Abstract
BackgroundInterpersonal dysfunction in Borderline Personality Disorder (BPD) is characterized by an ‘anxious preoccupation with real or imagined abandonment’ (DSM-5). This symptom description bears a close resemblance to that of rejection sensitivity, a cognitive affective disposition that affects perceptions, emotions and behavior in the context of social rejection. The present study investigates the level of rejection sensitivity in acute and remitted BPD patients and its relation to BPD symptom severity, childhood maltreatment, and self-esteem.MethodsData were obtained from 167 female subjects: 77 with acute BPD, 15 with remitted BPD, and 75 healthy controls who were matched with the patients for age and education. The instruments used for assessment were the Rejection Sensitivity Questionnaire, the short version of the Borderline Symptom List, the Childhood Trauma Questionnaire, and the Rosenberg Self-Esteem Scale.ResultsBoth acute and remitted BPD patients had higher scores on the Rejection Sensitivity Questionnaire than did healthy controls. Lower self-esteem was found to be positively correlated with both increased BPD symptom severity and higher rejection sensitivity, and mediated the relation between the two. History of childhood maltreatment did not correlate with rejection sensitivity, BPD symptom severity, or self-esteem.ConclusionsOur findings support the hypothesis that rejection sensitivity is an important component in BPD, even for remitted BPD patients. Level of self-esteem appears to be a relevant factor in the relationship between rejection sensitivity and BPD symptom severity. Therapeutic interventions for BPD would do well to target rejection sensitivity.Electronic supplementary materialThe online version of this article (doi:10.1186/s40479-015-0025-x) contains supplementary material, which is available to authorized users.
Highlights
Interpersonal dysfunction in Borderline Personality Disorder (BPD) is characterized by an ‘anxious preoccupation with real or imagined abandonment’ (DSM-5)
Based on the findings described above, we hypothesized that BPD patients would report higher rejection sensitivity (RS) than healthy controls; that BPD symptom severity is linked to a history of childhood maltreatment and that this association is mediated by RS; and that selfesteem is closely related to both RS and BPD symptom severity and constitutes a mediator in the relationship between the two
To assess whether group differences in Rejection Sensitivity Questionnaire (RSQ) scores could be completely explained by BPD symptom severity, we conducted the same analysis with BSL scores as a covariate (Table 3)
Summary
Interpersonal dysfunction in Borderline Personality Disorder (BPD) is characterized by an ‘anxious preoccupation with real or imagined abandonment’ (DSM-5). In the alternative model of DSM-5, Bungert et al Borderline Personality Disorder and Emotion Dysregulation (2015) 2:4 extend the concept of RS by postulating a ‘defensive motivational system’ as underlying physiological mechanism, which enables an efficient way to detect and react to a potential threat of belonging [2,3] They defined RS according to the general approach avoidance motivational model [4,5] that distinguishes two affective-motivational systems: an approach system responds to positive stimuli, while an avoidance/defensive system is responsive to negative stimuli and leads when activated to a preferred perception and processing of potential threat cues [4,5]. Downey et al [2] observed enhanced startle reflex responses in people high in RS while viewing rejection-related pictures compared to people low in RS and compared to pictures showing acceptance or non-interpersonal positive or negative scenes
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