• depersonalization
• derealisation
• panic
• separation anxiety

Background: Depersonalization (DP) and derealisation (DR) are dissociative symptoms, that occur in many psychiatric pathologies. Several studies report a high prevalence of DP/DR in patient with Panic Disorder (PD), in which they seem to worsen the clinical course and prognosis. Separation Anxiety Disorder (SAD) is a psychiatric condition that generally begins in childhood and which, as reported for DP/DR, appears to have a negative impact on PD, causing more severe forms of it. In light of this, some researchers have hypothesized that there are similar mechanisms underlying anxiety and dissociation. An important etiological factor common to both conditions seems to be traumatic experiences especially in childhood, such as physical abuse, exposure to violence or poor parental care. In this framework, our aim is to analyze the possible associations between Separation Anxiety (SA) symptoms and DP/DR, in particular we would like to evaluate whether SA in subjects with PD can be a predictive factor triggering the onset of DP/DR and also to assess the common features of anxiety (paying attention to SA) and dissociation.
Methods: 91 outpatients (63 females and 28 males) diagnosed with PD in according to DSM 5 were recruited. We employed the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS) to select subjects with SA; moreover, we used the Structural Clinical Interview for Depersonalization/Derealisation Spectrum (SCI-DER), the Dissociative Experience Scale (DES) and the Cambridge Depersonalization Scale (CDS), in order to evaluate all possible aspects of the dissociative phenomena in patients with PD and also in those with PD and SA.
Results: Based on the SCI-PAS, the sample was divided into two group, one with PD only (31 patients) and the other with PD and SA (60 patients). With the Student's T-test it emerged that the group with SA had higher scores in all scales assessing dissociative symptoms. The most significant result was obtained with DES score. With the Pearson correlation analysis, we found a strong association between some items of the domain 1 of the PAS (Separation sensitivity) and the DER score, both for the total and for the domain 2 (Somatopsychic depersonalization). Similar findings were obtained also with the total of DES score. Considering Linear Regression, we found a positive correlation between domain 2 of SCI-PAS (panic-like symptoms) and the total of DER score, and also between domain 6 of SCI-PAS (agoraphobia) and the total of DES score. Finally, using Chi-Square Test, we found that the group with SA had significantly more females than the group without SA.
Conclusion: Our data demonstrate a significant correlation between SA and dissociative symptoms in patients with PD. In particular SA seems to be a predictive factor of the onset of DP/DR. In keeping with previous studies, we also detect a strong association between panic symptoms, including agoraphobia, and dissociative manifestations. Overall, our study supports the idea that anxiety manifestations, including SA, and DP/DR share similar underlying mechanisms, which are not yet fully understood.