Rejection sensitivity (RS) is defined as a cognitive-affective processing disposition of anxious expectation, ready perception and overreaction to rejection cues. RS is widely investigated in social psychology, but research on RS in clinical samples is scarce. Focus of the present study was to examine the role of RS in patients with borderline personality disorder (BPD) compared to other clinical disorders. The Rejection Sensitivity Questionnaire (RSQ) was adapted for application in clinical and non-clinical samples and proved to be a methodologically sound measure. High correlations between the RSQ and borderline-specific cognitions (Questionnaire of Thoughts and Feelings) were observed. Compared to several clinical samples as well as healthy controls, BPD patients indicated the highest scores on both measures and differed significantly from all other groups, even from patients with social anxiety disorders.

Interpersonal dysfunction is a key feature of borderline personality disorder (BPD). Distorted perception of participation in social situations and altered emotional responses could contribute to these typical interpersonal problems in BPD. Thirty patients with BPD were compared with a healthy control group (n = 30) in their perceptions and subjective emotional reactions to situations of social inclusion and exclusion. Participants played Cyberball, a virtual ball-tossing paradigm, in which social inclusion and exclusion are experimentally induced. Control participants reacted with an increase in sadness, anger and overall negative affect when excluded. In BPD patients, social exclusion also induced anger, while general participating in the game seemed to reduce levels of sadness. Compared with healthy controls, BPD patients felt more readily excluded independent of the condition of inclusion or exclusion. In conclusion, patients with BPD displayed a negative bias toward perceived participation in social situations. Key PRACTITIONER MESSAGE: Patients with BPD have a biased perception for exclusion. Virtual ball-tossing games can be used to induce anger in patients with BPD. Participating in a virtual ball-tossing game may reduce levels of sadness in BPD in the short term.

Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.

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