Psychologists often make a distinction between fears and phobias. A fear is an emotional response to a real or perceived threat. Fears are common in the population and are often normal -- or at least innocuous -- reactions to objects or events. For example, many people fear spiders -- they experience a mild to moderate anxiety reaction when they see one.
A phobia is similar to a fear with one key difference: the anxiety they experience is so strong that it interferes with their quality of life and/ or their ability to function. Whereas many people fear spiders, only a small subsection of the population will meet criteria for a spider phobia. People who have a spider phobia often spend considerable time worrying about spiders, spend an inordinate amount of time ensuring they do not come in contact with a spider, and will avoid places and activities in order to avoid spiders.
Making a distinction between a fear and a phobia is useful because they are qualitatively very different problems.
Similarly, we can make a distinction between being afraid of rejection and being phobic of rejection. Whereas most people are at least mindful and vigilant for rejection (it hurts [1], so it is best to avoid it if possible), there is a subsection of the population that would be considered rejection phobic. While these two groups -- fearful and phobic -- obviously share some commonalities, they are fundamentally different groups.
When someone has a real phobia, they spend an inordinate amount of time or make an unnecessarily large effort to avoid the thing they fear. The terms "inordinate" and "unnecessarily" are used to highlight the discrepancy between the level of fear and preventative action, and the actual probability of harm.
Re-arranging your day and even your life to avoid being near a harmless spider (the vast majority of spiders on the planet are non-threatening) is extreme and unnecessary.
Similarly, taking great pains to avoid rejection when such a threat is low is also a defining feature of someone who has a phobia of rejection. An interesting thing about people with rejection phobia is their creative efforts to avoid rejection. Indeed, while it is usually easy to spot a spider phobic, it is not always obvious to spot a rejection phobic, because avoidance can includebehaviours that are obvious and those that are quite subtle.
Obvious avoidance of rejection would include avoidance of relationships and social situations. When this type of avoidance interferes with functioning and quality of life, we are likely talking about a significant mental health problem.
However, avoidance can also be more subtle. For example, spending an inordinate amount of time on one's physical appearance could be a form of rejection avoidance. The logic of this strategy is as follows -- if I can look good all the time, I significantly reduce the chances of being rejected. Similar to the example of obvious avoidance, if the amount of time spent on physical appearance interferes with quality of life and functioning, it can be considered a significant mental health issue.
In my own practice, I have observed a very interesting phenomenon among people with rejection phobia. I will often ask someone how likeable or attractive they think they are on a scale from 1 to 10, in order to gauge their self-beliefs. I typically hear the number "7" a lot of the time. Most people seem to rank themselves around this number, which on the surface seems great - as "7" is technically above average on a 10-point scale.
Unfortunately, the person with rejection phobia is not happy with a "7" - they want a "9" or "10." Their preference for the top end of the scale reminds me of a test that is often done with spider phobics. In order to measure how strong a phobia is, psychologists can use a Behavioural Approach Test (BAT), where you put the person in a room with a spider and measure how close (ex: in meters) they are willing to get to the spider.
The 10-point rating scale is similar to the BAT in that it reveals how close someone is willing to be to the "feared" end of the scale. Being a 7/ 10 on likeability for those with rejection phobia can be like a spider phobic being 7 meters from a spider - both distances are still too close for their liking, despite being a safe distance away.
Treating Rejection Phobia
When a spider is actually dangerous, then the person's fear and avoidance behaviour is considered normal and adaptive. If you had good evidence that there were deadly spiders or snakes living in your house, then being anxious and avoidant would be a good idea.
Similarly, if the threat of rejection and social isolation is probable, either because of characteristics you possess (ex: lack of social skills) or characteristics of your environment (ex: the people in your life), then being anxious and avoidant could be considered adaptive as well. It is understandable to want to avoid pain that is probable.
In both types of scenarios -- deadly snakes or probable rejection -- it is advisable to consult an expert to handle the situation.
A good psychologist will not simply tell you that everything is fine if things are not fine -- which includes assessing whether you have personal qualities that need modification. An honest and objective assessment of "likeability" is an important first step in dealing with this issue. If you have qualities or behaviours that are in need of fixing, then they should be addressed with a qualified expert. If you are deemed to be a "likeable" person and the people in your life seem to like and accept you, then the problem is in your head -- which would also require change as rejection is perception based. If you believe you are being rejected, then the pain is real and felt -- regardless of whether another person is actually rejecting you.
Rejection phobia is a problem that can seriously impair one's life, especially when it interferes with the formation and maintenance of close, interpersonal relationships. Properly identifying rejection phobia can be difficult at times and the person may not be fully aware that they are as phobic as is actually the case.
As mentioned, avoidance can be subtle but harmful -- there is often a pattern of avoidance built into the person's life that serves to avoid rejection, but on the surface is not obvious to others.
These are just some of the example of how someone can subtly avoid painful rejection and yet appear to most people (even themselves) as being functional and healthy:
1. Focusing on work and career to the exclusion of social relationships
2. Being socially engaged but avoiding intimacy and closeness, and
3. Overcompensating (ex: always trying to be above average in things like intelligence, humour and attractiveness)
Many psychologists have clients who present with depression and anxiety and the client has no idea as to what could be the cause.
It is only after multiple therapy sessions that both the therapist and client learn about the true impact that rejection phobia is having on their lives.