INTRODUCTION Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psychotherapy (IPT) for veterans with PTSD assessed these SAD domains. METHODS Twenty-nine veterans diagnosed with chronic PTSD on the Clinician-Administered PTSD Scale were assessed for SAD using the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and for Symptom-Specific Reflective Function (SSRF), another dysregulated-attachment marker capturing patients' emotional understanding of their symptoms. Patients received 14 IPT sessions for PTSD with assessments at baseline, Week 4 (SCI-SAS and SSRF), and termination for SAD, PTSD, and depression. RESULTS At baseline, 69% of patients met SAD criteria. Separation anxiety did not correlate with baseline PTSD severity, depressive severity, or age when traumatized; patients with and without SAD had comparable PTSD and depression severity. Patients with baseline comorbid SAD who completed IPT (N = 17) reported significantly improved adult separation anxiety (p = .009). Adult SAD improvements predicted depressive improvement (p = .049). Patients with SAD showed a stronger relationship between early SSRF gains and subsequent adult SAD improvement (p = .021) compared with patients without SAD. DISCUSSION This first exploration of dysregulated/insecure attachment features among patients with PTSD found high SAD comorbidity and adult SAD improvement among patients with SAD following IPT. Highly impaired attachment patients normalized attachment posttreatment: 14-session IPT improved attachment dysregulation. This small study requires replication but begins to broaden clinical understanding of separation anxiety, attachment dysregulation, and PTSD.

中文翻译：

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PTSD 中的分离焦虑：接受 IPT 的患者机制的初步研究。

引言 分离焦虑症 (SAD) 包括依恋失调或不安全感的一方面。尽管 SAD 会加重创伤后应激障碍 (PTSD) 风险，但尚无临床研究追踪有多少 PTSD 患者患有 SAD、其临床关联或其对 PTSD 治疗的反应。我们对患有 PTSD 的退伍军人进行的人际心理治疗 (IPT) 公开试验评估了这些 SAD 领域。方法 使用分离焦虑症状结构化临床访谈 (SCI-SAS) 对 29 名根据临床医生管理的 PTSD 量表诊断为慢性 PTSD 的退伍军人进行 SAD 评估，并评估症状特异性反射功能 (SSRF)（另一种失调的依恋）标记捕获患者对其症状的情感理解。患者接受了 14 次针对 PTSD 的 IPT 疗程，并在基线、第 4 周（SCI-SAS 和 SSRF）以及终止时对 SAD、PTSD 和抑郁进行评估。结果 在基线时，69% 的患者符合 SAD 标准。分离焦虑与基线 PTSD 严重程度、抑郁严重程度或受创伤时的年龄无关；患有和不患有 SAD 的患者的 PTSD 和抑郁严重程度相当。完成 IPT 的基线共病 SAD 患者 (N = 17) 报告成人分离焦虑显着改善 (p = .009)。成人 SAD 的改善预示着抑郁症的改善 (p = .049)。与没有 SAD 的患者相比，SAD 患者的早期 SSRF 增益与随后的成人 SAD 改善之间存在更强的关系 (p = .021)。讨论 对 PTSD 患者失调/不安全依恋特征的首次探索发现，IPT 后 SAD 患者的 SAD 合并症较高，且成人 SAD 有所改善。依恋高度受损的患者在治疗后依恋正常化：14 次 IPT 改善了依恋失调。这项小型研究需要重复，但开始拓宽对分离焦虑、依恋失调和创伤后应激障碍 (PTSD) 的临床理解。