Separation Anxiety and Dependent Personality

A number of personality disorders have parallel diagnoses in children.

By: THEODORE MILLON and

      Seth Grossman

      Carrie Millon

      Sarah Meagher

      Rowena Ramnath

Separation anxiety disorder, first introduced in DSM-III (1980) and elaborated in DSM-IV (1994), provides a diagnostic label for children who experience intense anxiety upon separation from home or from important attachment figures.

When separated from caretakers, many children become frightened, requiring frequent reassurance that they will eventually be reunited. Separation may lead to fearful fantasies that the caretaker or the child will suffer a horrible accident or illness and never return. Younger children may fear becoming lost, after which they never find their way home or see their parents again. In more extreme cases, they have nightmares, rarely leave their parents’ side, and may not be able to be left alone in a room without one parent present. Many of these children cannot stay overnight with a friend; they resist going to school or even being left with relatives.

Although separation anxiety reflects a pathology of attachment, theorists nevertheless distinguish between attachment and dependence (Ainsworth, 1969, 1972; Bowlby, 1973; Sears, 1972).

Attachment is generally regarded positively and refers to an exclusive relationship in which the individual seeks proximity to another individual who is usually stronger or wiser. This proximity increases feelings of security in the individual.

Dependency, on the other hand, refers to generalized behaviors that are not directed at any specific individual but designed to elicit assistance, guidance, or approval (Hirschfeld et al., 1977).

Current conceptualizations of dependent personality disorder appear to include components of both attachment and dependency. The sixth diagnostic criterion states, “Feels uncomfortable or helpless when alone”; the seventh, “urgently seeks another relationship . . . when a close relationship ends”; the eighth, “is unrealistically preoccupied with fears of being alone to take care of self.”

Livesley, Schroeder, and Jackson (1990) obtained two factors when studying the dependent personality criterion of the DSM-III-R. One had as its central feature lack of confidence or assurance about themselves and their abilities. People who scored high on this factor were probably “impressionable, dependent on advice and guidance from others, and prone to establish submissive relationships” (p. 138). The second factor was descriptive of insecure attachment and related to persons who are “unable to function independently, and that require the presence of attachment figures to feel secure” (p. 138).

Accordingly, persons could presumably be diagnosed as dependent personalities in two different ways, either suffering the effects of insecure attachment or lacking confidence and assurance in themselves. This duality may help explain the results of some research that shows that many adult patients who can be diagnosed as suffering from separation anxiety disorder do not suffer from dependent personality disorder (Manicavasagar, Silove, & Curtis, 1997). For example, some might have a secure attachment but no self-confidence. Others may have developed a level of self-confidence but nevertheless experience an insecure attachment. These are the individuals who are likely to have had separation anxiety concerns as children.

References

Personality Disorders in Modern Life, second edition, 2000, 2004 by John Wiley & Sons, Inc.

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