Reviewing the clinical significance of ‘fear of abandonment’ in borderline personality disorder

Objectives: To review and highlight the clinical significance of the symptom ‘fear of abandonment’ in borderline personality disorder (BPD). Methods: A systematic search of the literature was conducted using MEDLINE and PubMed, employing search terms including ‘fear of abandonment’, ‘borderline personality disorder’ and ‘rejection’. The most relevant English-language articles and books were selected for this review. Results: Fear of abandonment is widely recognised as a core symptom in BPD; a biopsychosocial explanation for the occurrence of the symptom is presented. While fear of abandonment may differ in its clinical presentation, it has a significant impact on therapeutic engagement, suicidal behaviour and non-suicidal self-injury, clinical management and prognosis. Most evidence based psychotherapies for BPD address the phenomenon of fear of abandonment; however, the lack of specifically targeted treatment interventions is disproportionate to its prominence and clinical significance. Conclusions: Given its defining role in BPD, we recommend fear of abandonment as an important subject of future research and a specific therapy target.