Borderline personality disorder is a heavily stigmatized and misunderstood diagnosis. People with BPD are living in a constant state of psychological survival; making relationships and socializing especially difficult.
One of the most challenging parts of living with BPD is struggling with feelings of rejection. Some patients describe it as ”unbearable and personal.” This can cause patients to be unable to determine if a relationship is healthy or if they even like the person that has rejected them. Rejection can cause a traumatic fawn response that might not be in their best interest. This inherent inability to access our true emotions and to be accepted, makes relationships feel impossible for both parties involved.
Dr. Eric A. Fertuck from City College of New York has given us more insight into this phenomenon. He and his team conducted scans on BPD brains and discovered differences in the rostro-medial prefrontal area. In a brain without BPD, we see that when we are faced with repeated rejection this area lights up and becomes more active. People with BPD that have a propensity to social sensitivity do not show this activity when experiencing rejection.
When this part of the brain is activated in non-BPD brains it is interpreted as if there is something wrong with the environment or situation. This then causes a reaction to try to improve social interactions to fix the relationship and “socially survive.” BPD brains might not have this neurological reaction, therefore, creating much harsher and more internalized feelings of rejection and alienation.
When someone is very distressed by a rejection or even a perceived rejection, it can be easy to internalize things and blame ourselves. It is much harder to ascertain if that was rejection, or am I overthinking. And when we are caught in that spiral it is much harder to perform in social situations because we are harshly criticizing everything we say or do.
Studies like this can help us understand how to understand ourselves and see how differently BPD brains are wired. Feeling really negatively impacted by rejection is very normal when dealing with BPD. But with the right treatment plan and a wanting for change, patients can make huge strides in their inner world.
References
Eric A. Fertuck, Barbara Stanley, Olena Kleshchova, J. John Mann, Joy Hirsch, Kevin Ochsner, Paul Pilkonis, Jeff Erbe, Jack Grinband. Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 2023; 8 (6): 651 DOI: 10.1016/j.bpsc.2022.11.006
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