Please Don’t Leave Me—Separation Anxiety and Related Traits in Borderline Personality Disorder

Abstract

Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.

Genetic and Environmental Causes of Individual Differences in Borderline Personality Disorder Features and Loneliness are Partially Shared

“…This sensation of chronic emptiness and fear of abandonment may specifically contribute to loneliness for those with BPD (Lieb et al, 2004). Although loneliness and an intolerance of aloneness (Matthies et al, 2018) are prevalent in those with BPD, in a maladaptive manner, it may actually lead to the avoidance of others (vs. affiliation with others). For example, Hauschild et al (2018) found that the loneliness drive to affiliate with others is actually reversed in people with BPD.…”

Level of Structural Integration and Its Association with Intersession Experiences and Outcomes: A Pilot Study

“…This problem is also closely linked to deficient object constancy in patients with borderline personality disorder. Object constancy is the ability to maintain an emotional bond with other individuals even when they are not physically present, an ability that is limited in patients with borderline personality disorder [ 54 , 55 , 56 ]. These patients may need to complete substantial mental homework and think about therapy or the therapist, since the objects of therapy and therapist are not internally represented.…”

Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence

“…Increasing recognition is important because of overlapping symptomatology with separation anxiety disorder (separation AD) and generalized anxiety disorder (GAD). Although these anxiety disorders have been associated with insecure attachment [ 133 , 134 ], less is clear about how disturbed attachment may lead to different types of anxiety disorders. Separation AD may be seen as a disorder in which attachment developed more problematic than in SAD, and thus addresses more basic fears (of ‘being left alone and unable to survive’).…”