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Fırat Tıp Dergisi
2023, Cilt 28, Sayı 4, Sayfa(lar) 286-295
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Rejection Sensitivity and Fear of Intimacy in Individuals with and without Borderline Personality Disorder
Haydeh FARAJİ, Ahmet Ertan TEZCAN
Istanbul Aydın University, Department of Psychology, Istanbul, Turkey
Keywords: Borderline Personality Disorder, Rejection Sensitivity, Fear of Intimacy, Close Relationship, Romantic Relationship, Borderline Kişilik Bozukluğu, Reddedilme Duyarlılığı, Yakınlık Korkusu, Yakın İlişki, Romantik İlişki
Summary
Objective: Borderline personality disorder is a disorder characterized by real or imaginary abandonment and excessive preoccupation with irregularities in interpersonal relationships, self, affect, behavior, and cognitions. The sensitivity of rejection is one of the main features of borderline personality disorder. Borderline patients experience great discomfort in their close relationships which looks so familiar with the fear of intimacy, the concept that affects people's interpersonal relationships and is defined by the unconscious fear of intimacy and avoidance of intimacy. The aim of this study clarifying the relationship between rejection sensitivity and fear of intimacy, the features which make borderline patients’ close relationships even more complicated.

Material and Method: Participants were asked to fill in the Borderline Personality Questionnaire, Adult Rejection Sensitivity Scale, Fear of Intimacy Scale, and socio-demographic data form. Pearson correlation analysis, Independent Groups t-test, ANOVA, and Multiple Linear Regression were used for predictive analysis.

Results: As a result of the study, It was found that borderline personality features were higher in individuals with higher levels of both the rejection sensitivity level and the fear of intimacy level (p <0.05). Both rejection sensitivity (39%) and fear of intimacy (43%) predicted personality features. When fear of intimacy and rejection sensitivity comes together they explain the variation in borderline personality features (49%). Also rejection sentivity predicted fear of intimacy (46%).

Conclusion: The results of the study show that interventions to reduce anxiety about rejection and intimacy can contribute to the prevention or reduc-tion of borderline personality traits. Also it is seen fear of intimacy may be an aspect of rejection sensitivity to prevent rejection.

  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Introduction
    A borderline personality disorder is a disorder characterized by real or imaginary abandonment and excessive preoccupation with irregularities in interpersonal relationships, self, affect, behavior, and cognitions1. Borderline personality disorder patients experience separation-individuation problems, affective and impulse control problems, and intense attachment problems that cause serious difficulties in relationships, along with problems in forming a holistic self-perception2.

    Sensitivity to rejection is a condition that involves being left out by other important people (parents, close friends, peers, romantic partners, etc.) in interpersonal relationships and causes a belief of worthlessness. Rejection sensitivity is a concept that includes the individual's perception of the behavior and words of others and feel offended by it, being sure that the situation shows rejection in case of rejection or an ambiguous situation, and overreacting to it 3. Individuals with rejection sensitivity wait in anxiety, are more ready to perceive rejection in the overstimulated state of anxiety, overreact to rejection, and report higher levels of depression and anxiety in response to rejection4. Sensitivity of rejection, which is one of the main features of borderline personality disorder, is considered as a kind of abandonment experience5. It is a limitation in an individual's capacity to share thoughts and feelings of personal importance with another highly valued individual due to anxiety6. The perception of rejection is perceived as a blow to the ego in the borderline patient, who is dependent on others, has significant difficulty in tolerating loneliness due to feelings of emptiness,, and adopts a "sticky" relationship style7, causing severe tension7,8.

    One of the main characteristics of borderline personality disorder is experiencing feelings of great discomfort in close relationships 9. The borderline patient has difficulties in relationships due to the desire to approach and the fear of being penetrated and this difficulty seems to be related to the fear of intimacy10. Fear of intimacy is a concept that affects people's interpersonal relationships and is defined by the unconscious fear of intimacy and avoidance of intimacy11.

    It has been known that people with high rejection sensitivity and fear of intimacy are more likely to suffer from interpersonal problems and intrapersonal malad-justment than healthy individuals12. They report higher levels of psychopathology 4,13. They have increased inflammatory responses also decreased levels of well-being and relational satisfaction than healthy individuals14,15.

    Although there are many studies on rejection sensitivity in the literature, studies on fear of intimacy are limited. When the relevant literature is investigated, no study has been found that deals with the fear of intimacy in borderline personality disorder. However, Richman and Leary's16 explanations for rejection point to the relationship between fear of intimacy and sensitivity to rejection. According to the Multimotive model of Richman and Leary16, rejection episodes can elicit three different behavioral motives: affiliation, aggression, and withdrawal which have a close relationship with fear of intimacy. The closeness versus distance conflict of the borderline patient indicates that the fear of intimacy in the borderline patient may be a manifestation of rejection sensitivity. According to the authors, aggression is more attached to the features of the situation and comes up with perceived unfairness, whereas social withdrawal may be linked to more internal attributions like low selfesteem17 and feelings of shame18 which are core features of borderline personality disorder. Rüsh et al.19 reveal borderline patients have higher levels of shame and anxiety even more than patients with social phobia and healthy comparison subjects. Shame is usually experienced as being exposed and devalued and accompanied by avoidance behaviors. Also, feelings of shame elicit secondary emotional responses, such as anger or rage which are common causations of close relationship problems in borderline patients. Therefore, it is thought that the fear of intimacy can be evaluated as a result of the borderline patient's low selfesteem and shame feelings, as well as an effort to avoid anger and destructive behaviors that occur after these feelings and have devastating effects on close relationships. Also, there is a lack of studies in the literature which include both borderline patiens and individuals with borderline personality features. Each individual has various personality traits. However, an increase in the level and prominence of any personality trait in a way that negatively affects the functionality of the person indicates the presence of a personality disorder. So when borderline personality is stated as a disorder, it indicates that the level of the features are high and they disrupt the functionality of the individual. Therefore the aim of this study is to clarify the relationship between borderline personality features, rejection sensitivity, and fear of intimacy. It is thought that the information obtained from this study can shed light on the solution to relational conflicts and social life problems of borderline personality disorder patients and even healthy individuals.

  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Methods
    Participants
    The relational screening method was used in this study. The sampling method used is convenience sampling. The universe of the research consists of individuals living in Istanbul. The sample of the research consists of individuals between the ages of 18-43 living in Istanbul.

    Sample size It was calculated with the“G. Power-3.1.9.4” program before data collection at a 95% confidence interval. The effect size standardized by Cohen (1992) was taken as a reference. Accordingly, in this study, the minimum number of samples was determined as 84 by taking the effect size of 0.30, the alpha value of 0.05, and the theoretical power of 0.80. A sample group was formed with 159 people participating in the research.

    While forming the comparison groups in the study, the doubleblind method was used based on the criterion of having a high or low score on the bpq, not the diagnosis criterion. Both the participants and the researcher do not know which group got higher scores on the scales. People with lower scores on BPQ were female, 8.5% were high school graduates, 66.2% were undergraduate, 25.4% had graduate degrees, 2.8% low-income level, 67.6% middle level income level, 29.6% of them have a high-income level.

    People with higher scores on BPQ were female, 12.5% were high school graduate, 72.7% undergraduate, 14.8% graduates, 1.1% low-income, 52.3% middle-level income level, 46.6% of them have a high-income level. There was no significant difference between the groups (p >0.05).

    Instruments
    Sociodemographic Data Form, Borderline Personality Questionnaire, Adult Rejection Sensitivity Scale, and Fear of Intimacy Scale applicated to our sample.

    Sociodemographic Data Form
    Sociodemographic data form developed by the researcher includes questions to obtain information such as the age, educational status, economic level, etc. of the participants.

    Borderline Personality Questionnaire (BPQ)
    While creating the borderline personality questionnaire, it was aimed to develop a self-evaluation scale with separate subscales for the borderline personality disorder criteria defined by the DSM-IV. Development studies were conducted on a healthy sample at a school in the United States. The psychometric properties of the scale were determined by sample groups from Australia, America and England. Poreh et al.20 reveal Principal Components Analysis scores range between 0.40-0.81. The Turkish translation of the scale was made by Samet Köse and Hakan Türkçapar. A validity and reliability study was conducted with 763 university students, and the internal consistency coefficient was found to be between 0.65 and 0.84, and the Cronbach α value was found to be 0.94. The scale consists of 80 questions21. The scale consists of 80 questions. It consists of 9 subdimensions: impulsivity, emotional lability, abandonment, relationships, self-image, suicidal/self-injurious behavior, feeling of emptiness, intense anger, and psychosis-like states.

    Adult Rejection Sensitivity Scale (ARSS)
    In the study, the 9-item adult form of the scale develo-ped by Downey and Feldman22 to determine the sensitivity of individuals to rejection was used. The ARSS shows high internal reliability (a =0.83). The ARSS also shows high test-retest reliability; the correlation between first and second administration (three weeks later) was 0.83 (p <0.01)22.The items include hypothetical situations in which the individual is likely to be rejected by others that are meaningful to him/her, and the person is asked to answer the rejection and acceptance expectations about the stated situation in a 6-point Likert type23. The Turkish validity and reliability study of the scale was conducted by Bozkuş and Araz24 and Cronbach's alpha value for the total score was found to be 0.62.

    Fear of Intimacy Scale (FIS)
    It is a self-report scale consisting of 35 items created by Descutner and Thelen6 to measure the attitude of avoidance in relationships. FIS shows high test-retest reliability; the correlation between first and second administration (1 month later) was 0.89 (p <0.01). The 5-point Likert-type scale consists of three factors; imaginary intimacy, imaginary openness, and past intimacy fear. Elibol and Tok25 conducted the validity and reliability study for Turkey, and Cronbach's alpha value for the total score of the scale was found to be 0.81, and the test-retest reliability score was found to be 0.76.

    Data analysis
    For statical analysis IBM SPSS 25 program used. At first the assumption of normal distribution was checked with the kurtosis and skewness values of the scale and subscales. Taking the study of George and Mallery (2010) as a reference, these values are -2 +2 reference range provides a normal distribution and our results ware fitting the range of normal distribution27. Pearson correlation analysis, which was in the parametric test group and testing the relationship between variables, Independent Groups t-test, and ANOVA were used to determine the significant difference between groups. Multiple Linear Regression was used for predictive analysis. PROCESS 3.5 was used for mediator role analysis. The value range for the correlation coefficient; It is defined as a weak correlation between 0.000*-0.300, a medium between 0.301-0.700, and high degree between 0.701-1.000. The confidence interval referenced in the whole study was 95%, and the p-value was 0.05.

    Procedure and Design
    After the application permission obtained by the Ethics Committee of Istanbul Aydin University (No: E-45379966-050.06.04-17510, Date: 13/07/2021) the study was conducted. Participants were selected by the convenience sampling method. This study has been carried out with borderline personality disorder patients and non-patients individuals, in total of 159 individuals, who voluntarily participated in to study between June and August 2021 by filling the Socio-Demographic Data Form, Adult Rejection Sensitivity Scale, Borderline Personality Questionnaire, Fear of Intimacy Scale. The participants with borderline personality disorder are the individuals who applied to the psychiatry clinic which locates in Aydin/Turkey and got borderline personality disorder diagnosed with semi-structured interviews with DSM-5 by a psychiatrist. The selection criteria for the borderline patients were getting a BPD diagnosis but do not meet the crite-ria for social phobia, PTSD, ADHD, and bipolar mood disorder. The ages of participants are between 18-43 and they were residing in Istanbul/Turkey. The identical information of the participants were hidden and they were not included in the study. The control group’s participants are individuals who have no psychiatric diagnosis and live in Istanbul and voluntarily participated in the study between June and August 2021.

  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Results
    When the ages of the participants were compared according to the level of borderline personality features, it was found that there was no significant difference between the ages (p =0.934).(Table 1, 2).


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    Table 1: Demographic characteristics of the participants.


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    Table 2: Comparison of the ages of the participants according to borderline personality feature level.

    Adult Rejection Sensitivity Scale mean (X̅ =54.04, DF =14.52), Fear of Intimacy Scale mean (X̅ =102.79, DF =28.24), Fear of Imaginary Intimacy mean (X̅ =41.90, DF =12.08), Imaginary Openness mean (X̅ = 45.47, DF =13.99), Former Fear of Intimacy mean (X̅ =15.43, DF =4.59), Borderline Personality Questi-onnaire mean (X̅ =32.04, DF =11.14), Emotional Instability mean (X̅ =5.26, DF =2.19), Abandonment mean (X̅ =3.09, DF =2.04), Relationships mean (X̅ =3.89, DF =2.32), Self Image mean (X̅ =3.11, DF =1.91), Suicide and Self-Mutilation mean (X̅ =1.64, DF=1.65), Emptiness mean (X̅ =5.21, DF =2.04), Intense Anger mean (X̅ =5.14, DF =2.89), Quasi Psychotic States mean (X̅ =2.64, DF =1.81), Impulsivity mean (X̅ =2.06, DF = 1.56) (Table 3

    ).


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    Table 3: Correlation between rejection sensitivity, fear of ıntimacy scale, and borderline personality traits.

    There is a moderate and positive correlation between Adult Rejection Sensitivity Scale and Fear of Intimacy Scale (r =.680, p =0.000), Fear of Imaginary Intimacy (r =.682, p =0.000), Imaginary Openness (r =.595, p =0.000), Former Fear of Intimacy (r =.578, p =0.000), Borderline Personality Questionnaire (r =.621, p =0.000), Emptiness (r =.506, p =0.000), Emotional Instability (r =.454, p =0.000), Abandonment (r =.340, p =0.000), Relationships (r =.446, p =0.000), Self Image (r =.423, p =0.000), Intense Anger (r =.408, p =0.000). Also there is a weak and positive correlation between Adult Rejection Sensitivity Scale and Suicide and Self-Mutilation (r =.269, p =0.000), Quasi Psychotic States (r =.215, p =0.000) and Impulsivity (r =.220, p =0.000).

    There is a moderate and positive correlation between Fear of Intimacy Scale and Borderline Personality Questionnaire (r =.661, p =0.000) Emotional Instability (r =.471, p =0.000), Abandonment (r =.338, p =0.000), Relationships (r =.549, p =0.000), Self Image (r =.368, p =0.000), Suicide and Self-Mutilation (r =.365, p =0.000), Emptiness (r =.562, p =0.000), Intense Anger (r =.408, p =0.000). Also there is a weak and positive correlation between Fear of Intimacy Scale and Quasi Psychotic States (r =.269, p =0.000).

    There is moderate and positive correlation between Fear of Imaginary Intimacy and Borderline Personality Questionnaire (r =.615, p =0.000), Emotional Instability (r =.448, p =0.000), Abandonment (r =.301, p =0.000), Relationships (r =.508, p =0.000), Self Image (r =.362, p =0.000), Suicide and Self-Mutilation (r =.384, p =0.000), Emptiness (r =.509, p =0.000), Intense Anger (r =.364, p =0.000) and there is a weak and positive correlation between Fear of Imaginary Intimacy and Quasi Psychotic States (r =.246, p =0.000).

    There is a moderate and positive correlation between Imaginary Openness and Borderline Personality Ques-tionnaire (r =.603, p =0.000), Emotional Instability (r =.436, p =0.000), Abandonment (r =.325, p =0.000), Relationships (r =.526, p =0.000), Self Image (r =.308, p =0.000), Suicide and Self-Mutilation (r =.329, p =0.000), Emptiness (r =.512, p =0.000), Intense Anger (r =.379, p =0.000). Besides there is a weak and positive correlation between Imaginary Openness and Quasi Psychotic States (r =.246, p =0.000).

    There is a moderate and positive correlation between Former Fear of Intimacy and Borderline Personality Questionnaire (r =.608, p =0.000), Emotional Instability (r =.516, p =0.000), Relationships (r =.437, p =0.000), Self Image (r =.372, p =0.000), Emptiness (r =.556, p =0.000), Intense Anger (r =.397, p =0.000). Besides there is a weak and positive correlation between Former Fear of Intimacy ile Abandonment (r =.295, p =0.000), Quasi Psychotic States (r =.260, p =0.000) and Self-Mutilation (r =.235, p =0.000) (Table 4).


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    Table 4: Comparison of fear of ıntimacy and rejection sensitivity scale by borderline personality features.

    The comparison of Fear of Intimacy Scale (t(106.613)=-7.45, p <0.05), Fear of Imaginary Intimacy subscale (t(108.368)=-6.95, p <0.05), Imaginary Openness subscale (t(106.547)=-6.27, p <0.05), Former Fear of Intimacy subscale (t(119.527)=-7.36, p <0.05), Rejection Sensitivity Scale (t(101.345)=-7.30, p <0.05 to borderline personality trait level that there is a significant difference between the mean scores obtained. When the averages are compared, it is seen that those in the Low group have a higher average than those in the High group (Table 5).


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    Tablo 5: Findings on the prediction of borderline personality traits of fear of intimacy.

    When the regression findings were examined, it was determined that the independent variables of fear of imaginary intimacy, imaginary openness and fear of former fear of intimacy were significant predictors of borderline personality traits (R =67, R2 =.43, p =0.000). It was found that the independent variables in the obtained regression model explained 43% of the change in the borderline personality traits score. Relative order of effect according to beta; imaginary openness (β =.25), past intimacy fear (β =.25), imaginary closeness fear (β =.24). It was determined that the variable that best explained the change in the borderline personality traits score was the imaginary openness independent variable (Table 6).


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    Table 6: Findings on the prediction of borderline personality traits of rejection sensitivity.

    When the regression findings were examined, it was determined that the independent variable of rejection sensitivity was a significant predictor of the variable of borderline personality traits (R =42, R2 =.39, p =0.000). It was found that the independent variables in the obtained regression model explained 39% of the change in borderline personality traits (Table 7).


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    Table 7: Findings on the prediction of fear of ıntimacy of rejection sensitivity.

    When the regression findings were examined, it was determined that the independent variable of rejection sensitivity was a significant predictor of the fear of intimacy variable (R =68, R2 =.46, p =0.000). It was determined that the independent variable in the obtained regression model explained 46% of the change in the fear of intimacy variable score (Table 8).


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    Table 8: Mediator role of rejection sensitivity in predicting fear of ıntimacy of borderline personality features.

    When the results in the table of findings were evaluated, it was seen that in the first model, the independent variable of fear of intimacy explained 43% of the variance in the score of the dependent variable of borderline personality traits. In the second step, the independent variable of rejection sensitivity was added to the model. It was observed that the independent variable of rejection sensitivity explained 6% of the variance in the dependent variable score of borderline personality traits. The independent variables of fear of intimacy and rejection sensitivity were determined according to the findings, which explained 49% of the variance in the score of the dependent variable of borderline perso-nality traits. With the addition of the independent vari-able of the rejection sensitivity scale in the second stage, the beta value of the fear of intimacy independent variable decreased from 66 to 44. Then, in order to control this decrease in beta value, 5000 resampling options, and 95% confidence interval options from Bootstrapping analysis were applied and it was determined that the lower limit and upper limit did not include 0 in the result. When the mediator role analysis results were evaluated, it was determined according to the findings that there was partial mediation (Figure 1).


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    Figure 1: Beta coefficients on the mediator role of rejection sensitivity in predicting borderline personality traits of ıntimacy fear.

  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Disscussion
  • References
  • Discussion
    Rejection sensitivity, which is defined as anxiously waiting for rejection, being ready to perceive and over-reacting to it, is an important phenomenon that affects the social and psychological adjustment of the individual in interpersonal relationships22. The fear of intimacy is angrily expecting, readily perceiving, and over reacting to social rejection22,27. Borderline personality disorder is a disorder characterized by real or perceived abandonment1. Accordingly, the main hypotheses of this study, which say that there is a relationship between rejection sensitivity and fear of intimacy, and both two phenomenons has a relationship with borderline personality disorder, were confirmed.

    It was determined that the higher levels of rejection sensitivity and fear of intimacy predict borderline personality features. Borderline patience experiences dramatic changes in feeling of self-worth especially when feel rejected their feeling of self-worth decreases and indicating that a decrease in self-worth increases rejection sensitivity even more28,29. Hence borderline patients become twice as fragile as an ordinary human beings. Rejection sensitivity model says that30, rejection experiences in various domains render individuals more hypervigilant to any clues of rejection. People with rejection sensitivity generate feelings and perceptions of rejection so they feel icreased anxiety, emotionaly pain and hostility31. Therefore, they are likely to engage in maladaptive behavioral reactions (e.g., social withdrawal, aggression, and self-harm), which begets occurrence of true social rejection, eternalize the rejection cycle30. Anxious expectations of rejection causes individuals with BPD to experience extreme tension hence they becoma more vulnerable in front of rejection and they feel rejected more easily8. Stiglmayr et al. 8 examined the subjective experience of aversive tension in daily life stressors such as rejection, being alone, and failure with 63 female patients with BPD and 40 healthy controls. Participants rated their subjective tension throughout the day and were instructed to note if rejection, being alone, failure, or another event preceded the rating. The researchers found that states of subjective tension occurred significantly more frequently in patients with BPD compared to healthy controls. Additionally, the researchers found that rejection, being alone, and failure accounted for 39% of the events preceding the aversive state of tension. The results of the study provide evidence that rejection may precede the onset of extreme tension, such as anxiety, in individuals with BPD. People with higher rejection sensitivity and higher borderline personality features may respond to these anxious states of tension with hostile behavior, social avoidance, depression, thought suppression, or self-harm in order to relieve themselves from their painful thoughts and feelings related to rejection22,54. Also, they experience implicit feelings of shame19. In this respect, it is thought that individuals who have higher levels of rejection sentivity and borderline personality features avoid intimacy and develop a fear of intimacy in order to stay away from shame and other painful emotions.

    Experiential avoidance occurs when a person does not want to stay in touch with their inner experiences (eg, bodily sensations, emotions, thoughts, memories, behavioral tendencies) and takes steps to change the pattern and to decrease the frequency of these events and contexts. The duty of awareness is to experience and tolerate being human in all its aspects, whereas experiential avoidance is an effort to stay away from emotions, thoughts, and bodily sensations32. Individuals with higher levels of borderline personality features have difficulty in emotion regulation. Difficulty in emotion regulation makes borderline patients more vulnerable, especially when they become face to face with negative emotions. Therefore difficulty in emotion regulation increases borderline patients’ likelihood of turning to maladaptive coping methods such as experiential avoidance. The division defense mechanism, which is frequently used by individuals with borderline personality features, serves to keep away from negative emotions, especially anxiety, by keeping alternative self-states and alternative emotions separate from each other33. In a situation where there was an opportunity for individuals to engage in vulnerable disclosures, individuals with higher levels of experiential avoidance typically report higher rejection sensitivity34. Accordingly, individuals with higher levels of borderline personality features who also have higher rejection sensitivity are expected to exhibit more experiential avoidance and more fear of intimacy due to their high tendency to perceive relational encounters negatively. They engage in behaviors related to experiential avoidance in order to avoid painful emotions including feelings related to rejection sensitivity. Accordingly, it is thought that experiential avoidance in individuals with borderline personality features may be the first step in the process leading to fear of intimacy. It is observed that as individuals' experiential avoidance levels increase, their perceived loneliness also increases35. Individuals with higher levels of borderline personality features, who frequently use denial and projection defense mechanisms, have deteriorated relationships and feelings of loneliness as rejection as a result of experiential avoidance. It is thought that this situation increases the possibility of individuals with higher levels of borderline personality features to develop a fear of intimacy to prevent rejection.

    All attachment styles reveal some unique behavioral patterns for both children and adults. In this respect, it is stated that insecure attachment styles have an effect on the formation of borderline personality features36. Individuals with higher levels of borderline personality features have an extremely increased sensitivity to abandonment, relationship damage and interruption 37. One of the attachment styles determined to be effective on this sensitivity is the avoidant attachment style. Avoidant attachment style also has relationship with fear of intimacy38. It is based on the parent's neglectful indifferent and avoidant behavior patterns. Anxiety and confusion are observed in children with avoidant attachment style. When these children become adults, independence turns out to be something that has an amount of import for them. They start to avoid close relationships and believe that close relationships are not so important. Also, they produce someself-mutilating behaviors which are constantly seen in borderline patients like alcohol abuse and insecure sexuality39,40. The other attachment style determined to be effective on higher levels of borderline personality features is the anxious attachment style. Anxiously attached people especially borderline patients over value relationships and see themselves as unworthy of being loved and perceive others as unreliable and rejecting. They mostly prefer to be socially present, relying on other people, and fearing distance from their beloved ones41. They experience separation as an experience that evokes feelings of loss and death. Against these feelings, they first try to defend themselves by clinging to the object they have lost and then withdrawing themselves42,28. Borderline patients do not have a stable sense of self and a strong ego. They usually achieve them by clinging to the other with whom they are in a relationship. They experience the absence of the other as a loss in the self. Therefore, borderline patients have a very low tolerance for lone-liness and can easily be frustrated by not being able to reach their beloved ones1. Individuals who place high importance and dependence on others, especially borderline patients, are more likely to seek connectedness and positive remarks from their dear ones to feel valued, and they are also searching for negative remarks which give clues about rejection43. Individuals who have higher levels of borderline personality features commonly have internalized adverse child-hood experiences like rejection, abuse, and experiences from their early close relationships44. Insecure attachment styles and early experiences of social exclusion make individuals see themselves as worthless or flawed and make them feel in danger because of potentially threatening relationships 45. Experiences of parental rejection during childhood are related to the current fear of intimacy in adults46. Perceived parental rejection in childhood causes distortions in social cognition and distortions in mental representations; the individual's selective perception becomes sensitive about perceiving hostility and rejection, and the individual exhibits rejection sensitivity47.

    But at the other side, individuals with higher levels of borderline personality features who put high importance on others, show fear of intimacy, because their need for approval and acceptance is very high. The finding of this study which says fear of intimacy is affected by to feelings of emptiness is compatible with this information. Fear of intimacy is associated with a lower perception of social support48 and individuals with higher levels of borderline personality features avoid intimacy for not to be disappointed, not be rejected, and feel empty than before49.

    Other researchers’ findings are in line with this studies finding that the level of rejection sensitivity predicts fear of intimacy. People who have rejection sensitivity has fewer resources and fewer skills in the social area and they also approach new interactions with greater trepidation and defensiveness50. These concerns make them feel more nervous in social gatherings, particularly, they even show reduced appreciation for face-to-face interactions 51. Individuals who have rejection sensitivity are more likely to misperceive ambiguous cues as signs of rejection21. Whereas people with low rejection sensitivity overlook rejection cues as a form of interpersonal optimism52. As a result, even the smallest cues in social interaction can be interpreted as rejection. While these inappropriate interpretations make one feel hurt or angry by blaming oneself, they may lead to dysfunctional behaviors such as withdrawal. Moreover, all these forms of perception and interpretation can almost become self-fulfilling prophecies, leading to genuine rejecting interpersonal experiences 5. Therefore individuals with higher levels of rejection sensitivity show more depressive symptoms than others in their relationships and also get less joy and support from their relationships51,53. Accordingly, it becomes more possible for individuals with higher levels of borderline personality features, who have a tend recurrent negative romantic relationship experiences, to develop relationship avoidance and fear of intimacy as a way of self-protection. Findings of this study which says rejection sensitivity predicts fear of intimacy are in line with the theory of closeness versus distance conflict of the borderline patient and it indicates that the fear of intimacy in the borderline patient is a manifestation of rejection sensitivity.

    As a result of the study, it was seen both rejection sensitivity (39%) and fear of intimacy (43%) predicted personality features. When fear of intimacy and rejection sensitivity comes together they explain the variation in borderline personality features (49%). Also rejection sensitivity predicted fear of intimacy (46%). Considering the intense and widespread nature of the difficulty experienced by individuals with high levels of borderline personality features in close relationships, it is recommended that the presence of rejection sensitivity and fear of intimacy be questioned with these individuals and if determined, priority should be given to eliminating these phenomena or reducing their levels. It is thought that providing new social skills will positively affect individuals with high levels of rejection sensitivity and fear of intimacy and also individuals with high levels of borderline personality features who strongly might have these two difficulties too. The limitation of the study is the small sample size, low effect size and consists of only women. It is thought that it would be beneficial to use a larger sample and to evaluate male participants, especially as a comparison group in future studies.

    Ethical statement
    The study was approved by the ethics committee of Istanbul Aydin University (No: E-45379966-050.06.04-17510, Date: 13/07/2021)

    Role of the funding source
    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Discussion
  • References
  • References

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    2) Kernberg OF. Sınır durumlar ve patolojik narsisizm. Atakay M (Çeviren). 4. Baskı, İstanbul: Metis Yayınları, 2016: 34-51.

    3) 3)Sarıçam H, Gençdoğan B, Erözkan A. The examination of the relationship between the university students’ rejection sensivities, self esteem and loneliness levels. Procedia Soc Behav Sci 2012; 46: 2716-20.

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  • Top
  • Summary
  • Introduction
  • Methods
  • Results
  • Discussion
  • References
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