Is "Fear of Abandonment" Pathological?

Fear of Abandonment

People will describe themselves as having “abandonment issues,” which may include “fear of abandonment,” “emotional abandonment,” “primal abandonment fear,” and “abandonment” that creates traumatic stress.

What are we to make of these “abandonment issues”?

How People and Professionals Think About Abandonment Issues

“Abandonment issues” is an informal term that covers a range of experiences. “Fear of abandonment” (FOA) can occur because of a variety of interpersonal encounters: a romantic rejection, the ending of a friendship, not being included in a group, being estranged from a family member, or being ignored in casual encounters. These “rejections” are thought to engender a “fear of abandonment.”

A quick visit to Google suggests we view “abandonment issues” as a diagnosable and treatable syndrome. Here are a few titles I found:

• Abandonment Issues: Signs and Symptoms
• Fear of Abandonment as an “Autophobia”
• FOA: Overview, Symptoms, and Treatment
• FOA: Issues and Therapy Treatment

Clinicians diagnose “fear of abandonment” and “emotional abandonment” as separation anxiety, post-traumatic stress disorder, and/or borderline personality disorder. And clinicians offer a range of therapeutic interventions such as cognitive processing therapy, emotion-focused therapy, dialectical behavior therapy, and acceptance and commitment therapy.

Sorting Out “Abandonment Issues”

What does adult “abandonment” look like? To abandon someone is defined as voluntarily leaving a person, forever, to whom one is bound by a special relationship, such as a wife, husband, or child.

Do events such as a lover ending a relationship, ending a friendship, being estranged from a family member, and being excluded from casual encounters qualify as abandonment? It seems that we have enlarged the concept of abandonment to include almost any negative experience in our interaction with others. What is going on?

This may be an example of what psychologist Nick Haslam, Professor of Psychology at the University of Melbourne in Australia, identifies as “concept creep.^{” 1} He noted that concepts that refer to the negative aspects of human experience and behavior have come to include a much broader range of phenomena. This “concept creep” includes qualitatively new experiences along with less extreme experiences.

Is the concept of “abandonment” experiencing such “concept creep,” which results in more and more of our life experiences being “pathologized”? Haslam argued that the pathologizing of life experience is a form of concept creep.

Pathologizing Human Experience

Professionals continue to raise awareness about the concept creep in the mental health field. Critics note that under the DSM-5, more and more people can be diagnosed with a mental illness because new diagnostic categories have been added, and fewer symptoms are required to “meet diagnostic criteria” for some categories.²

One concern is the change in the criteria for a major depressive episode. The DSM-5 removed a “bereavement exclusion” from the diagnosis of major depressive disorder (MDD). Previously, someone experiencing grief over losing a loved one, particularly in the months following their loss, would not be diagnosed with MDD. In addition, the DSM-5-TR added a new diagnosis, prolonged grief disorder (PGD), for people experiencing extreme grief after one year of the death of a loved one.

In the case of the “bereavement exclusion,” experiencing sadness or lack of interest or pleasure for at least two weeks was not a “symptom” of depression if it is associated with the death of an intimate. The belief was that such experiences are better explained by bereavement than depression.³

One critic noted that the absence of context in defining PGD is stunning. What about widows observing a cultural norm by wearing black for the rest of their lives? What about the parents who we colloquially say will never get over the loss of their child?⁴

These critics argue that excluding the natural reaction of bereavement and the absence of social and cultural considerations in defining mental disorders are the arbitrary labeling of emotions and feelings that are part of our universal experiences as pathological.

Is Abandonment Subject to Concept Creep?

Fear Essential Reads

Subconscious Fear: The Role of the Lower Brain

Managing Turbulence During Air Travel

Social Worker Cathy Harris asked, “Can adults be abandoned?^{” 5} To which she answered, “No.” Harris reminded us that adults could not be abandoned in the same sense that a child can. As she wrote:

What happens when a child is 'abandoned?' That child is left without resources. This is important because a child cannot gain their own food, housing, clothing, etc. They can truly be discarded, left behind. A child does not have the physical or financial status to obtain their own means of life. This is one reason why we have laws about child abuse and neglect.

The concept of being “abandoned” applied to adults has undergone concept creep in two significant ways: “fear of abandonment” and “emotional abandonment.”

One medically reviewed mental health-oriented internet site provides a range of life experiences that can cause “fear of abandonment.”These include: the death of a loved one, a friend moving away, a relationship ending, and the transition to marriage and parenthood. While we all may struggle with these life events, the “fear of abandonment” can prevent us from managing them successfully.

“Emotional abandonment” in adults is another example of concept creep of abandonment. A marriage and family therapist notes that abandonment is “something physical,” but “emotional abandonment” has nothing to do with physical closeness–it can happen when our emotional needs are not being met in our relationships.⁶

The author listed several causes of this “emotional abandonment”–conflicting work schedules, lack of mutual interests, demands of parenting, etc. The concept of abandonment has grown to include many of the vicissitudes of married life.

Concept Creep and the Pathologizing of Human Experience

While increasing the range of experiences that can be captured by concepts like bullying, abuse, trauma, addiction, or abandonment may be useful because it increases our sensitivity to the harm people can experience. Haslam alerted us to the harm that can be done by concept creep in the mental health field.⁷ He noted:

• Applying concepts of abuse, bullying, trauma, and abandonment to less severe events can result in unjustified accusations about other people and excessive medical treatment use.
• When a concept expands to include less extreme phenomena, the concept’s original meaning, such as trauma as a response to terrifying events outside normal human experience, can be seen in a more benign light.
• When we increase the number of people who are defined as patients because of their perceived capacity to suffer and be harmed, we risk reducing the number of people who see themselves as capable of agency.
• The more people see themselves as patients defined by their suffering and vulnerability, the more they cast others as villains, abusers, bullies, and traumatizers.

Using a concept creep perspective to understand the pathologizing of human experience can clarify the harm, along with the possible benefits of the “…several decades of rising rates of mental illness, increasing mental health utilization, and evidence of over-diagnosis, over-treatment, and over-prescription.”⁸

A better way to talk about the negative experiences people have—sadness, worry, fear, anger, and compulsions is addressing each as a specific phenomenon rather than as “symptoms” to be clumped together and labeled a disease.⁹