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ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1565217
Relationships between depersonalization-derealization symptoms and separation anxiety in adult patients with mood and anxiety disorders
Provisionally accepted
Stefano Pini 1
Benedetta Nardi 1*
Barbara Carpita 1
Giada Lorenzi 1 Marco Mula 2
Barbara Milrod 3 Gabriele Massimetti 1
Ivan Mirko Mirko Cremone 1 Chiara Bonelli 1
Katharina Domschke 4
Miriam A. Schiele 4 Liliana Dell'Osso 1 David Baldwin 5- 1 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Tuscany, Italy
- 2 St George’s University Hospitals NHS Foundation Trust, London, England, United Kingdom
- 3 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
- 4 Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
- 5 Department of Psychiatry, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, United Kingdom
Aims: To establish the relationship between depersonalization/derealization symptoms (DPs), as assessed by different standardized DP scales, and separation anxiety in a sample of outpatients with anxiety and mood disorders as a primary diagnosis (n=156). We hypothesized that patients with high levels of separation anxiety had more frequent, severe, and clinically relevant DP symptoms than those with low levels of separation anxiety. Methods: A consecutive sample of 156 outpatients with mood and anxiety disorders was evaluated by the Structured Clinical Interview for Derealization/Depersonalization Spectrum (SCI-DER), the Cambridge Depersonalization Scale (CDS), the Body Sensation Questionnaire (BSQ), the Dissociative Experience Scale (DES), the Panic/Agoraphobic Questionnaire-self report (PAS-SR) for the evaluation of separation anxiety. Results: The sample was dichotomized into a group with high levels of separation anxiety (3 or more DSM-IV diagnostic items endorsed) vs. those with low levels of separation anxiety (less than 3 items endorsed) by PAS-SR ‘Separation Anxiety’ domain scoring. Patients with high separation anxiety scored significantly higher in all DPs scales compared to the low-separation anxiety group. Derealization was significantly correlated with suicidal ideation (p<.001) and overall suicidality (p<.01). Auto-psychic depersonalization, intended as the feeling unfamiliarity of the self in terms of sensation of being an outside observer of one’s mental process, appeared to exert a significant effect on both suicidality (p<.01) and depression (p<.01). Conclusions: Our findings highlight a link between separation anxiety and DP symptoms. This connection contributes to understanding and evaluating suicidality in individuals with mood and anxiety disorders.
Keywords: Separation anxiety, Adult separation anxiety, Depersonalization, derealization, Suicidality, dissociative symptoms
Received: 22 Jan 2025; Accepted: 03 Apr 2025.
Copyright: © 2025 Pini, Nardi, Carpita, Lorenzi, Mula, Milrod, Massimetti, Cremone, Bonelli, Domschke, Schiele, Dell'Osso and Baldwin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Benedetta Nardi, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Tuscany, Italy
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