Childhood trauma, post-traumatic stress disorder, and age at onset in adult separation anxiety disorder: a cross-sectional outpatient study

BACKGROUND: Adult separation anxiety disorder (ASAD) can persist from childhood or first emerge in adulthood, but the relationships of reported age at onset with childhood trauma and post-traumatic stress disorder (PTSD) remain unclear. OBJECTIVE: We compared adults with ASAD and comparison participants and examined trauma-related correlates of ASAD severity and differences between child-onset and adult-onset groups. METHOD: This cross-sectional outpatient study included 120 adults with ASAD and 110 selected hospital-based comparison participants. ASAD was diagnosed using the Structured Clinical Interview for Separation Anxiety Symptoms; relevant SCID-5 components assessed traumatic experiences and PTSD. Participants completed the Adult Separation Anxiety Questionnaire (ASAQ), Childhood Trauma Questionnaire (CTQ), and Hospital Anxiety and Depression Scale (HADS). Analyses included group comparisons and hierarchical linear regression with Benjamini-Hochberg correction for multiple testing. The association persisted in sensitivity analyses, although model checks suggested possible nonlinearity. CONCLUSIONS: ASAD was associated with greater childhood trauma and affective symptom burden, and childhood trauma remained associated with separation anxiety severity after adjustment for measured covariates. The numerical PTSD pattern remains descriptive and requires replication; it does not establish distinct clinical profiles or developmental pathways.