Borderline personality disorder (BPD) is a severe mental illness affecting about 31 million Americans (Lenzenweger, 2008). Although its prevalence is not particularly high, BPD is associated with the highest rate of suicidal attempts and psychiatric hospitalizations among all personality disorders (Lenzenweger, 2008). Since the early 1990’s, researchers have been extensively studying the causes, development, and treatment of BPD, and a large amount of studies have provided strong evidence indicating a positive relation between childhood abuse and BPD symptoms in adulthood. Those diagnosed with BPD have reported significantly more instances of childhood sexual abuse, physical abuse, and violence exposure compared to both non- clinical populations and patients diagnosed with other personality disorders (Afifi et al., 2011; Battle et al., 2004; Herman, Perry & Kolk, 1989; Zanarini, Gunderson, Marino, Schwartz, & Frankenburg., 1989). However, not all forms of childhood maltreatment lead to the development of BPD according to previous research; rather, only childhood emotional abuse does (Gratz, Delany-Brumsey, Paulson, & Lejuez, 2006; Frias, Palma, Farriols, Gonzalez, & Horta, 2016).
Even so, childhood emotional abuse does not sufficiently affect the development of BPD alone. Instead, childhood emotional abuse is particularly detrimental for children with certain trait vulnerabilities, which are innate personality traits that make them more susceptible to abnormal development when facing adverse situations (Bounoua et al., 2015; Chesin, Fertuck, Goodman, Lichenstein, & Stanley, 2015; Gratz et al., 2011; Lobbestael & McNally, 2016). In other words, an emotionally abused child’s risk of developing BPD is only likely to be higher when one or more trait vulnerabilities is already present (Bornovalova et al., 2006; Bounoua et al., 2015; Gratz et al., 2011). Several trait vulnerabilities have been identified by previous research, but many of them have similar definitions and can be included under two main factors: rejection sensitivity, the tendency to frequently expect and experience interpersonal rejection (Chesin et al., 2015); and negative affectivity, the tendency to experience a large amount of strong negative emotions (Rosenthal, Cheavens, Lejuez, & Lynch, 2005). However, there is a
limited amount of research explaining how rejection sensitivity and negative affectivity relate to childhood emotional abuse and the subsequent development of BPD. Therefore, this paper attempts to address this gap in the literature by answering the following research question: How do rejection sensitivity and negative affectivity affect the relation between childhood emotional abuse and BPD development?
Rejection Sensitivity
Rejection sensitivity is a trait vulnerability that is highly prevalent among people with BPD symptoms. It is found to be higher among BPD patients than people diagnosed with anxiety disorders, mood disorders, and even social phobias (Staebler, Helbing, Rosenbach, & Renneberg, 2011). High rejection sensitivity is characterized by a constant and unjustified higher expectation of rejection, and thus, higher likelihood to feel rejected by others during social interactions (Chesin et al., 2015; Lobbestael & McNally, 2016; Staebler, Helbing, Rosenbach, & Renneberg, 2011). Past research has found that children with higher rejection sensitivity are significantly more likely to develop BPD features after experiencing emotional abuse (Chesin et al., 2015; Staebler et al., 2011). With high rejection sensitivity, children often misinterpret ambiguous social situations as rejecting when actual rejection is very mild or not present at all; they frequently perceive social situations to be more emotionally upsetting than their peers (Chesin et al., 2015; Lobbestael & McNally, 2016). Therefore, when these children experience emotional abuse from others, they often inaccurately interpret others’ emotions toward them as rejection, instead of other negative emotions like anger, anxiety, or frustration (Lobbestael & McNally, 2016).
To protect themselves from rejection, children with high rejection sensitivity often develop two coping mechanisms overtime: avoidance and over-attachment. Both coping mechanisms are highly prevalent among BPD patients’ behavioral symptoms, and they are often both present within the same individual (Frias et al., 2016). As these children grow up, they might learn to avoid social interactions with most people to minimize possible chances of rejection, while simultaneously seeking extreme intimacy from a few people with whom they feel secure (Frias et al., 2016; Lobbestael & McNally, 2016; Staebler et al., 2011). Consequently, they are often described as desiring closeness and fearing it at the same time, a prevalent behavioral symptom among BPD patients (Frias et al., 2016; Staebler et al., 2011).
Negative Affectivity
Higher negative affectivity is characterized by a tendency to be easily disturbed by emotionally triggering events and experience more intense negative emotions from those triggers (Rosenthal et al., 2005). Compared to rejection sensitivity, which only causes children to subjectively experience more rejection, negative affectivity intensifies all their negative emotions (Gratz et al., 2011; Rosenthal et al., 2005). Therefore, emotionally abusive experiences are likely to cause much more trauma in children with higher negative affectivity than those with lower negative affectivity, and such trauma often hinders their emotional and social development (Gratz et al., 2011; Rosenthal et al., 2005). As Gratz and colleagues (2011) found, only children with high negative affectivity developed more BPD symptoms after experiencing instances of emotional abuse; children with low negative affectivity, on the other hand, were not significantly affected by those negative experiences.
It is worth noting that thought suppression, a tendency to actively disassociate oneself from negative thoughts, significantly decreases the effect of negative affectivity on BPD development (Ebner- Priemer et al., 2005; Rosenthal et al., 2005). However, although thought suppression might be a useful emotional regulatory strategy for people with high negative affect, it can also be maladaptive and harmful to overall mental health in the long run (Rosenthal et al., 2005).
CONCLUSION
When emotional abuse is present, children with either, or both, rejection sensitivity and negative affectivity are likely to have more frequent subjective thoughts about being rejected, and the negative emotions triggered by those thoughts are often much more intense. Therefore, emotionally abused children experience more trauma from the abuse they receive, which significantly hinders their future emotional and social development and leads to an elevated risk of developing BPD. This interaction between childhood emotional abuse and the two trait vulnerabilities in the development of BPD provides strong evidence to support the gene-environmental interaction model of mental disorders (Purcell, 2002), as neither innate traits nor environmental factors alone lead to BPD pathology. As mentioned above, children without innate trait vulnerabilities might not be more vulnerable to BPD even if they experience emotional abuse. Similarly, children with innate trait vulnerabilities are not necessarily under more risk of developing BPD if they do not grow up in emotionally abusive households. As a result, it might be important for clinicians to conduct screenings on all three factors to identify children with high risk of developing BPD, rather than only focusing on one aspect of the issue. In addition, children with innate high rejection sensitivity or negative affectivity might benefit from preventive counselling services to lower their risk of abnormal development.
Although both rejection sensitivity and negative affectivity significantly increase emotionally abused children’s likelihood of developing BPD, how those two factors interact with each other to predict BPD development is in need of further investigation. There is some evidence indicating that higher rejection sensitivity is significantly related to higher negative affectivity, meaning that people who perceive rejection more often are also more likely to experience frequent and intense negative emotions (Gratz et al., 2011). Besides that, the relation between those two factors has not been well studied, and future research should further examine this issue. Additionally, future research should explore possible interventions or treatments targeting either, and/or both of the two trait vulnerabilities or childhood emotional abuse. Besides providing legal and counseling services to children experiencing abuse, it might also be helpful to investigate possible ways to minimize the negative impacts brought by rejection sensitivity and negative affectivity. Thus, more research on how to accurately identify these two traits in children and potential treatments for them is needed.
