Separation Anxiety: The Core of Attachment and Separation-Individuation

ABSTRACT

This paper, written in honor of Anni Bergman, focuses on the concept of separation anxiety as it was conceptualized and developed in attachment theory by Bowlby and in separation-individuation theory by Mahler and colleagues. The focus is on how separation anxiety manifests differentially in individuals with secure versus insecure attachment and in different subphases of the separation-individuation process, with emphasis on the areas of overlap and divergence in the two traditions. The paper then reviews recent research that has focused on how separation anxiety has provided a transdiagnostic risk factor for psychopathology, including anxiety, depression, and PTSD, complicating the treatment course of individuals with these disorders. These findings have contributed to the delineation of the DSM-5 diagnosis of Separation Anxiety Disorder (SAD) and to the development of new assessment instruments to measure it. We consider how separation anxiety has been assessed in several treatment studies of these disorders and how it is related to other factors such as insecure attachment and reflective function (RF, mentalization in attachment relationships). The ways in which recent research on separation anxiety in individuals with psychopathology, including depression and PTSD, has affirmed and expanded the original formulations of Bowlby and Bergman and her colleagues is also discussed.

KEYWORDS:

• Separation anxiety
• attachment
• development
• psychopathology

Acknowledgement

We are grateful to the following people whose intellectual acumen and generous support helped to bring this manuscript to fruition. Drs. Wendy Olesker, Barbara Milrod, William Singletary, Mark Blechner, and Adrienne Harris.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. While in line with the theoreticians central to this paper (Bergman, Mahler, and Bowlby) we are using the term mother throughout this article, the majority of these references to maternal figures could also apply to any bonded, primary caregiver of an infant.

2. It should be noted while the evidence for the continuity between infant and adult attachment status is somewhat questionable, with stability of attachment dependent on consistency of the environment and particularly consistency noted under situations of repeated trauma or disruption, nonetheless the evidence for the transgenerational transmission of attachment patterns is robust (Main, Kaplan, and Cassidy 1985; Steele and Steele 2008).

Additional information

Notes on contributors

Diana Diamond

Diana Diamond, PhD, is Professor Emerita in the Doctoral Program in Clinical Psychology at the City University of New York and Senior Fellow at the Personality Disorders Institute at Weill Cornell Medical College where she helped to develop Transference Focused Psychotherapy for patients with personality disorders. She is also on the faculty of the New York Psychoanalytic Society and Institute and the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis where she did her psychoanalytic training. She is the co-author or co-editor of four books, most recently Treating Pathological Narcissism with Transference Focused Psychotherapy (Guilford Press, 2022). She has lectured and published widely in the areas of personality disorders, attachment and mentalization, gender and sexuality, and the application of psychoanalytic concepts to understanding narrative and symbolism in cinema. She is the recipient of several awards, including most recently the Aaron Stern distinguished visiting professor award from Weill Cornell Medical College for her contributions to understanding the etiology and treatment of narcissistic pathology. She is an honorary member of the American Psychoanalytic Association and heads their research committee for the Department of Psychoanalytic Education (DPE). Dr. Diamond currently teaches, lectures, and supervises TFP nationally and internationally, and is in private practice of psychoanalytic psychotherapy and psychoanalysis in New York City and Sag Harbor, NY.

John R. Keefe

John R. Keefe (“Jack”), PhD, is an Assistant Professor of Psychology at Long Island University-Brooklyn and a clinical faculty member at the Albert Einstein College of Medicine in the Bronx, NY. Dr. Keefe is an early career psychotherapist and researcher focusing on psychodynamic outcome and process research, especially in anxiety and PTSD. A former NIH-National Center for Advancing Translational Science fellow, Dr. Keefe has won several accolades, including the American Psychoanalytic Association Scientific Paper Prize, the International Society of Transference Focused Psychotherapy award for Best Scientific Presentation, and the Teacher of the Year Award in clinical psychology training at New York Presbyterian-Weill Cornell’s Department of Psychiatry.