# Separation anxiety disorder in pregnancy: The relationship between attachment styles, childhood trauma, and prenatal attachment

## TL;DR

This study finds that nearly half of pregnant women in their third trimester show signs of separation anxiety disorder, which is linked to insecure attachment styles and childhood trauma, but not to how they bond with their unborn child.

## Contribution

The study is the first to systematically assess Adult Separation Anxiety Disorder (ASAD) in pregnancy and its associations with attachment styles and childhood trauma.

## Key findings

- 48.2% of third-trimester pregnant women met criteria for Adult Separation Anxiety Disorder (ASAD).
- Anxious/ambivalent and avoidant attachment styles and childhood trauma were strongly associated with ASAD severity.
- Childhood sexual abuse was linked to weaker prenatal attachment, while positive paternal care strengthened it.

## Abstract

Separation anxiety, rooted in attachment theory, involves distress when separated from attachment figures. This study aims to investigate the prevalence Adult Separation Anxiety Disorder (ASAD) among pregnant women and to explore its associations with attachment styles, childhood trauma, and prenatal attachment.

This cross-sectional study included 106 third-trimester pregnant women, who were classified into ASAD (n = 51) and non-ASAD (n = 55) groups based on the Structured Clinical Interview for Separation Anxiety Symptoms (SAD-SCI). Participants were also assessed using the Structured Clinical Interview for DSM-5 (SCID-5), along with a sociodemographic data form, the Adult Attachment Style Scale (AASS), the Childhood Trauma Questionnaire-33 (CTQ-33), and the Prenatal Attachment Inventory (PAI). Statistical analyses included chi-square tests, t-tests, correlation analyses, and regression models.

ASAD was identified in 48.2% of the participants. Anxious/ambivalent attachment, avoidant attachment styles and childhood trauma were significantly associated with ASAD severity (p<0,001). In multivariable logistic regression analysis, anxious/ambivalent attachment style was independently associated with ASAD diagnosis (OR = 1.81; 95% CI: 1.085–3.021). Supportive parental bonding was associated with lower ASAD severity, whereas overprotective parenting attitudes were associated with higher severity. No significant relationship was found between ASAD and prenatal attachment (p>0.05), but childhood sexual abuse negatively correlated with prenatal attachment (p=0.012). Positive paternal care (p=0.004) and overprotective parenting attitudes (p=0.050) were associated with stronger prenatal attachment.

ASAD is common during late pregnancy and is closely associated with insecure attachment patterns and adverse childhood experiences, but not with prenatal attachment. These findings support the clinical value of routine ASAD screening during late pregnancy and targeted interventions for at-risk women. Longitudinal studies are needed to clarify the postpartum course of ASAD and its implications for mother–infant relationships and child development.