Physical and social pains in borderline disorder and neuroanatomical correlates: A systematic review

Current Psychiatry Reports

Volumn 16, Issue 5, 2014, Pages

  Ducasse, Déborah ^a   Courtet, Philippe ^a   Olié, Emilie ^a  

^a UNIV MONTPELLIER   (France)

Author keywords

Borderline personality disorder; Neuroimaging; Physical pain; Physiopathology; Psychological pain; Self injurious behavior; Social exclusion; Social pain

Indexed keywords

BETA ENDORPHIN; METENKEPHALIN; NALOXONE; NARCOTIC ANALGESIC AGENT;

AUTOMUTILATION; BORDERLINE STATE; CHRONIC PAIN; CORRELATION ANALYSIS; DISEASE SEVERITY; EMOTIONALITY; FACIAL EXPRESSION; FUNCTIONAL MAGNETIC RESONANCE IMAGING; HUMAN; LIMBIC CORTEX; NEUROANATOMY; NEUROIMAGING; NONHUMAN; PAIN; PERCEPTION; PHYSICAL PAIN; PREFRONTAL CORTEX; PREVALENCE; PROTEIN POLYMORPHISM; PSYCHOLOGICAL PAIN; REVIEW; SELF ESTEEM; SOCIAL BEHAVIOR; SOCIAL EXCLUSION; SOCIAL PAIN; SOMATOSENSORY CORTEX; SYSTEMATIC REVIEW; AMYGDALOID NUCLEUS; BRAIN; BRAIN MAPPING; MENTAL STRESS; PAIN THRESHOLD; PATHOPHYSIOLOGY; PHYSIOLOGY; PSYCHOLOGICAL ASPECT;

AMYGDALA; BORDERLINE PERSONALITY DISORDER; BRAIN; BRAIN MAPPING; HUMANS; PAIN; PAIN THRESHOLD; SELF-INJURIOUS BEHAVIOR; STRESS, PSYCHOLOGICAL;

EID: 84897032331     PISSN: 15233812     EISSN: 15351645     Source Type: Journal    
DOI: 10.1007/s11920-014-0443-2     Document Type: Review

References (97)

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
2. Kaplan H, Sadock B, Grebb J. Kaplan and Sadock's Synopsis of Psychiatry. Baltimore: Williams & Wilkins; 1994.
3. Paris J, Zweig-Frank H. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42:482-7. (Pubitemid 33095793)
4. Brodsky BS, Groves SA, Oquendo MA, Mann JJ, Stanley B. Interpersonal precipitants and suicide attempts in borderline personality disorder. Suicide Life Threat Behav. 2006;36:313-22. (Pubitemid 44030746)
5. Herpertz S. Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of self-injurers. Acta Psychiatr Scand. 1995;91:57-68.
6. Welch SS, Linehan MM. High-risk situations associated with parasuicide and drug use in borderline personality disorder. J Pers Disord. 2002;16:561-9. (Pubitemid 36176972)
7. Bohus M, Limberger M, Ebner U, Glocker FX, Schwarz B, Wernz M, et al. Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res. 2000;95:251-60.
8. Kleindienst N, Bohus M, Ludäscher P, Limberger MF, Kuenkele K, Ebner-Priemer UW, et al. Motives for nonsuicidal self-injury among women with borderline personality disorder. J Nerv Ment Dis. 2008;196:230-6. (Pubitemid 351417108)
9. Ludäscher P, Greffrath W, Schmahl C, Kleindienst N, Kraus A, Baumgärtner U, et al. A cross-sectional investigation of discontinuation of self-injury and normalizing pain perception in patients with borderline personality disorder. Acta Psychiatr Scand. 2009;120:62-70.
10. Sansone RA, Whitecar P, Meier BP, Murry A. The prevalence of borderline personality among primary care patients with chronic pain. Gen Hosp Psychiatry. 2011;23:193-7.
11. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA group. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
12. Magerl W, Burkart D, Fernandez A, Schmidt LG, Treede RD. Persistent antinociception through repeated self-injury in patients with borderline personality disorder. Pain. 2012;153:575-84. Compared to healthy controls, BPD patients have reduced unpleasantness of pain experience. Blunting of pain sensation is significantly predicted by the delay of SIB, suggesting an excess of endogenous anti-nociception as a result of multiple SIB.
13. Schmahl C, Bremner JD. Neuroimaging in borderline personality disorder. J Psychiatr Res. 2006;40:419-27. (Pubitemid 43833310)
14. Schmahl C, Meinzer M, Zeuch A, Fichter M, Cebulla M, Kleindienst N, et al. Pain sensitivity is reduced in borderline personality disorder, but not in posttraumatic stress disorder and bulimia nervosa. World J Biol Psychiatry. 2010;11:364-71. BPD patients have a significantly higher pain threshold at baseline and under stress conditions compared with patients suffering from post-traumatic stress disorder or bulimia nervosa, and to healthy controls.
15. Schmahl C, Greffrath W, Baumgärtner U, Schlereth T, Magerl W, Philipsen A, et al. Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain. 2004;110:470-9. (Pubitemid 38953313)
16. Pavony MT, Lenzenweger MF. Somatosensory processing and borderline personality disorder features: a signal detection analysis of proprioception and exteroceptive sensitivity. J Pers Disord. 2013;27:208-21. BPD patients do not present generalized somato-sensory deficits.
17. Cárdenas-Morales L, Fladung AK, Kammer T, Schmahl C, Plener PL, Connemann BJ, et al. Exploring the affective component of pain perception during aversive stimulation in borderline personality disorder. Psychiatry Res. 2011;186:458-60.
18. Nixon MK, Cloutier P. Ottawa Self-Injury Inventory 2005. Available at: http://www.insync-group.ca/publications/OSI-clinical-October-20051.pdf. Accessed 3 Jan 2014.
19. Russ MJ, Roth SD, Lerman A, Kakuma T, Harrison K, Shindledecker RD, et al. Pain perception in self-injurious patients with borderline personality disorder. Biol Psychiatry. 1992;32:501-11.
20. Kemperman I, Russ MJ, Clark WC, Kakuma T, Zanine E, Harrison K. Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Res. 1997;70:175-83. (Pubitemid 27288353)
21. van der Kolk BA, Perry JC, Herman JL. Childhood origins of self-destructive behavior. Am J Psychiatry. 1991;148:1665-71.
22. Russ MJ, Clark WC, Cross LW, Kemperman I, Kakuma T, Harrison K. Pain and self-injury in borderline patients: sensory decision theory, coping strategies, and locus of control. Psychiatry Res. 1996;63:57-65. (Pubitemid 26228648)
23. Russ MJ, Campbell SS, Kakuma T, Harrison K, Zanine E. EEG theta activity and pain insensitivity in self-injurious borderline patients. Psychiatry Res. 1999;89:201-14. (Pubitemid 30053002)
24. Ludäscher P, Bohus M, Lieb K, Philipsen A, Jochims A, Schmahl C. Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res. 2007;149:291-6. (Pubitemid 46108099)
25. Nijenhuis ER, Spinhoven P, van Dyck R, van der Hart O, Vanderlinden J. The development of the somatoform dissociation questionnaire (SDQ-5) as a screening instrument for dissociative disorders. Acta Psychiatr Scand. 1997;96:311-18. (Pubitemid 27496009)
26. Martín-Blanco A, Soler J, Villalta L, Feliu-Soler A, Elices M, Pérez V, Arranz MJ, Ferraz L, Alvarez E, Pascual JC. Exploring the interaction between childhood maltreatment and temperamental traits on the severity of borderline personality disorder. Compr Psychiatry. 2014;55(2):311-8.
27. Kraus A, Valerius G, Seifritz E, Ruf M, Bremner JD, Bohus M, et al. Script-driven imagery of self-injurious behavior in patients with borderline personality disorder: a pilot FMRI study. Acta Psychiatr Scand. 2010;121:41-51.
28. van der Kolk B, Greenberg M, Boyd H, Krystal J. Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress. Biol Psychiatry. 1985;20:314-25. (Pubitemid 16036397)
29. Coid J, Allolio B, Rees LH. Raised plasma metenkephalin in patients who habituallymutilate themselves. Lancet. 1983;2:545-6. (Pubitemid 13041553)
30. Davis GC, Buchsbaum MS, Naber D, Pickar D, Post R, van Kammen D, et al. Altered pain perception and cerebrospinal endorphins in psychiatric illness. Ann N YAcad Sci. 1982;398:366-73. (Pubitemid 13026803)
31. Richardson JS, Zaleski WA. Naloxone and self-mutilation. Biol Psychiatry. 1983;18:99-101. (Pubitemid 13195038)
32. Stanley B, Sher L, Wilson S, Ekman R, Huang YY, Mann JJ. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord. 2010;124:134-40.
33. Sher L, Stanley BH. Biological models of non-suicidal self-injury, in understanding nonsuicidal self-injury: origins, assessment, and treatment. Washington, DC: American Psychological Association; 2009.
34. Stanley B, Siever LJ. The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry. 2010;167:24-39.
35. Kalira V, Treisman GJ, Clark MR. Borderline personality disorder and chronic pain: a practical approach to evaluation and treatment. Curr Pain Headache Rep. 2013;17:350.
36. McWilliams LA, Higgins KS, Dick BD, Verrier MJ. A longitudinal investigation of pain-related social support preferences in a chronic pain treatment sample. Clin J Pain. 2013. doi:10.1097/01.ajp.0000435446.89019.f3.
37. Sansone RA, Pole M, Dakroub H, Butler M. Childhood trauma, borderline personality symptomatology, and psychophysiological and pain disorders in adulthood. Psychosomatics. 2006;47:158-62. (Pubitemid 43346965)
38. Sansone RA, Sansone LA. Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 2012;9:10-4. This article focuses on the association between chronic pain and BPD.
39. Tragesser SL, Bruns D, Disorbio JM. Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample. Clin J Pain. 2010;26:348-53.
40. Eisenberger NI, Lieberman MD. Why rejection hurts: a common neural alarm system for physical and social pain. Cogn Sci. 2004;8:294-300. (Pubitemid 38887445)
41. Kroll J. The challenge of the borderline patient. New York: WW Norton & Company; 1988.
42. Keuroghlian AS, Frankenburg FR, Zanarini MC. The relationship of chronic medical illnesses, poor health-related lifestyle choices, and health care utilization to recovery status in borderline patients over a decade of prospective follow-up. J Psychiatr Res. 2013;47:1499-506.
43. Kaplan MA, Korelitz BI. Narcotic dependence in inflammatory bowel disease. J Clin Gastroenterol. 1988;10:275-8.
44. Hatzitaskos P, Soldatos CR, Kokkevi A, Stefanis CN. Substance abuse patterns and their association with psychopathology and type of hostility in male patients with borderline and antisocial personality disorder. Compr Psychiatry. 1999;40:278-82. (Pubitemid 29319242)
45. Dulit RA, Fyer MR, Haas GL, et al. Substance use in borderline personality disorder. Am J Psychiatry. 1990;147:1002-7. (Pubitemid 20257509)
46. Eisenberger NL. The neural bases of social pain: evidence for shared representations with physical pain. Psychosom Med. 2012;74:126-35. Evidence suggests that physical and social pains rely on shared neural substrates.
47. Eisenberger NI. The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev. 2012;13:4214-434.
48. Leary MR. The role of low self-esteem in emotional and behavioral problems: why is low self-esteem dysfunctional? J Soc Clin Psychol. 1995;14:297-314.
49. Bowles DP, Armitage CJ, Drabble J, Meyer B. Self-esteem and other-esteem in college students with borderline and avoidant personality disorder features: An experimental vignette study. Personal Ment Health. 2013;7:307-19.
50. Shneidman ES. Perspectives on suicidology. Further reflections on suicide and psychache. Suicide Life Threat Behav. 1998;28:245-50. (Pubitemid 28503742)
51. Meerwijk EL, Ford JM, Weiss SJ. Brain regions associated with psychological pain: implications for a neural network and its relationship to physical pain. Brain Imaging Behav. 2013;7:1-14.
52. Zittel Conklin C, Westen D. Borderline personality disorder in clinical practice. Am J Psychiatry. 2005;162:867-75. (Pubitemid 40676198)
53. Zanarini MC, Frankenburg FR. Emotional hypochondriasis, hyperbole, and the borderline patient. J Psychother Pract Res. 1994;3:25-36.
54. Williams KD. Ostracism. Annu Rev Psychol. 2007;58:425-52.
55. Mauchnik J, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2010;12:46-55.
56. Williams KD, Jarvis B. Cyberball: a program for use in research on interpersonal ostracism and acceptance. Behav Res Methods. 2006;38:174-80. (Pubitemid 44945615)
57. Renneberg B, Herm K, Hahn A, Staebler K, Lammers CH, Roepke S. Perception of social participation in borderline personality disorder. Clin Psychol Psychother. 2012;19:473-80. BPD patients display a negative bias toward perceived participation in social situations. They feel more readily excluded independently of conditions of inclusion or exclusion during the Cyberball game.
58. Dixon-Gordon KL, Gratz KL, Breetz A, Tull M. A laboratory-based examination of responses to social rejection in borderline personality disorder: the mediating role of emotion dysregulation. J Pers Disord. 2013;27:157-71. BPD patients show increased interpersonal rejection sensitivity than controls. BPD patients are characterized by heightened threat to all social needs and nonspecific distress, but not overall negative affect during the Cyberball game.
59. Domsalla M, Koppe G, Niedtfeld I, Vollstädt-Klein S, Schmahl C, Bohus M, Lis S. Cerebral processing of social rejection in patients with borderline personality disorder. Soc Cogn Affect Neurosci. 2013. doi:10.1093/scan/nst176.
60. Arntz A, Dreesen L, Schouten E, Weertman A. Beliefs in personality disorders: a test with the personality disorder belief questionnaire. Behav Res Ther. 2004;42:1215-25. (Pubitemid 39179914)
61. Berenson KR, Downey G, Rafaeli E, Coifman KG, Paquin NL. The rejection-rage contingency in borderline personality disorder. J Abnorm Psychol. 2011;120:681-90.
62. Sadikaj G, Russell JJ, Moskowitz DS, Paris J. Affect dysregulation in individuals with borderline personality disorder: persistence and interpersonal triggers. J Pers Assess. 2010;92:490-500.
63. Tragesser S, Lippman Louis G, Trull Timothy J, Barrett KC. Borderline personality disorder features and cognitive, emotional, and predicted behavioral reactions to teasing. J Res Pers. 2008;42:1512-23.
64. Dixon-Gordon KL, Chapman AL, Lovasz N, Walters K. Too upset to think: the interplay of borderline personality features, negative emotions, and social problem solving in the laboratory. Personal Disord. 2011;2:243-60. BPD patients show reduced ability to resolve social problems and are more prone to find inappropriate solutions following induction of a negative emotion.
65. Chapman AL, Walters KN, Dixon Gordon KL. Emotional reactivity to social rejection and negative evaluation among persons with borderline personality features. J Pers Disord. 2012;6:1-14. BPD patients present higher levels of emotional reactivity, irritability, distress, and shame to social rejection than controls.
66. Limberg A, Barnow S, Freyberger HJ, Hamm AO. Emotional vulnerability in borderline personality disorder is cue specific and modulated by traumatization. Biol Psychiatry. 2011;69:574-82.
67. Staebler K, Renneberg B, Stopsack M, Fiedler P, Weiler M, Roepke S. Facial emotional expression in reaction to social exclusion in borderline personality disorder. Psychol Med. 2011;41:1929-38. Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in disturbed relationships in BPD patients.
68. Bland AR, Williams CA, Scharer K, Manning S. Emotion processing in borderline personality disorders. Issues Ment Health Nurs. 2004;25:655-72. (Pubitemid 39273159)
69. Donegan NH, Sanislow CA, Blumberg HP, Fulbright RK, Lacadie C, Skudlarski P, et al. Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biol Psychiatry. 2003;54:1284-93. (Pubitemid 37464873)
70. Wagner AW, Linehan MM. Facial expression recognition ability among women with borderline personality disorder: implications for emotion regulation? J Pers Disord. 1999;13:329-44. (Pubitemid 30020303)
71. Eisenberger NI, Jarcho JM, Lieberman MD, Naliboff BD. An experimental study of shared sensitivity to physical pain and social rejection. Pain. 2006;126:132-8. (Pubitemid 44751962)
72. Kross E, Berman MG, Mischel W, Smith EE, Wagner TD. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci U S A. 2011;108:6270-5.
73. Eisenberger NI, Lieberman MD, Williams KD. Does rejection hurt? An FRMI study of social exclusion. Science. 2003;302:290-2. (Pubitemid 37248760)
74. Schmahl CG, Elzinga BM, Vermetten E, Sanislow C, McGlashan TH, Bremner JD. Neural correlates of memories of abandonment in women with and without borderline personality disorder. Biol Psychiatry. 2003;54:142-51. (Pubitemid 36859774)
75. Schmahl CG, Vermetten E, Elzinga BM, Bremner JD. A positron emission tomography study of memories of childhood abuse in borderline personality disorder. Biol Psychiatry. 2004;55:759-65. (Pubitemid 38376189)
76. Ruocco AC, Amirthavasagam S, Choi-Kain LW, McMain SF. Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biol Psychiatry. 2013;73:153-60. This meta-analysis showed that an abnormal reciprocal relationship between limbic structures (involved in emotion processing) and anterior brain regions supporting (involved emotional regulation may underlie the processing of negative emotions in BPD patients.
77. Kluetsch RC, Schmahl C, Niedtfeld I, Densmore M, Calhoun VD, Daniels J, et al. Alterations in default mode network connectivity during pain processing in borderline personality disorder. Arch Gen Psychiatry. 2012;69:993-1002.
78. Ludäscher P, Valerius G, Stiglmayr C, Mauchnik J, Lanius RA, Bohus M, et al. Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study. J Psychiatry Neurosci. 2010;35:177-84.
79. Wolf RC, Sambataro F, Vasic N, Schmid M, Thomann PA, Bienentreu SD, et al. Aberrant connectivity of resting-state networks in borderline personality disorder. J Psychiatry Neurosci. 2011;36:402-11.
80. Schmahl C, Ludäscher P, Greffrath W, Kraus A, Valerius G, Schulze TG, et al. COMT val158met polymorphism and neural pain processing. PLoS One. 2012;7:e23658.
81. Silbersweig D, Clarkin JF, Goldstein M, Kernberg OF, Tuescher O, Levy KN, et al. Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. Am J Psychiatry. 2007;164:1832-41. (Pubitemid 351739236)
82. Simpson Jr JR, Drevets WC, Snyder AZ, Gusnard DA, Raichle ME. Emotion-induced changes in human medial prefrontal cortex: II. During anticipatory anxiety. Proc Natl Acad Sci U S A. 2001;98:688-93. (Pubitemid 32105104)
83. Koenigsberg HW, Fan J, Ochsner KN, Liu X, Guise KG, Pizzarello S, et al. Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biol Psychiatry. 2009;66:854-63.
84. Herpertz SC, Dietrich TM, Wenning B, Krings T, Erberich SG, Willmes K, et al. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study. Biol Psychiatry. 2001;50:292-8. (Pubitemid 32778446)
85. Mier D, Lis S, Esslinger C, Sauer C, Hagenhoff M, Ulferts J, et al. Neuronal correlates of social cognition in borderline personality disorder. Soc Cogn Affect Neurosci. 2013;8:531-7. BPD patients have an enhanced emotional approach in the processing of social stimuli. It might be the bases of social-cognitive deficits in real-life social interactions.
86. Augustine JR. Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Brain Res Rev. 1996;22:229-44. (Pubitemid 26390178)
87. Kross E, Egner T, Ochsner K, Hirsch J, Downey G. Neural dynamics of rejection sensitivity. J Cogn Neurosci. 2007;19:945-56. (Pubitemid 46849730)
88. Onoda K, Okamoto Y, Nakashima K, Nittono H, Yoshimura S, Yamawaki S. Does low self-esteem enhance social pain? The relationship between trait self-esteem and anterior cingulate cortex activation induced by ostracism. Soc Cogn Affect Neurosci. 2010;5:385-91.
89. Lynum LI, Wilberg T, Karterud S. Self-esteem in patients with borderline and avoidant personality disorders. Scand J Psychol. 2008;49:469-77.
90. Staebler K, Helbing E, Rosenbach C, Renneberg B. Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother. 2011;18:275-83. This study examined the role of rejection sensitivity in BPD patients compared with patients suffering from other psychiatric disorders, such as social anxiety disorders.
91. Dong WK, Hayashi T, Roberts VJ, Fusco BM, Chudler EH. Behavioral outcome of posterior parietal cortex injury in the monkey. Pain. 1996;64:579-87. (Pubitemid 26180161)
92. Binkofski F, Kunesch E, Classen J, Seitz RJ, Freund HJ. Tactile apraxia: unimodal apractic disorder of tactile object exploration associated with parietal lobe lesions. Brain. 2001;124:132-44. (Pubitemid 32055995)
93. Niedtfeld I, Schulze L, Kirsch P, Herpertz SC, Bohus M, Schmahl C. Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biol Psychiatry. 2010;68:383-91. Both negative and neutral pictures lead to higher activation of the amygdala, insula, and ACC in BPD patients than in healthy controls. During thermal stimulation, BPD patients show decreased activation of amygdala and ACC, independently of pain.
94. Korner A, Gerull F, Stevenson J, Meares R. Harm avoidance, self-harm, psychic pain, and the borderline personality: life in a "haunted house". Compr Psychiatry. 2007;48:303-8.
95. Niedtfeld I, Kirsch P, Schulze L, Herpertz SC, Bohus M, Schmahl C. unctional connectivity of pain-mediated affect regulation in Borderline Personality Disorder. PLoS One. 2012;7:e33293. This study shows alterations in emotional regulation process in BPD patients. Pain could improve prefrontal inhibition on limbic areas.
96. Ripoll LH, Snyder R, Steele H, Siever LJ. The neurobiology of empathy in borderline personality disorder. Curr Psychiatry Rep. 2013;15(3):344. This study presents a neurobiological model of empathic dysfunction in BPD, involving hyper-reactivity of shared representations networks and impairment of explicit mental state attribution networks.
97. Prossin AR, Love TM, Koeppe RA, Zubieta JK, Silk KR. Dysregulation of regional endogenous opioid function in borderline personality disorder. Am J Psychiatry. 2010;167:925-33. This case control study investigated the role of the endogenous opioid system and mu-opioid receptors in emotional regulation in BPD.