The Basics of Separation Anxiety Disorder in Adults

Separation Anxiety Disorder (SAD) is often associated with children, but it can also affect adults in significant and sometimes debilitating ways. Understanding this condition is essential for recognizing its symptoms and seeking appropriate help. Adult separation anxiety can significantly impact daily life, relationships, career functioning, and overall well-being. While many people assume separation anxiety is exclusively a childhood issue, research has revealed that this disorder is surprisingly common in adults and can emerge for the first time during adulthood.

What is Separation Anxiety Disorder in Adults?

Separation Anxiety Disorder in adults is characterized by excessive fear or anxiety about being apart from loved ones or significant attachments. Unlike typical worries about separation that most people experience occasionally, this condition involves intense distress that interferes with daily functioning and persists over extended periods.

One key difference between children and adults with separation anxiety involves the type of attachment figures. In children, attachment figures are usually adults such as parents, whereas adults experience anxiety due to actual or anticipated separation from children, spouses, or romantic partners. This distinction is important for understanding how the disorder manifests differently across the lifespan.

Affected adults experience intense fears that harm will befall close attachment figures, engaging in a range of strategies to maintain close contact with them. These strategies can range from excessive phone calls and text messages to avoiding situations that require separation, such as business trips or social events without their attachment figure present.

Recognition in the DSM-5

In the DSM-5, the diagnosis was extended to include adults first diagnosed with SAD in adulthood. This represented a significant shift from previous diagnostic manuals. Unlike other DSM-IV anxiety disorders, separation anxiety disorder had been considered a disorder that typically begins in childhood, and could be diagnosed only in adults “if onset is before 18.” The removal of this age restriction acknowledged the growing body of evidence showing that separation anxiety can begin in adulthood and is more prevalent than previously recognized.

Prevalence and Epidemiology

Adult separation anxiety disorder is far more common than many healthcare professionals and the general public realize. The National Comorbidity Study Replication was the first large-scale epidemiological study to include the diagnosis, revealing a lifetime prevalence of 6.6%. This means that approximately one in fifteen adults will experience separation anxiety disorder at some point in their lives.

Lifetime separation anxiety disorder prevalence averaged 4.8% across countries, with 43.1% of lifetime onsets occurring after age 18. This international data from the World Health Organization World Mental Health Surveys demonstrates that adult separation anxiety is a global phenomenon, not limited to specific cultures or regions.

Interestingly, approximately one-third (36.1%) of respondents classified as childhood cases persist into adulthood, while the majority (77.5%) of respondents classified as adult cases have first onsets in adulthood. This finding challenges the traditional view that adult separation anxiety is simply a continuation of childhood symptoms. Instead, it suggests that many adults develop separation anxiety for the first time in response to adult life circumstances and relationships.

Gender Differences

Lifetime prevalence was higher among women than men in 15 of the 18 countries and significantly so in the total sample (5.6% compared with 4.0%). This gender difference is consistent with patterns observed in other anxiety disorders and may reflect biological, psychological, and social factors that influence how men and women experience and report anxiety symptoms.

Clinical Settings

In clinical populations, the prevalence rates are even higher. When ASAD was identified, that category comprised 23% of all diagnoses made in an adult anxiety clinic. Between 20%-40% of adult patients with mood and anxiety disorders have been found to have symptoms of the disorder, and between one-third and one-half of these patients reported onsets after 18 years of age. Patients with adult separation anxiety disorder experience high levels of functional impairment and show a poor response to conventional treatments used for other anxiety subtypes.

Common Symptoms of Adult Separation Anxiety

The symptoms of adult separation anxiety disorder can manifest in various ways, affecting emotional, cognitive, behavioral, and physical domains. Understanding these symptoms is crucial for early identification and intervention.

Emotional and Cognitive Symptoms

Persistent worry about losing loved ones or them getting hurt
Fear of being alone or abandoned
Excessive concern that something catastrophic will happen to attachment figures
Preoccupation with scenarios involving separation
Intense distress when separation occurs or is anticipated
Difficulty concentrating when separated from attachment figures

Behavioral Symptoms

Reluctance or refusal to be apart from attachment figures
Avoidance of situations requiring separation, such as work travel or social events
Excessive checking behaviors (frequent calls, texts, or location tracking)
Reluctance to leave home without the attachment figure
Following the attachment figure from room to room
Difficulty making independent decisions without consulting the attachment figure

Nightmares involving separation themes
Difficulty sleeping without loved ones nearby
Insomnia when separated from attachment figures
Reluctance to sleep away from home

Physical Symptoms

Headaches when anticipating separation
Stomachaches or nausea related to separation
Rapid heartbeat or palpitations
Dizziness or lightheadedness
Muscle tension
Sweating or trembling

When physically separated, adults with SAD likely resort to calling, texting, or using other technological means to communicate with their attached figure. Often, the person suffering from SAD is perceived as having excessive demands and can be a source of frustration for family members or the caregiver, leading to further resentment and familial conflict, perpetuating the course of the condition.

Diagnostic Criteria

To receive a formal diagnosis of separation anxiety disorder, adults must meet specific criteria outlined in the DSM-5. The diagnosis requires developmentally inappropriate and excessive fear or anxiety concerning separation from attachment figures, as evidenced by at least three of eight specific symptoms.

Duration Requirements

The symptoms must last at least 4 weeks in children and adolescents but typically occur for 6 months or more in adults. This extended duration requirement for adults reflects the chronic nature of the disorder in adult populations and helps distinguish it from temporary adjustment reactions to life changes.

Functional Impairment

The disturbance causes clinically significant impairment in a major life function (ie, academic or occupational functions). This criterion ensures that the diagnosis is reserved for cases where the anxiety significantly interferes with daily life, rather than mild concerns that don’t substantially impact functioning.

Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. This highlights how the presence of other mental health conditions can compound the functional difficulties experienced by individuals with separation anxiety disorder.

Differential Diagnosis

The symptoms are not better explained by another psychiatric condition. Mental health professionals must carefully evaluate whether the separation anxiety is better accounted for by other disorders such as agoraphobia, generalized anxiety disorder, or psychotic disorders. This differential diagnosis process is essential for ensuring appropriate treatment.

Causes and Risk Factors

The development of adult separation anxiety disorder is multifactorial, involving a complex interplay of genetic, environmental, psychological, and social factors. Understanding these risk factors can help identify individuals who may be more vulnerable to developing the disorder.

Childhood Experiences

Early life experiences play a significant role in the development of adult separation anxiety. Childhood trauma, loss of a parent or caregiver, prolonged separations during critical developmental periods, or having experienced childhood separation anxiety disorder can all increase vulnerability to adult separation anxiety.

Consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

Genetic and Familial Factors

Research on putative risk factors is limited to childhood SAD: SAD runs in families, albeit patterns of familial aggregation and heritability estimates indicate low specificity. This suggests that while there is a genetic component to separation anxiety disorder, it is not highly specific, and environmental factors play an important role in whether the disorder develops.

History of anxiety or other mental health disorders
Family history of anxiety disorders
Parental anxiety or overprotective parenting styles
Genetic predisposition to anxiety sensitivity

Life Stressors and Transitions

Stressful life changes can trigger or worsen symptoms of separation anxiety in adults. These may include:

Divorce or relationship breakup
Death of a loved one or significant loss
Moving to a new environment or relocating
Major illness in oneself or a loved one
Birth of a child or children leaving home
Job changes or retirement
High levels of stress in personal or professional life

Personality Characteristics

Adults with separation anxiety disorder have higher levels of neuroticism compared to other anxiety disorder patients. Personality traits such as behavioral inhibition, harm avoidance, and low self-directedness have been associated with increased risk for developing separation anxiety disorder.

Attachment Patterns

Insecure attachment styles, particularly anxious attachment, are closely linked to separation anxiety in adults. Individuals who developed insecure attachment patterns in childhood may be more prone to experiencing excessive anxiety about separation from romantic partners or other significant figures in adulthood.

Comorbidity and Associated Conditions

Adult separation anxiety disorder rarely occurs in isolation. SAD in adulthood is prevalent, often comorbid and debilitating. Understanding the common comorbid conditions is important for comprehensive assessment and treatment planning.

Common Comorbid Disorders

Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. This bidirectional relationship suggests that separation anxiety can both lead to and result from other mental health conditions.

Panic Disorder: There is a particularly strong association between separation anxiety disorder and panic disorder, with some researchers suggesting that panic attacks may be secondary to separation anxiety in some cases
Generalized Anxiety Disorder: Excessive worry about multiple domains often co-occurs with separation-specific anxiety
Social Anxiety Disorder: Fear of social situations may overlap with concerns about being separated from safe attachment figures
Specific Phobias: Particular fears may develop related to situations involving separation
Major Depressive Disorder: Depression commonly co-occurs with separation anxiety, potentially developing as a consequence of the chronic stress and functional impairment
Agoraphobia: Fear of situations where escape might be difficult can overlap with separation concerns

Impact on Relationships

Adult separation anxiety can significantly strain romantic relationships, friendships, and family dynamics. Partners may feel suffocated by the constant need for contact and reassurance, while the individual with separation anxiety may feel misunderstood and unsupported. This can create a cycle of increasing anxiety and relationship conflict.

Diagnosis and Assessment

Accurate diagnosis of adult separation anxiety disorder requires a comprehensive evaluation by a qualified mental health professional. The assessment process involves multiple components to ensure an accurate diagnosis and rule out other conditions.

Clinical Interview

A thorough clinical interview forms the foundation of the diagnostic process. The mental health professional will evaluate symptoms, personal and family history, onset and duration of symptoms, and the impact on daily life and functioning. When interviewing an adult with potential SAD, understanding who the adult patient has difficulty separating from is a good starting point. If the patient has difficulty separating from a romantic partner, obtaining a history of the patient’s dating history can be revealing.

Standardized Assessment Tools

Several validated assessment instruments can aid in the diagnosis and severity assessment of adult separation anxiety:

Adult Separation Anxiety Symptom Questionnaire (ASA-27): A self-report measure specifically designed to assess separation anxiety symptoms in adults
Severity Measure for Separation Anxiety Disorder—Adult: A 10-item measure that assesses symptom severity on a scale from none to extreme
Structured Clinical Interview for DSM-5 (SCID-5): A comprehensive diagnostic interview that includes assessment of separation anxiety disorder
Adult Separation Anxiety Semistructured Interview (ASA-SI): A specialized interview tool for assessing adult separation anxiety

The Severity Measure for Separation Anxiety Disorder—Adult is a 10-item measure that assesses the severity of symptoms of separation anxiety disorder in individuals age 18 and older. The measure was designed to be completed by an individual upon receiving a diagnosis of separation anxiety disorder and thereafter, prior to follow-up visits with the clinician. Each item asks the individual to rate the severity of his or her separation anxiety disorder during the past 7 days.

Comprehensive Evaluation

A complete diagnostic evaluation should also include:

Assessment of comorbid mental health conditions
Medical history to rule out physical health conditions that may contribute to anxiety symptoms
Evaluation of substance use, as some individuals may use alcohol or drugs to cope with separation anxiety
Assessment of functional impairment in work, relationships, and daily activities
Evaluation of suicide risk, particularly if depression is present

Treatment Options

Effective treatment for adult separation anxiety disorder typically involves a combination of psychotherapy, medication, and self-management strategies. The specific treatment plan should be tailored to the individual’s symptoms, severity, comorbid conditions, and personal preferences.

Psychotherapy

Psychotherapy is considered a first-line treatment for separation anxiety disorder in adults. Several therapeutic approaches have shown effectiveness:

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy is one of the most well-researched and effective treatments for separation anxiety disorder. CBT helps individuals identify and challenge negative thought patterns related to separation, such as catastrophic thinking about harm befalling loved ones or beliefs about inability to cope alone.

Key components of CBT for separation anxiety include:

Identifying automatic thoughts and cognitive distortions related to separation
Challenging and restructuring maladaptive beliefs
Developing more balanced and realistic thinking patterns
Learning to tolerate uncertainty about the safety of attachment figures
Building confidence in one’s ability to function independently

Exposure Therapy

Exposure therapy involves gradually confronting feared situations related to separation in a controlled and systematic way. This approach helps reduce anxiety through a process called habituation, where repeated exposure to the feared situation leads to decreased anxiety over time.

Exposure therapy for separation anxiety might include:

Creating a hierarchy of separation situations from least to most anxiety-provoking
Gradually practicing separations of increasing duration and distance
Reducing safety behaviors and excessive checking
Learning that feared outcomes rarely occur and that anxiety naturally decreases
Building tolerance for the discomfort of separation

Other Therapeutic Approaches

Acceptance and Commitment Therapy (ACT): Helps individuals accept anxiety as a normal human experience while committing to valued actions despite discomfort
Psychodynamic Therapy: Explores unconscious conflicts and early attachment experiences that may contribute to separation anxiety
Couples or Family Therapy: Addresses relationship dynamics that may maintain or exacerbate separation anxiety
Support Groups: Provide shared experiences, validation, and coping strategies from others dealing with similar challenges

Medications

Medication can be an important component of treatment, particularly for moderate to severe separation anxiety or when comorbid conditions are present. Medications are typically most effective when combined with psychotherapy.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most commonly prescribed medications for separation anxiety disorder in adults. These medications work by increasing serotonin levels in the brain, which can help reduce anxiety symptoms. Common SSRIs include:

Sertraline (Zoloft)
Fluoxetine (Prozac)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Citalopram (Celexa)

SSRIs typically take several weeks to reach full effectiveness and should be taken consistently as prescribed. Side effects are generally mild and often diminish over time.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs are another class of antidepressants that can be effective for anxiety disorders, including:

Venlafaxine (Effexor)
Duloxetine (Cymbalta)

Anti-Anxiety Medications

Benzodiazepines may be prescribed for short-term relief of severe anxiety symptoms, but they are generally not recommended for long-term use due to the risk of dependence and tolerance. These medications include:

Alprazolam (Xanax)
Lorazepam (Ativan)
Clonazepam (Klonopin)

Buspirone is a non-benzodiazepine anti-anxiety medication that may be used for some individuals with separation anxiety.

Medication Considerations

Important factors to consider regarding medication treatment include:

Medications should be prescribed and monitored by a qualified healthcare provider
Regular follow-up appointments are essential to assess effectiveness and side effects
Medication should not be stopped abruptly without medical supervision
The decision to use medication should consider severity of symptoms, functional impairment, comorbid conditions, and individual preferences
Medication is most effective when combined with psychotherapy

Managing Separation Anxiety in Daily Life

In addition to professional treatment, adults with separation anxiety can adopt various self-management strategies to reduce symptoms and improve quality of life. These techniques can complement formal treatment and provide ongoing support.

Establishing Healthy Routines

Maintaining consistent daily routines can provide structure and predictability, which can help reduce anxiety. This includes:

Regular sleep schedule with good sleep hygiene practices
Consistent meal times and balanced nutrition
Regular exercise and physical activity
Scheduled time for relaxation and self-care
Predictable check-in times with attachment figures rather than constant contact

Relaxation and Mindfulness Techniques

Learning and practicing relaxation techniques can help manage anxiety symptoms when they arise:

Deep Breathing Exercises: Slow, diaphragmatic breathing activates the body’s relaxation response
Progressive Muscle Relaxation: Systematically tensing and releasing muscle groups to reduce physical tension
Mindfulness Meditation: Focusing attention on the present moment without judgment
Guided Imagery: Using mental visualization to promote relaxation and calm
Yoga or Tai Chi: Mind-body practices that combine movement, breathing, and meditation

Building a Support Network

Developing a strong support system beyond primary attachment figures is crucial:

Cultivate multiple meaningful relationships rather than relying solely on one person
Join support groups for individuals with anxiety disorders
Maintain connections with friends, family members, and community
Consider peer support programs or online communities
Engage in social activities and hobbies that provide connection and purpose

Communication Strategies

Open communication with loved ones about feelings and needs can alleviate anxiety and improve relationships:

Explain your separation anxiety to attachment figures so they understand your experience
Discuss reasonable accommodations and boundaries
Express needs clearly without demanding constant reassurance
Work together to develop separation plans that feel manageable
Practice assertive communication rather than anxious or demanding communication

Gradual Independence Building

Systematically increasing independence can build confidence and reduce anxiety:

Start with brief separations and gradually increase duration
Practice being alone for short periods and engaging in enjoyable activities
Develop skills and competencies that increase self-reliance
Challenge yourself to try new activities independently
Celebrate successes and progress, no matter how small

Lifestyle Modifications

Certain lifestyle changes can support overall mental health and reduce anxiety:

Limit caffeine and stimulants that can increase anxiety
Avoid excessive alcohol use as a coping mechanism
Maintain regular physical exercise, which has proven anti-anxiety effects
Ensure adequate sleep, as sleep deprivation worsens anxiety
Engage in activities that provide meaning and purpose
Practice stress management techniques regularly, not just during crises

Impact on Work and Career

Adult separation anxiety can significantly affect professional life and career development. Understanding these impacts and developing strategies to manage them is important for maintaining employment and achieving career goals.

Common Workplace Challenges

Difficulty with business travel or assignments requiring time away from home
Reduced productivity due to preoccupation with attachment figures
Excessive personal phone calls or texts during work hours
Reluctance to accept promotions or opportunities that require relocation
Difficulty concentrating when separated from loved ones
Absenteeism related to anxiety symptoms or avoidance of separation

Workplace Accommodations

Some individuals with severe separation anxiety may benefit from workplace accommodations under disability laws:

Flexible work arrangements or remote work options when appropriate
Modified travel requirements
Adjusted work schedules to accommodate therapy appointments
Private space for managing anxiety symptoms
Clear communication with supervisors about needs and limitations

Separation Anxiety in Specific Adult Populations

New Parents

The transition to parenthood can trigger or exacerbate separation anxiety, with parents experiencing intense fear about being separated from their infant or concerns about the baby’s safety. While some level of protective concern is normal and adaptive, excessive anxiety that interferes with functioning may indicate separation anxiety disorder.

Empty Nesters

When children leave home for college or independent living, some parents experience significant separation anxiety. This can manifest as excessive worry about the child’s wellbeing, difficulty adjusting to the change, or depression related to the separation.

Older Adults

Separation anxiety in older adults may relate to concerns about being separated from adult children, spouses, or caregivers. Health concerns, cognitive changes, and increased dependency can contribute to separation fears in this population.

Military Families

Deployment and frequent relocations can trigger or worsen separation anxiety in military service members and their families. The real dangers associated with deployment can make it particularly challenging to distinguish between realistic concern and excessive anxiety.

Cultural Considerations

Cultural factors influence how separation anxiety is experienced, expressed, and perceived. What may be considered excessive dependence in individualistic cultures might be viewed as appropriate interdependence in collectivistic cultures. Mental health professionals must consider cultural context when assessing and treating separation anxiety.

Cultural factors to consider include:

Cultural norms regarding family closeness and independence
Expectations about adult children living with or near parents
Cultural attitudes toward mental health treatment
Language and communication styles
Religious or spiritual beliefs about family relationships
Immigration experiences and separation from family of origin

Prognosis and Long-Term Outlook

With appropriate treatment and support, the prognosis for adult separation anxiety disorder is generally positive. Many individuals experience significant symptom reduction and improved functioning with evidence-based treatment.

Factors Affecting Prognosis

Early intervention and treatment engagement
Severity of symptoms at presentation
Presence and severity of comorbid conditions
Quality of social support and relationships
Adherence to treatment recommendations
Availability of ongoing mental health care
Life stressors and stability

Relapse Prevention

Even after successful treatment, maintaining gains and preventing relapse is important:

Continue practicing coping skills learned in therapy
Maintain healthy lifestyle habits and self-care routines
Stay connected with support systems
Monitor for early warning signs of symptom return
Seek booster therapy sessions if symptoms begin to return
Continue medication as prescribed if applicable
Address new stressors or life changes proactively

When to Seek Professional Help

Seeking professional help is crucial if separation anxiety causes significant distress or impairment. Warning signs that professional intervention is needed include:

Anxiety that interferes with work, relationships, or daily activities
Inability to function when separated from attachment figures
Physical symptoms that are severe or persistent
Avoidance of important activities due to separation fears
Relationship problems caused by excessive dependence or reassurance-seeking
Depression or thoughts of self-harm
Substance use to cope with anxiety
Symptoms that persist despite self-help efforts

Finding the Right Provider

When seeking treatment for adult separation anxiety disorder, consider:

Look for mental health professionals with experience treating anxiety disorders
Ask about specific training in evidence-based treatments like CBT
Consider whether individual, couples, or family therapy would be most beneficial
Verify insurance coverage and costs
Ensure the provider’s approach and style feel like a good fit
Don’t hesitate to seek a second opinion if needed

Resources and Support

Numerous resources are available for individuals dealing with adult separation anxiety disorder and their loved ones:

Professional Organizations

Anxiety and Depression Association of America (ADAA): Provides education, resources, and a therapist directory at https://adaa.org
American Psychological Association (APA): Offers information about anxiety disorders and psychologist locator services at https://www.apa.org
National Institute of Mental Health (NIMH): Provides research-based information about anxiety disorders at https://www.nimh.nih.gov

Crisis Resources

National Suicide Prevention Lifeline: 988 (call or text) for 24/7 crisis support
Crisis Text Line: Text HOME to 741741 for free, 24/7 crisis counseling
SAMHSA National Helpline: 1-800-662-4357 for mental health and substance use treatment referrals

Online Resources and Apps

Mental health apps for anxiety management and mindfulness
Online support communities and forums
Teletherapy platforms for remote access to mental health care
Educational websites with information about anxiety disorders
Self-help workbooks and guided programs

Supporting a Loved One with Separation Anxiety

If someone you care about struggles with separation anxiety disorder, your support can make a significant difference in their recovery:

Do’s

Educate yourself about separation anxiety disorder
Listen without judgment and validate their feelings
Encourage professional treatment and offer to help find resources
Be patient with the recovery process
Support gradual exposure to separation rather than forcing sudden changes
Maintain your own boundaries and self-care
Celebrate progress and improvements
Communicate openly about needs and concerns

Don’ts

Don’t enable avoidance behaviors or excessive reassurance-seeking
Don’t dismiss or minimize their anxiety
Don’t take their anxiety personally or as a reflection of your relationship
Don’t sacrifice your own wellbeing to accommodate their anxiety
Don’t expect immediate change or quick fixes
Don’t participate in excessive checking or safety behaviors
Don’t make major decisions based solely on their anxiety

Conclusion

Adult separation anxiety disorder is a legitimate and often debilitating mental health condition that affects millions of people worldwide. Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

Recognition of adult separation anxiety disorder has grown significantly in recent years, leading to improved diagnostic criteria, better understanding of the condition, and more effective treatments. The removal of the childhood-onset requirement in the DSM-5 has validated the experiences of many adults who develop separation anxiety for the first time in adulthood.

With proper treatment and support, adults with separation anxiety disorder can lead fulfilling lives despite their fears. Evidence-based treatments, particularly cognitive-behavioral therapy and exposure therapy, have demonstrated effectiveness in reducing symptoms and improving functioning. Medication can provide additional support, especially when combined with psychotherapy.

Self-management strategies, including relaxation techniques, gradual independence building, and maintaining healthy routines, complement professional treatment and support long-term recovery. Building a strong support network and communicating openly with loved ones about the condition can alleviate anxiety and strengthen relationships.

If you or someone you know is struggling with excessive anxiety about separation from loved ones, remember that help is available and recovery is possible. Don’t hesitate to reach out to a mental health professional for evaluation and treatment. Early intervention can prevent the condition from worsening and improve quality of life significantly.

Understanding that separation anxiety is not a sign of weakness but rather a treatable mental health condition is the first step toward recovery. With appropriate support, treatment, and self-compassion, individuals with adult separation anxiety disorder can develop healthier attachment patterns, build confidence in their ability to function independently, and maintain meaningful relationships without excessive fear or distress.

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