Attachment, Separation, and Phobias
Donald K. Routh
Jean E. Bernholtz
Evidence is reviewed linking attachment and separation in infants and preschool children to separation anxiety disorder, agoraphobia, and panic attacks in later life. The first hypothesis reviewed concerns possible functional similarities underlying some of the diverse phenomena of attachment, separation, and phobias. Several biological findings relate separation anxiety disorder/school phobia in children to depression, agoraphobia, and panic disorders. For example, research reports abnormal results of the dexamethasone suppression test in children with separation anxiety disorder as well as in depressed children. Imipramine, an antidepressant, also relieves the symptoms of school phobia and agoraphobia. Haloperidol and pimozide can produce a drug-induced separation anxiety disorder. Agoraphobia has been spoken of as adult separation anxiety, and behaviorally agoraphobics prefer the presence of a particular person or in some cases a nonhuman attachment object that is similar to behavior found in toddlers separated from their mothers. Another hypothesis reviewed concerns the continuity of individual and family differences in attachment behavior. Early attachment behavior predicts later social and cognitive behavior, with insecure attachment leading to an increased risk for psychopathology. Childhood separation anxiety has been linked with agoraphobia in adulthood. The evidence reviewed in this chapter is, for the most part, suggestive rather than conclusive.
This chapter addresses one intersection between attachment and psychopathology. It sets up the scaffold for a building that can be only partially constructed at present, because the current data base is so small. It explores the connections between the phenomena of attachment and separation as seen in infants, young children, and in adults, and the most prevalent and severe phobias and related conditions seen in older children and adults, namely separation