Fear of Abandonment Ipswich, Suffolk

Diagnosis: Borderline Personality Disorder. Target Behaviour: Inability to spend time alone (Patient lives in Ipswich, Suffolk)

Sophie  (not her real name) is 33 years old and lives with her boyfriend. She presents with a range of symptoms of Borderline Personality Disorder (BPD), and this study looks at her fear of abandonment.

Sophie has had a few partners during her adult life and with each she has quickly become dependent and 'clingy'. On a recent occasion, fearing that her partner was going to leave her on her own, she became angry, desperate and increasingly distressed until she made her first suicide attempt, having threatened suicide many times previously.

We have managed to relate this hatred and fear of abandonment to her childhood experiences of being left to fend for herself by her parents.

When she came to see me she reported that she found it impossible to be on her own for more than fifteen minutes. She said that if she were left on her own for fifteen minutes or more, then she would, literally, die.

When I asked her how this would happen, she told me that she would become increasingly distressed, as had happened on previous occasions, and believed that if she wasn’t “rescued” within the fifteen minutes, she would end up killing herself. This obviously presented particular challenges for therapy.

Sophie lacked any real skills in being able to comfort herself or soothe herself if she was on her own.  So, before any graded exposure experiment could take place, she had to learn how to self-soothe, and how to distract herself; two of the main Distress Tolerance techniques in Dialectical Behaviour Therapy (DBT).  Once we’d practised together these Distress Tolerance skills, she would be able to implement them, generalise the skills, in her home environment.

We worked through a hierarchical Crisis Management plan based on subjective levels of distress that she was likely to experience when on her own; the DBT range of techniques known as ACCEPTS.

  • A Activities
  • C Contributing
  • C Comparisons
  • E Emotions ("act opposite to…")
  • P Pushing Away
  • T Thoughts
  • S Sensation

This was to be a graded approach, and we built up the periods of time on her own step-by-step. After three months Sophie managed to spend an entire weekend in her own company, alone, and without feeling suicidal — actively managing her distress.

Consequently, Sophie's depression has reduced significantly and she is in sufficient control of her fear of abandonment that she no longer feels she needs to be rescued.