Rejection sensitivity and symptom severity in patients with borderline personality disorder: effects of childhood maltreatment and self-esteem

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.

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

“…The domains of social rejection sensitivity, provocation of aggressive behaviour, and inability to become involved in trustful and cooperative behaviour stand out as particularly important (for a review, see [108]). In adult BPD patients, the experience of being socially excludedmainly under experimental conditions [109]-leads to distorted perceptions of others, as expressed in feelings such as contempt, resentment and anger towards others [110,111]. Similar to findings in adults, a recent study in adolescent BPD patients found that, compared with normal controls, they experienced negative emotions more intensely in a social exclusion paradigm; however, there were no differences in their pattern of responding [112].…”

The link between rejection sensitivity and borderline personality disorder: A systematic review and meta‐analysis

“…There was less consistency in outcomes on other forms of abuse. Five studies indicated physical abuse significantly correlated with RS (Bungert, Liebke, et al ., ; Erozkan, ; Feldman & Downey, ; Hernandez, Trout, & Liu, ; Kahya, ), and three studies indicated physical neglect correlated significantly (Bungert, Liebke, et al ., ; Goodman, Fertuck, Chesin, Lichenstein, & Stanley, ; Kahya, ). However, one study reported no significant relationship between physical abuse and RS in a non‐clinical population (Goodman et al ., ) and another reported no significant relationship between physical abuse or neglect in a mixed population (Masland, ).…”

“…Emotional abuse and/or neglect (EAN) consistently correlated with RS in a non‐clinical sample despite study quality, with typically moderate effect sizes though the range was large ( r = .17 to .49). Two studies considered the overall CTQ and found significant moderate correlations (Bungert, Liebke, et al ., ; Kahya, ). There was less consistency in outcomes on other forms of abuse.…”

“…Emotional abuse and/or neglect correlated with RS in a mixed sample of people with BPD and/or MDD (Chesin, Fertuck, Goodman, Lichenstein, & Stanley, ), but not in a pure BPD sample (Bungert, Liebke, et al ., ) or community sample with clinically significant levels of BPD (Masland, ). Physical neglect was only measured in one study due to low internal reliability, and a small correlation was found with RS (Bungert, Liebke, et al ., ). Physical abuse showed a strong correlation in a community sample with clinically significant levels of BPD traits (Masland, ).…”

Dialectical Behavior Therapy: A Portuguese Pilot Program

“…On the domains of self-image is the construct of self-esteem, which is usually low in BPD patients (James, 1890;Kanter, 2001). According to Bungert and colleagues (Bungert et al, 2015) rejection sensitivity is an important component in BPD and seems to be related with low self-esteem and BPD symptom severity. Self-esteem is described as "how you evaluate yourself" and is considered part the construct named self-concept "your ideas about yourself" and this last one part of what is known by identity "who you are" (Baumeister, 1999).…”