Fear of Abandonment—Is it OCD or Anxiety?

What is a fear of abandonment?

Fear of abandonment can present at any age and involves a chronic, persistent fear that someone will leave them, for any number of different reasons. This fear can present on its own or as an obsession in obsessive-compulsive disorder (OCD). 

Let’s take a look at an example to learn about how these fears can impact people with OCD:

Charlie is 10 years old and in 4th grade. She has been a worrier since she was able to start talking and expressing her fears and has struggled with a fear of abandonment since she started kindergarten. Charlie is an only child and lives with her mother and father. They noticed that when she started going to school for the first time, she struggled with separation anxiety and had extreme reactions to her parents leaving her for the day. In the first months of kindergarten, she would cry, scream, hold on to her parents’ legs and do everything she could to avoid separation. The teachers all reassured the parents that this was normal for a child her age and that it would get better over time—and in some ways, it did. 

As Charlie progressed through school she started to engage in daily rituals involving her parents. Every morning she would ask them if they loved her. Her parents would say, “Because you are the only Charlie in our lives.” She would say “I love you” over and over and would expect her parents to say it back. When she was dropped off at school, she would ask what time they would be there to pick her up from school. They always repeat “3:15.” Now, as a fourth grader, Charlie has intrusive thoughts that her parents will leave town while she is at school and no one will pick her up. She also has intrusive thoughts about her parents getting into a car accident. Along with her morning rituals of asking why they love her saying she loves them repeatedly, she will go to the office in the middle of the day to call her parents to make sure they are at work. The office at school has accommodated this compulsion because Charlie is so tearful if they say they won’t do it. 

Charlie also asks her parents at the end of the day to tell her why they will never leave her. She seeks reassurance about their health, and about their driving habits. Charlie is now having trouble sleeping because of her intrusive thoughts. Her mind tells her she is a “bad kid” and her parents probably “hate” her. She often gets out of bed and wakes her parents up to confess what her mind is saying to her and seek reassurance that it is not true. Charlie’s parents finally decide it is time to seek help from a qualified therapist. 

These fears could be a sign of OCD

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Obsessive Compulsive Disorder (OCD) is characterized primarily by two components: obsessions and compulsions. 

What are Obsessions?

Obsessions are defined as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals caused marked anxiety or distress.” Someone with OCD focused on a fear of abandonment may experience persistent obsessions about others leaving them, feeling alone, or about their own dependency on others.

Common obsessions experienced by people with a fear of abandonment in OCD include:

• What if I’m not attractive to my partner?
• What if my partner is having an affair?
• What if something bad happens to my partner and I’m alone?
• Are my partner’s other relationships a threat to ours?
• Who are they texting? Are they cheating?
• I’m just unworthy of love.
• I’ll never be good enough. 
• What if my parents don’t come home?
• What if my parents get in an accident and I’m alone?
• What if I’m not the child my parents wanted?

What are Compulsions?

Compulsions are “repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.” Compulsions are done in an attempt to relieve the anxiety that comes from obsessions or to prevent a feared outcome. 

Consider some examples for people with fears of abandonment: 

• Calling a partner repetitively to check in
• Looking through a partner’s phone record, emails, or receipts
• Feeling unable to enjoy independent activities
• Seeking reassurance from a partner to make sure they’re faithful or committed
• Researching about partners who cheat
• Calling parents repeatedly
• Praying repeatedly for a partner’s or parent’s safety
• Avoiding activities without a partner or parent

How can I tell if it’s OCD, anxiety, or something else?

In addition to the presence of obsessions, compulsions, or both, a person with OCD will engage in these behaviors for a significant amount of time. These behaviors will also cause a significant amount of distress and will interfere with a person’s daily life and ability to function.

On the other hand, if a person struggles with a fear of abandonment but does not engage in compulsive behavior or their symptoms don’t interfere in their life, it may be better described as one of several anxiety disorders, or just general worry. Someone who has been abandoned by a spouse in the past because of infidelity or death, for example, could be dealing with a different diagnosis or no diagnosis at all.

How the fear of abandonment can be treated

A fear of abandonment in OCD can be treated with a particular form of therapy called exposure and response prevention (ERP) therapy. This evidence-based treatment has shown to be highly effective in treating all forms of OCD. Most individuals who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

By doing ERP therapy with a trained therapist, individuals can find relief from the cycle of OCD. In ERP, people will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built. 

When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety without relying on compulsions or avoidance to feel better.

Example exposures done to treat OCD centered around a fear of abandonment may include:

• Writing a script about one’s partner cheating on them
• Visiting family without one’s partner coming along
• Reading a book in which a character’s parents die or get divorced
• Taking the school bus instead of being dropped off

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.