes a fresh perspective to the psychiatric literature, emphasizing that while attachment insecurities coexist with panic and separation anxiety disorders, they do not necessarily explain their interplay. The direct impact of ASAD on PD suggests a priority on addressing separation fears clinically to mitigate the progression of panic symptoms. Such insights not only enhance theoretical understanding but have the potential to refine therapeutic interventions and improve patient quality of life.
The study’s implications resonate beyond academia, touching on the lived experiences of millions grappling with anxiety disorders worldwide. By clarifying where attachment fits—or does not fit—within the pathology of PD and ASAD, this research empowers clinicians with greater precision in diagnosis and treatment planning. It simultaneously invites the wider scientific community to pursue novel investigative pathways into the multifactorial origins of anxiety.
Advancing our grasp on PD and ASAD comorbidity promises to transform mental health care, paving the way for more personalized medicine approaches. As researchers continue to untangle the complex dance of emotional bonds, fear responses, and psychological distress, such integrative studies chart a vital course toward more effective, evidence-based interventions for anxiety disorders of adulthood.
Subject of Research: The mediating effect of attachment on the relationship between Panic Disorder (PD) and Adult Separation Anxiety Disorder (ASAD).
Article Title: The mediating role of attachment in panic disorder and separation anxiety disorder
Article References:
Baltacioğlu, M., Çelik, F.H. & Puşuroğlu, M. The mediating role of attachment in panic disorder and separation anxiety disorder. BMC Psychiatry 25, 415 (2025). https://doi.org/10.1186/s12888-025-06852-x
Image Credits: AI Generated
