Impairment 11: Significant impairments in interpersonal functioning –  b. Intimacy: anxious preoccupation with real or imagined abandonment.

What We Know

     Liebke and others (2018) developed an interesting computer based assessment tool, the Mannheim Virtual Group Interaction Paradigm, using computer-controlled avatars. They investigated the responses of fifty-six non-medicated BPD patients and 56 healthy controls to the avatars which the subjects believed  represented real human co-players. The subjects introduced themselves, evaluated their co-players, assessed their social expectations, and received feedback signaling either acceptance or rejection. BPD patients adjusted their expectations in response to negative, but not to positive, feedback. The subjects then played a modified trust game, which measured cooperative and aggressive behavior. BPD patients behaved less cooperatively. They concluded that cognitive and behavioral responses to social acceptance may hamper the forming of stable cooperative relationships.

Zanarini (2009) obtained data from 77 female subjects with acute BPD, 15 with remitted BPD, and 75 healthy controls. They were assessed using the Rejection Sensitivity Questionnaire, the short version of the Borderline Symptom List, the Childhood Trauma Questionnaire, and the Rosenberg Self-Esteem Scale. Zanarina discovered that all the BPD patients including those in recession, had higher scores on rejection sensitivity, which correlated with lower self-esteem. Childhood maltreatment did not appear to be a factor. She concluded that rejection sensitivity is an important component in BPD, even for remitted BPD patients, and that the level of self-esteem appears to be a relevant factor in the relationship between rejection sensitivity and BPD symptom severity.

So what does this mean in plain English. First, we must realize that both of these studies equate “real or imagined abandonment” with “rejection sensitivity”.  We then can conclude that we respond to perceived negative feedback but not positive. In other words, we are hypersensitive to any indication of possible rejection. Secondly, we can conclude that these fears are related to our low self-esteem. Thirdly, stepping outside the boundaries of these studies, we can conjecture that these negative thinking patterns are possibly connected to some genetic predisposition coupled with early childhood social-emotional experiences, rather than physical maltreatment. We can further conjecture, based on past studies of the human brain, (Michl and others, 2014) that these feelings are possibly related to mechanisms of shame located in the anterior cingulate cortex and the parahippocampal gyrus both found in the temporal lobes. Again, with further conjecture, we see that the temporal lobes are responsible for the processing of language and the emotions attached to the delivery of  words.

The development of the overactive shame mechanisms in the brain seems to be related to the object (relations) constancy theory; the child develops a psychological representation of the parent that satisfies the need for contact when separated. This may involve the parent’s ability to soothe the child with verbal and physical prompts. With neglectful or emotionally abusive parents, the child may not receive verbal and physical soothing modeling and therefore may not be able to develop relations constancy or develop the ability to self-soothe.  Separation anxiety can eventually lead to fear of abandonment later in childhood and on into adulthood.                      .

Some degree of abandonment fear can be normal, but when fear of abandonment is severe and frequent, it can lead to a whole host of problems. A person who has experienced feelings of abandonment may be more likely to have mood swings or be unable to control their emotions. Self-esteem can also be affected making it harder to feel worthy or to be intimate. These fears could make a person prone to anxiety, depression, co-dependency or other issues.

Abandonment fear usually affects our ability to form, lasting relationships. We may feel “other” or disconnected from those around us. We may have difficulty trusting others, and in extreme cases, may exhibit some form of paranoia. We may go to extremes to hold onto the relationship, often abandoning our own physical and emotional needs. We may tend to display compulsive behavior and thought patterns that sabotage our relationships. Any slight may be interpreted that our partner no longer loves us. From the partner’s point of view, sudden personality shifts seems to come from nowhere. She may be confused as to why her partner is suddenly acting clingy and demanding, smothering her with attention, reacting with anger, or pulling away altogether.

If the fear of abandonment is mild, we may be able to control it simply by becoming educated about our tendencies, building new thought patterns, and learning new behavior strategies. For most of us  though, the fear of abandonment is connected to deep seated issues. Intensive therapy may be needed to build the self-confidence and self-esteem needed to truly change our destructive thought and behavior patterns.

 

Liebke, L; Koppe, G; Bergert, M; Thome, J; Hauschild, S; Defiebren N; Izurietqa Hidalgo, N; Schmahl, C; Bohus, M; and Lis, S. “Difficulties with being socially accepted: An experimental study in borderline personality disorder”.J Abnormal Psycology. 2018.

Michl, Petra; Meindl, Thomas; Meister, Franziska; Born, Christine; Engel, Rolf, R; Reiser, Maximilian; and Henning-Fast, Kristine. Neurobiological underpinnings of shame and guilt: a pilot fMRI study. Social Cognitive and Affective Neuroscience, 2014,

Zanarini, Mary C. Reasons for Change in Borderline Personality Disorder (and Other Axis II Disorders). HHS Author Manuscripts. Psychiatry Clinic North Am. 2008