Does Self-Silencing Behavior Mediate the Relation Between Rejection Sensitivity and Sexual Violence Victimization?

Abstract

Previous research reveals that rejection sensitivity is associated with both sexual violence victimization and self-silencing behavior, yet the association among these variables has not been examined. As the foundation for this study, we propose a theoretical model that integrates these constructs. Using mediational analyses with bootstrapping, the results from a sample of 241 heterosexual college women revealed that consistent with the proposed model, self-silencing mediated the link between rejection sensitivity and reports of unwanted sexual contact and rape. The implications of the findings for the prevention of victimization/revictimization and interventions with victimized women are discussed.

Keywords

rejection sensitivity self-silencing behavior sexual violence victimization

Introduction

Sexual violence victimization (SVV) is a prevalent and pervasive phenomenon that affects many women; one in five women (20%) report a completed rape within their lifetime (Black et al., 2011) and one in three women endorse unwanted sexual contact in their lifetime (Smith et al., 2017). Broadly, sexual violence refers to sexual behavior or acts against a nonconsenting individual. It is a nonlegal term that includes a range of behavior such as assault, rape, harassment, and stalking. Sexual violence may be perpetrated through a variety of means such as physical aggression, verbal coercion, or the unwanted administration of alcohol or other substances (Abbey et al., 2004; Kanin, 1967; Rape, Abuse, and Incest National Network, n.d.).

Sexual violence is ubiquitous on college campuses; approximately 20% of women have experienced sexual assault during their college years (Krebs et al., 2009). Moreover, college-aged women are three times times more likely to be sexually assaulted than any other age group of women (Sinozich & Langton, 2014). In comparison to college women without victimization experiences, victims report a greater prevalence of psychopathology, trauma-related symptoms, pregnancies, and sexually transmitted diseases (Kaltman et al., 2005; Kilpatrick et al., 2007). Given these myriad detrimental consequences, it is important for researchers to continue to advance our understanding of factors and mechanisms that increase college women's risk of becoming victims of sexual violence. Findings from such investigations can shed light on the targets of future prevention and intervention efforts (Tirabassi et al., 2017). The target population was chosen given the high incidence rate of victimization and revictimization on college campuses (Krebs et al., 2009; Sinozich & Langton, 2014).

Prior research reveals that the risk of a person becoming a victim of sexual violence depends on numerous situational and personal factors (Basile et al., 2021; East & Hokoda, 2015; Patterson et al., 2022). Furthermore, there is substantial evidence to suggest that individuals who are revictimized display a specific subset of characteristics (Classen et al., 2005; Relyea & Ullman, 2017); by studying these characteristics, preventative measures and interventions can be designed to mitigate the risk, correlates, and consequences of victimization and revictimization.

Thus, in an effort to expand the current literature, the present study centers on the personal characteristics of victims. This focus on victim characteristics in no way is intended to imply the responsibility of or blame for the victim of sexual violence, as responsibility for the offense lies solely with the offender (Abbey, 2011). Rather, this focus was chosen because gathering more knowledge of victim characteristics may aid advocates and clinicians in their efforts to reduce the experience of sexual violence in this vulnerable population of women (Basile, 2015).

Rejection Sensitivity and SVV

There is evidence that rejection sensitivity as a feature of personality systems (Depue & Lenzenweger, 2005; Lenzenweger & Depue, 2016) is associated with risk for SVV (Bekele et al., 2011). Rejection sensitivity constitutes a bias toward the perception of rejection coupled with maladaptive behavioral responses (Downey & Feldman, 1996; Sun et al., 2018). Specifically, it has been defined as the tendency to “anxiously expect, readily perceive and overreact” to social rejection (Downey & Feldman, 1996, p. 1327). Invalidating experiences with attachment figures and peers may predispose individuals to heightened sensitivity to rejection (Downey & Feldman, 1996; Zimmer-Gembeck et al., 2014). Such adverse relational experiences may prime individuals to become more vigilant to the possibility of rejection in the future by heightening physiological arousal, increasing sensitivity to ambiguous social cues, and activating cognitive patterns that lead to misperception of social cues (Downey et al., 2004; Dyck et al., 2009; Roepke et al., 2012)

Of note, highly rejection-sensitive individuals are at greater risk of victimization because of attempts to prevent rejection, even at the cost of personal safety. Adolescent girls high on rejection sensitivity are more likely to engage in risky behaviors to avoid rejection (Purdie & Downey, 2000) and thus may be more likely to tolerate sexual violence. Moreover, highly rejection-sensitive individuals may struggle to assert themselves when pressured by an intimate partner. Indeed, data indicate that lower assertiveness is a correlate of SVV (Testa et al., 2007). Additionally, rejection sensitivity has been linked to lower perceived power in romantic relationships, with highly rejection-sensitive women showing difficulty in negotiating condom use even in scenarios that were high risk for the contraction of HIV (Berenson et al., 2015).

Notably, high levels of rejection sensitivity may be associated with revictimization. Research has found that individuals with a history of intimate partner violence (IPV) exposure are more likely to engage in risky sexual behavior and perceive others as wanting to have sex after a social rejection experience (Woerner, Kopetz et al., 2016; Woerner et al., 2016). A need to feel accepted, particularly after an incident of sexual violence, could constitute a significant risk for revictimization. Self-silencing behavior may be a mechanism that can explain the relation between rejection sensitivity and victimization risk, more generally.

Self-Silencing Behavior

Rejection sensitivity correlates with self-silencing behavior (Romero-Canyas et al., 2013), which can be defined as the act of silencing the self for the sake of a relationship (Jack, 1991). Logically, individuals who tend to exhibit this type of behavior should be more likely to acquiesce to others’ needs in the context of a relationship (Romero-Canyas et al., 2013), even when that acquiescence may come at a personal cost. Self-silencing has been conceptualized as a relational schema related to gender-based socialization, with women socialized to engage in self-silencing behavior in romantic relationships (Jack & Dill, 1992). Self-silencing behavior can have deleterious consequences because it involves the suppression of one's own desires for the sake of someone else's needs, which in turn can lead to inequality in a relationship (Jack & Dill, 1992). Rejection sensitivity and self-silencing behavior in romantic relationships have been linked across different age groups (Harper et al., 2006; Purdie & Downey, 2000; Romero-Canyas et al., 2013).

Furthermore, self-silencing behavior may be a risk factor for SVV. One possible mechanism by which it may serve as a risk factor pertains to the contribution of self-silencing behavior to ambiguous communication about one's respective wants and needs to be given that ambiguous communication during sex has been associated with SVV (Krahé et al., 2000). Notably, self-silencing behavior has been linked to unwanted, unprotected sex when an individual is coerced (Teitelman et al., 2011). Acquiescing to verbal pressure by silencing the self may manifest in difficulties negotiating one's needs, particularly when an individual is under duress.

To date, self-silencing behavior has been studied predominantly in the context of romantic relationships, though the concept could also be applied to lower-investment scenarios such as hookups that involve spontaneous and high-risk negotiations of sexual behavior. As evidenced by research on condom negotiation (e.g., Berenson et al., 2015) self-silencing behavior or acquiescing to another's needs may occur during a hookup, particularly when a partner uses coercive tactics to obtain gratification. Self-silencing behavior goes beyond problems with assertiveness in which individuals have difficulties contending and maintaining their needs (Testa et al., 2007); it is the act of putting one's partner and the relationship before oneself.

Summary of Study Model and Hypotheses

Sexual violence is extremely prevalent on college campuses (Sinozich & Langton, 2014). To better understand the relation between self-silencing behavior and SVV among college-aged women, this study tests a model (see Figure 1) of theoretical relations among rejection sensitivity, self-silencing behavior, and SVV in which self-silencing potentially helps to explain the process through which rejection-sensitive and SVV are related in this high-risk population. In accord with the model, it was hypothesized that (1) rejection sensitivity would be a significant and positive predictor of self-silencing and reported SVV, (2) self-silencing would be a significant positive predictor of reported victimization, and (3) self-silencing behavior would statistically mediate the relation between rejection sensitivity and SVV (see Figure 1).

Figure 1.

Hypothesized mediation model.

Method

Participants

A total of 241 college women who self-identified as heterosexual participated in this study. Age and racial identification were measured based on two self-report questions. The first question asked the participant to report their age. The second question requested the participant to report their racial/ethnic identification in accord with the following categories: Caucasian, Black/African American, Hispanic, Asian/Pacific Islander, Native American, biracial, and multiracial. The average age of the participants was approximately 19 years old (M = 18.96, SD = 1.02). The majority of the participants identified as Caucasian (71%), with Asian/Pacific Islander as the second, most-commonly reported racial/ethnic identification (13%). In terms of relationship status, most participants reported that they were not in a romantic relationship (56%), with less than half of the participants (44%) reporting that they had a romantic partner.

Procedure

Participants were recruited for this study from Binghamton University's (State University of New York) psychology department from a pool of students currently enrolled in the SONA system for psychology courses. Those agreeing to participate were screened for their appropriateness (i.e., meeting inclusion criteria) by responding to questions presented via a short survey on Qualtrics. Those who met the inclusion criteria were invited into the laboratory to enroll in the study where they completed a battery of paper-and-pencil surveys (along with two laboratory assessments not included as part of these analyses).

Participants came in for two visits. During their first visit, participants were given study instructions on laboratory assessments and questionnaires. Afterward, they had their photograph taken for a laboratory assessment. During the second visit, participants filled out questionnaires and completed laboratory assessments involving a chatroom-based paradigm and responding to a series of vignettes on dating scenarios. As this study involved a sensitive topic (SVV), any participant who preferred to un-enroll at any point was debriefed. At the end of both visits, the research assistant explained that the study explored risk factors for SVV in accord with a script. Participants were subsequently given sexual violence prevention packets with educational material and resources. Data from four participants were not included in analyses due to disqualifying answers related to age, gender identity, and/or sexual orientation. However, these participants still received credit for their participation in the study. Additionally, five participants did not complete the study and thus, their data also were excluded from analyses though they received credit for their participation.

Self-Report Psychometric Measures

Marlowe-Crowne Social Desirability Scale (MCSDS). The MCSDS-Short Form (Crowne & Marlowe, 1960) was used to assess the degree to which participants aim to present themselves in a positive light via self-report. This questionnaire asks participants to respond to 33 true–false questions such as “I can remember playing sick to ‘get out’ of something.” This self-report measure has been used to validate other self-report measures by testing for response bias. In this study, the MCSDS demonstrated high internal consistency reliability (Cronbach's alpha = .72).

Rathus Assertiveness Schedule (RAS). The RAS (Rathus, 1973) was used to examine assertiveness. This questionnaire asks participants to respond to 30 questions on a Likert scale of −3 to 3, with lower scores indicating that the statement is “very unlike me.” An example item is, “There are times when I look for a good, vigorous argument.” The RAS has moderate to high test–retest reliability and split-half reliability (Rathus, 1973). In this study, the RAS demonstrated high internal consistency reliability (Cronbach's alpha = .87).

Rejection Sensitivity Questionnaire (RSQ). The RSQ (Downey & Feldman, 1996) was used to assess rejection sensitivity. This questionnaire asks participants to respond to 18 scenarios with two questions that ask how anxious one might be and how likely the other person is to respond in this scenario.

These questions are responded to on a 1–6-Likert scale. An example scenario is “you can ask someone in class if you can borrow his or her notes.” The participant must indicate how concerned they would be about asking for notes and how likely the other person would be to give them their notes. In terms of psychometric properties, the RSQ demonstrates high test–retest reliability and high internal consistency reliability (Downey & Feldman, 1996). In this study, the RSQ demonstrated high internal consistency reliability (Cronbach's alpha = .89).

Sexual Experiences Survey, Short-Form Version (SES-SFV). SVV was measured using the SES-SFV (Koss et al., 2007). This questionnaire asks participants to respond to scenarios concerning sexual violence experiences. Ratings are made in terms of frequency of the experience (0–3+) and broken down into categories for each scenario (sexual coercion, using substances to obtain sexual activity, physical force). An example scenario is “Someone fondled, kissed, or rubbed up against the private areas of my body (lips, breast/chest, crotch or butt) or removed some of my clothes without my consent (but did not attempt sexual penetration).” By avoiding legal terms and nonjudgmental specific language, the SES captures the heterogeneity and frequency of SVV, which is advantageous in that SVV has been underreported by other surveys (Fisher & Cullen, 2000). There are a variety of methods to score the SES-SFV because of the depth and breadth of data provided. There is no “gold standard” scoring methodology due to the high convergent validity between methods (Davis et al., 2014). For this study, victimization was broken down into categorical data, as the frequency of victimization does not capture the type of victimization experiences that participants report. Category refers to the presence or absence of each type of victimization defined. Scoring was conducted in line with the revised SES-SFV instructions (Koss et al., 2008). Self-reported categories were constructed as nominal, binary criterion variables, which included a broad victim versus nonvictim category, as well as unwanted sexual contact, attempted coercion, coercion, attempted rape, and rape. A condom use coercion category was added for this study; it was not included in the original questionnaire. Each binary indicator (associated with a particular form of victimization) was coded in the dataset as 0 = did not report 〈form of〉 victimization, 1 = did report 〈form of〉 victimization. While the full set of items included references to victimization in the past year as well as since the age of 14, only those items addressing the experience of victimization in the past year were utilized (given the study's focus on college-aged women). The SES demonstrates moderate to high levels of internal consistency and test–retest reliability when used with samples of adult women (Krahé et al., 1999; Messman-Moore et al., 2000). In the current sample, the KR-20 reliability coefficient indicated high levels of internal consistency reliability for the binary indicators (KR-20 = 0.85).

Silencing the Self-Scale (STSS). The STSS (Jack & Dill, 1992) was used to measure self-silencing behavior. This questionnaire asks participants to respond to 31 questions on a 1–5-Likert scale, with lower scores indicative of strongly disagreeing. An example item is “Caring means putting the other person's needs in front of my own.” The STSS includes four subscales: externalized self-perception, care as self-sacrifice, silencing the self, and the divided self that can be treated either separately or in total. For this study, the full-scale STSS demonstrated high internal consistency reliability (Cronbach's alpha = .88).

Data Analysis

Descriptive statistics included means and standard deviations for each variable of interest. Then, Pearson's correlation coefficients were collected to illustrate the relation between variables. We tested our main hypotheses (see Figure 1) using Hayes’ SPSS PROCESS macro (Hayes, 2017). We relied on the Model 1 template, which allowed us to test for simple mediation of the effect of rejection sensitivity on victimization, with self-silencing serving as the mediating variable. Additionally, the template allowed us to include the RAS and Crowne-Marlow Scale and a binary indicator of relationship status (coded 0 = not in a relationship, 1 = in a relationship) as covariates to statistically control the effects of assertiveness, social desirability, and relationship status from the direct and indirect effects specified by our hypothesized model. Finally, Model 1 allows for the inclusion of a binary outcome variable, which was necessary given our binary sexual violence indicators.

Model 1 tests for mediation using a two-step regression modeling framework described in Steps 2 and 3 by Baron and Kenny (1986). First, to test for the direct effect of the independent variable on the mediator, the mediator was regressed onto the independent variable (as well as any covariates). Then, the outcome/dependent variable was regressed on the proposed mediator, the independent variable, and the covariates. Given the outcome in each of our models is binary, Model 1 produced binary logistic regression results for the second regression (as opposed to ordinary least square regression when the mediator was regressed onto the independent variable and covariates).

The indirect effect in each model was computed as the product of (a) the path (direct effect) from rejection sensitivity to self-silencing and (b) the path (direct effect) of self-silencing on victimization. This test was performed in PROCESS using 5,000 bootstrap standard errors and confidence intervals. Since each of the models included the same specified relation between rejection sensitivity and self-silencing and with the same covariates, we only discuss the results of these relations once.

Results

Descriptive Statistics and Correlations

Table 1 contains means and standard deviations for the study measures. Table 2 contains the correlations among these measures, as well as the binary indicators of whether an individual reported having been a victim of various forms of sexual violence.

Table 1.

Descriptive Statistics for Study Measures.

Measure	Mean	SD
RSQ	9.90	3.58
STSS	78.58	16.42
RAS	−9.84	25.60
MCSDS	16.84	4.59

Note. Rejection sensitivity (RSQ), self-silencing behavior (STSS), assertiveness (RAS), and social desirability (MCSDS). RSQ=Rejection Sensitivity Questionnaire; STSS=Silencing the Self-Scale; RAS=Rathus Assertiveness Schedule; MCSD=Marlowe-Crowne Social Desirability Scale.

Table 2.

Bivariate Correlations for Questionnaire Data.

Variable	STSS	RAS	MCDS	Relation Status	Victim	Sexual Contact	Attempt Coercion	Coercion	Attempt Rape	Rape	Condom
RSQ	.44*	−.39*	−.018	−.14*	.07	.03	.09	.12	.08	.09	.13*
STSS		.53*	−.01	−.08	.14*	.16*	.12	.11	.16*	.04	.17*
RAS			−0.10	−.03	−.04	−.09	−.004	−.05	−.01	.05	−.16*
MCDS				−.06	−.08	−.09	−.03	−.08	−.13	−.10	−.08
Relation Status					−.02	−.15	−.02	−.09	.02	−.08	.15*

Note. *p < .01, two-tailed. RSQ = Rejection Sensitivity Questionnaire; STSS = Silencing the Self-Scale; RAS = Rathus Assertiveness Schedule; MCDS = Marlowe–Crowne Social Desirability Scale. Relation is short for relationship status (0 = not in a relationship; 1 = in a relationship). Some questionnaire names were shortened to accommodate spacing.

Mediation Analysis

Results from the first-stage regression model revealed that in accord with what was predicted, rejection sensitivity was a positive predictor of self-silencing behavior (b = 1.22, SE = .27, p < .01). Individuals scoring higher on the RSQ endorsed greater self-silencing behaviors for each category of SVV after controlling for relationship status, social desirability, and assertiveness.

Across the second-stage logistic regression model, there was little evidence of direct effects of self-silencing on reported SVV across categories. Nevertheless, self-silencing was a predictor of reported unwanted sexual contact (b = .0242, SE = .0115, p = .0351) and reported attempted rape (b = .0371, SE = .0157, p = .0186). These results indicated that individuals reporting greater self-silencing behavior were more likely to report being a victim of attempted rape or unwanted sexual contact. With the exception of the tests of the direct effect of self-silencing on unwanted sexual contact and attempted rape, most results ran contrary to our hypothesis concerning the effect of self-silencing on reported victimization.

With regard to the mediation analyses, there were only two significant findings. First, the indirect effect of rejection sensitivity on reported attempted rape was positive and significant, bootstrap 95% CI = (.0064 ≤ .0452 ≤ .1045). Second, the indirect effect of rejection sensitivity on reported unwanted sexual contact was positive and significant, with bootstrap 95% CI = (.0017 ≤ .0295 ≤ .0667). These two results suggest the possibility of mediated effects, at least with respect to some types of victimization.

Discussion

To advance our understanding of SVV among college-aged women, this study explored self-silencing behavior as a mediator of the relation between rejection sensitivity and SVV. Findings on the association between rejection sensitivity and both self-silencing behavior and SVV were mixed. As hypothesized, rejection sensitivity was correlated with self-silencing behavior. Yet, contrary to what was predicted, rejection sensitivity was not associated with any category of SVV. Further, a significant relation emerged between self-silencing behavior and two forms of SVV, namely unwanted sexual contact and attempted rape. Most notably, the relation between rejection sensitivity and both unwanted sexual contact and attempted rape was mediated by self-silencing behavior. Taken together, the findings lend partial support to the hypothesized mediation model and underscore the likelihood that self-silencing serves as one mechanism for explaining the rejection sensitivity—SVV link.

As hypothesized, rejection sensitivity was a positive predictor of self-silencing behavior. This finding is consistent with previous literature on the link between these constructs (Harper et al., 2006; Purdie & Downey, 2000). However, the finding that rejection sensitivity was not associated with any category of SVV was contrary to results from previous studies demonstrating an association between rejection sensitivity and exposure to sexual violence in intimate partner relationships (Young & Furman, 2013) as well as difficulties negotiating condom use with one's partner in a long-term romantic relationship (Berenson et al., 2015). Yet the finding is worthy of further exploration as it suggests the rejection sensitivity personality dimension, on its own, may not increase young women's risk for SVV. It is possible that this is particularly true for individuals who are not partnered given that the limited existing research focuses on individuals in committed relationships. Future studies may benefit from exploring relationship status as a potential moderator of the relation between rejection sensitivity and SVV.

The second finding that was somewhat surprising was that self-silencing was not consistently associated with SVV. More consistent associations were hypothesized given prior findings linking self-silencing behavior to condom use coercion (Teitelman et al., 2011). In addition, the correlation between self-silencing and the two specific forms of SVV in the current study, namely unwanted sexual contact and attempted rape, is challenging to explain given that both types of victimization experiences involve physical rather than verbal coercion and previous research has shown that it is the ambiguous communication that often accompanies verbal coercion that is linked to SVV (Krahé et al., 2000). Findings from the present study when taken together with results from earlier investigations suggest that the role of self-silencing may vary across victimization categories and may depend on sample characteristics.

The most significant finding that emerged was the partial support for the mediation model. Specifically, we found that self-silencing might introduce a risk for unwanted sexual contact or attempted rape for individuals high in rejection sensitivity, but the same is not true for other categories of SVV. Thus, it appears that self-silencing varies in the role that it plays as a mechanism for explaining the link between rejection sensitivity and SVV. Inconsistencies in the link between these constructs may also reflect the extent to which a victim is confronted with having to negotiate their needs in each scenario (Berenson et al., 2015), which may not be fully captured by discrete categories of victimization. Perhaps, the frequency of victimization could be considered across categories with a summed total to more comprehensively show the relation between rejection sensitivity, self-silencing, and the spectrum of victimization experiences. Further, self-silencing may be treated as a potential moderator in the relation between rejection sensitivity and victimization in the future because it may influence the strength of the relation between these variables rather than serving as a mechanism. Lastly, the hypothesized model that guided the current investigation should be examined with other samples, such as women with a history of IPV. Doing so has the potential to yield different findings given that a recent study demonstrated a link between rejection sensitivity and IPV victimization (Kahya, 2021).

Strengths and Limitations

The study has several notable strengths. The first is the sample. College-aged women are three times more likely than any other demographic of women to experience SVV (Sinozich & Langton, 2014) and college presents a unique context that can exacerbate the risk of victimization. Second, sexual violence was not explored from a purely legal perspective. Variance in how sexual victimization can be defined was accounted for through collecting data on unwanted sexual contact and coercion, including attempted coercion and rape, which in many states do not hold up to legal standards as instances of SVV that can be pursued in a court of law. Third, a novel aspect of this study is the inclusion of questions on condom use coercion. While the SES-SFV encapsulates an expansive definition of SVV, it does not probe for condom use coercion. Lastly, this study sought to explore and comment upon the personality characteristics of victims. While somewhat of a risk in terms of how the data could be used, in terms of its potential for victim-blaming, hopefully, the benefits outweigh the costs. The majority of current empirical literature focuses on perpetrators and the environmental context, with limited data on victims and their characteristics. From an epidemiological framework, it is crucial to understand the unique characteristics of victims to inform the design of personality-informed preventative and intervention efforts for SVV and revictimization.

Despite the study's strengths, it has several notable limitations. First, the sample was drawn from only one university, which may limit the generalizability of the findings to other college campuses. Second, the unusual procedure of acquiring a photograph for the laboratory assessment may introduce bias. Participants may have been intimidated by this task, which could have limited their willingness to disclose experiences with SVV. Third, because the data are cross-sectional and there was no experimental manipulation, the interpretation of models considering personality-based risk factors for SVV should be done with a degree of caution. However, a current debate in the literature related to temporality and mediation suggests that because mediation is simply a tool to discover possible causal relations without inferring causality, it is acceptable to interpret such results with caution (Agler & De Boeck, 2017).

Future Directions

Given the limited research on the relation between personality characteristics and SVV, future studies should include examining risk and protective factors on the basis of personality dimensions. In addition, this work should attend to situational factors known to increase women's vulnerability for SVV such as participation in Greek (fraternity, sorority) culture among college students (DeKeseredy & Kelly, 1995), risk-taking behaviors such as substance misuse (Devries et al., 2014), relationship variables including peer relations and attachment (Bekele et al., 2011), and sexual attitudes (Nason & Yeater, 2012). While this study singularly focused on personality-based vulnerabilities, the most fruitful explorations of vulnerability to SVV are likely to involve the intersection among these variables. It is unlikely that there is a “one-size-fits-all” model for predicting victimization; vulnerability for victimization might differ based on how these variables intersect for each classification of victimization. Hopefully, a more in-depth study of personality characteristics associated with SVV can inform the development of personality-informed programs that serve to empower victims and individuals at risk for victimization through psychoeducation, targeted treatments, and advocacy.

Footnotes

Acknowledgments

I would like to thank Nadine Kaslow, PhD, ABPP for assisting me with editing my manuscript. I would also like to thank Wayne Kashinsky for helping me design my study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Stephanie L. Freitag

Author Biographies

Stephanie Freitag is an Adjunct Professor at the Emory University School of Medicine where she participates in research, and advocacy. She received her PhD in clinical psychology from Binghamton University (State University of New York) in 2021. During her time in graduate school, she studied borderline personality disorder. Clinically, she specializes in treating severe psychopathology and serious mental illness. She has published several articles and chapters on bipolar disorder, suicidal behavior, and intimate partner violence. Dr. Freitag has a private practice in New York and continues to engage in scholarship and social justice advocacy in addition to her clinical responsibilities.

H. Michael Crowson is an Associate Professor in the Learning Sciences Program in the Department of Educational Psychology at the Jeanine Rainbolt College of Education at The University of Oklahoma. He teaches graduate courses in introductory, intermediate, and advanced graduate courses in statistics and research methodology. His substantive research interests fall in areas of educational, personality, and social psychology where he has published on topics such as epistemological beliefs, need for closure, authoritarianism, attitudes toward human rights, and attitudes toward inclusion.

Mark Lenzenweger is a Distinguished Professor of Psychology at SUNY-Binghamton and a Professor of Psychology in Psychiatry (Adjunct) at Weill Cornell Medical College. He was a tenured professor at Cornell before moving on to Harvard. He has nearly 200 research publications, including a monograph on schizotypy and schizophrenia (2010) and 7 edited scholarly volumes, one of which is the field standard for theories of personality disorder. Dr. Lenzenweger has pursued psychological science research for 40 years in schizotypy and schizophrenia, longitudinal study of personality and severe personality disorders, advanced statistical methods for detecting latent classes, personality neuroscience, and neurobehavioral systems in personality disorder.

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