By Eric W. Dolan

A recent study has shed light on a critical psychological aspect of individuals dealing with severe alcohol use disorder (SAUD) that has been previously overlooked – their heightened fear of rejection. The study delved into rejection sensitivity, a phenomenon characterized by an anxious expectation of rejection, biased perception of rejection signals, and exaggerated reactions to them. The findings provide insight into how rejection sensitivity impacts individuals with SAUD and its potential implications for their social interactions and mental health.

Rejection sensitivity has long been recognized in psychology as a concept that affects how individuals interpret and react to social interactions. People with high rejection sensitivity often engage in maladaptive behaviors, such as avoidance, detachment, hostility, or submissiveness, in an attempt to prevent rejection or due to exaggerated perceptions of rejection in ambiguous situations. These behaviors, paradoxically, can lead to the very rejection they fear, deteriorating relationships and causing mental health issues.

Previous research has consistently shown that rejection sensitivity is associated with interpersonal problems and psychopathological symptoms. However, studies specifically examining rejection sensitivity in clinically diagnosed individuals, especially those with SAUD, have been scarce. This study aimed to fill this gap and explore how rejection sensitivity might be linked to social difficulties and mental health issues in SAUD patients.

“Psychological research (broadly understood) in alcohol use disorder has up to now mostly focused on understanding the alcohol consumption behavior itself. While this of course essential, we think there is also great complementary value in clarifying the sources of the interpersonal problems that often go hand in hand with clinically severe patterns of alcohol use,” explained study author Arthur Pabst, a PhD student at UCLouvain and member of the Laboratory for Experimental Psychopathology (LEP).

“Indeed, besides reducing quality of life, relational difficulties play an important role in maintaining the disorder (e.g., conflicts and isolation are important risk factors for relapse whereas a supportive social network constitutes an invaluable resource for promoting abstinence or controlled alcohol use). Rejection sensitivity (the tendency to disproportionately expect, perceive, and react to rejection) is known to contribute to interpersonal problems, and is a particularly interesting topic for alcohol use disorder for two main reasons.

“First, it is thought to develop as a consequence of frequent rejection, to which individuals with an alcohol use disorder are particularly exposed to, notably because the diagnosis is attached to considerable stigma,” Pabst said. “Second, rejection sensitivity, and particularly anxious expectations of rejection, which we focused on here, are thought to be the starting point of a series of problems that have previously been found in alcohol use disorder (e.g., the tendency to perceive social situations as more threatening than they are, or to experience particularly high levels of distress following exclusion). Hence, they may represent a particularly fruitful treatment target.”

The researchers recruited 105 inpatients with a diagnosis of severe alcohol use disorder (SAUD) from detoxification centers in Belgium. They also enrolled 73 healthy controls matched in terms of age and gender. The participants with SAUD had abstained from alcohol for at least 10 days at the time of testing.

To assess rejection sensitivity, the researchers used the Adult Rejection Sensitivity Questionnaire (ARSQ), which measures anxiety and estimated probability of rejection in imagined social situations. They computed scores for two components of rejection sensitivity: Anxious Anticipation and Rejection Expectancy.

Additionally, the study assessed interpersonal problems and psychopathological symptoms using various validated measures, including the Inventory of Interpersonal Problems, Beck Depression Inventory, State-Trait Anxiety Inventory, and Liebowitz Social Anxiety Scale.

The study’s findings revealed that patients with SAUD exhibited heightened anxious rejection expectations, as indicated by significantly higher scores in Anxious Anticipation compared to healthy controls. However, there were no significant differences in Rejection Expectancy between the two groups. This suggests that individuals with SAUD tend to anticipate rejection more anxiously than the general population but do not necessarily expect rejection at a higher rate.

Furthermore, the researchers discovered associations between Anxious Anticipation and interpersonal problems in SAUD patients. Specifically, Anxious Anticipation was positively correlated with interpersonal difficulties related to being self-centered, socially inhibited, non-assertive, overly accommodating, self-sacrificing, and intrusive/needy. Anxious Anticipation was also linked to symptoms of depression, trait anxiety, and social anxiety in SAUD patients.

“On average, individuals with an alcohol use disorder, compared to individuals with no history of psychiatric disorders or problematic alcohol use, report higher levels of anxiety about the possibility of being rejected,” Pabst told PsyPost. “In addition, the higher the levels of rejection anxiety reported by individuals with alcohol use disorder, the more these individuals reported relational difficulties such as tendencies to avoid social interactions, appear cold or distant, or fail to assert themselves.”

“This is important because it sheds light on a precise and presumably modifiable mental process that may contribute to interpersonal problems in individuals with alcohol use disorder. It may also be of direct relevance to the progression of the disorder, as excessive concerns about possible rejection may dissuade individuals in need from asking for help (from their entourage or from a professional), or lead them to comply with others’ expectations even if this compromises important personal goals (e.g., giving in to peer pressures to drink).”

While this study provides valuable insights into the relationship between rejection sensitivity and SAUD, it includes some limitations. The study relied on cross-sectional data, making it challenging to establish causal relationships. Future research could benefit from longitudinal designs to explore the complex interplay between SAUD, rejection sensitivity, interpersonal problems, and psychopathological symptoms over time.

“This study provides a ‘snapshot’ of the phenomena we are interested in,” Pabst said. “It offers an assessment, at a single moment in time, of certain variables (here, alcohol use disorder diagnosis, rejection sensitivity, and interpersonal problems). Such a study can reveal interesting relations among these variables, but cannot draw definitive conclusions about which caused the other(s). It cannot tell whether rejection sensitivity is a consequence of, or a risk factor for, alcohol use disorder, or both (although, importantly, it does not diminish the relevance of the findings, since elevated rejection sensitivity, regardless of its precise origin, likely plays an import role in the maintenance of alcohol use disorder).”

“Similarly, it cannot tell whether interpersonal problems are a cause or consequence of rejection sensitivity, or both,” Pabst continued. “Future studies assessing these variables at different points in time will be needed to address these questions. It must also be noted that although we used a well-validated measure of rejection sensitivity, self-report questionnaires are subject to biases. A promising avenue for future research will also be to extend the current study to individuals with problematic alcohol use, but who did not seek treatment, to examine if rejection sensitivity, and particularly anxious expectations of rejection, play a role in delayed access to care.”