Most grow out of it, but not all. Classic movie examples might include "Casablanca" where Ilsa (Ingrid Bergman) clings to Rick (Humphrey Bogart) shortly before they part forever and even the frighteningly bizarre Hollywood thriller "Psycho" where Norman Bates (Anthony Perkins) sleeps next to his mother long after she has died.

But, adult separation anxiety can persist from childhood into adulthood or even begin in adulthood. According to an article in the January 7, 2007, issue of the Harvard Mental Health Letter, one national survey found that 2 percent of the American adult population had suffered from separation anxiety in the previous year. The survey's researchers estimated that in a third of these cases, childhood separation anxiety persisted into adulthood, while others had late onset, appearing first in late teens or early 20s and often much later adulthood.

An earlier study (part of a national comorbidity study) conducted by professor of psychiatry at Columbia University, Katherine Shear, M.D., and published in "Psychiatric News" 2005 found that approximately 7 percent of adult Americans had suffered from separation anxiety at least once in their lives, an even greater prevalence rate than that of childhood separation anxiety disorder, which is estimated by the statistics published by the Office of the Surgeon General to be 4 percent.

Adolescents and adults with separation anxiety may worry about leaving someone close or going away on a trip. They may be anxious when unable to speak regularly to someone on the telephone with whom they feel close. They may feel extremely anxious about events that might separate them from people close to them, have nightmares about being away from home, find it difficult to sleep alone and develop other psychological and physical symptoms that overlap with other mood and anxiety disorders, especially panic disorder. By and large, symptoms mirror those found in childhood separation anxiety disorder disclosed in the first article of this series.

Traumatic or complicated grief may also be related to separation anxiety. Symptoms may include obsessive yearning after the person no longer with you, imagining of feeling his or her presence, ruminating about the events surrounding the loss and blaming oneself or others for the loss. A person who has always been anxious about parting is at increased risk for traumatic or complicated grief.

 The most widely used treatments for separation anxiety disorder are behavioral and cognitive therapies. Exposure therapy gradually accommodates the adult or child to increased distance from significant others or parents. Cognitive therapy teaches both how to identify and then how to resist unrealistic fears by restructuring them into a more assertive and adaptive framework. Relaxation training helps with physical symptoms and, finally, contingency management - rewards, praise and occasionally loss of privileges - sometimes proves effective (for adults as well as children).

Parents and/or significant others can be educated about the problem and trained in how to facilitate a loved one's recovery from overwhelming fears. If family troubles are one source of the anxiety or serve unwittingly to reinforce fears or the adult or child is emulating an anxious significant other or parent, joint family therapy may be helpful. Studies have found that individual and group cognitive behavioral therapies are effective as is added family involvement.

No drugs are approved for separation anxiety in children. Selective serotonin reuptake inhibitors (Prozac and its cousins), the standard drug treatment for adult anxiety disorder, may be helpful, but little is known about the long-term risks and benefits in children. Physicians may be reluctant to prescribe antidepressant or anti-anxiety medication for children because of concerns about the potential for increased suicidal ideation and behavior.

Pharmacological therapies should be considered for use in an adjunct manner when the level of functional impairment is severe. For a child with severe separation anxiety and/or depression, conservative and closely monitored use of a prescribed medication by a licensed medical professional may be helpful.

Peggy Nolen is a licensed professional counselor in Covington. She specializes in recovery from traumatic experience, depression, anxiety and problems with drugs and alcohol. She can be reached at (770) 314-5924.