Accounting for the association between BPD features and chronic pain complaints in a pain patient sample: The role of emotion dysregulation factors.

Abstract

Although borderline personality disorder (BPD) features consistently show strong relations with chronic pain, the mechanisms underlying this association remain unclear. BPD is characterized by dysregulated emotion. Given previously observed relationships between emotion dysregulation and pain, we hypothesized that components of this dysregulation-elevated and labile negative affect and emotion sensitivity-would account for the relationship between BPD features and various pain complaints in a chronic pain patient sample. Specifically, we hypothesized that negative affect would indirectly predict pain through higher emotion sensitivity to pain, operationalized as pain anxiety sensitivity. To test these hypotheses, we administered a series of self-report measures to 147 patients at a chronic pain treatment facility. As expected, BPD features predicted pain severity (β = .19, p = .029), activity interference from pain (β = .22, p = .015), and affective interference from pain (β = .41, p < .001). Using path analyses, we found that the associations between BPD features and pain severity and interference were accounted for by serial indirect pathways through affective lability then pain anxiety and, to a lesser extent, through trait anxiety then pain anxiety. This is the first study to demonstrate roles for affective lability and pain anxiety sensitivity in the association between BPD features and chronic pain complaints in a chronic pain sample. We discuss implications for the relationship between dysregulated emotion and pain as well as for psychologically-focused treatment interventions for pain. (PsycINFO Database Record

Recent advances in understanding physical health problems in personality disorders

“…Emotion dysregulation is one psychological factor that may confer risk for physical problems [40]. Consistent with this view, the association between borderline PD features and pain outcomes was accounted for by indirect pathways from emotional dysfunction through maladaptive cognitive-affective responses to pain in nonclinical [41] and chronic pain patient [42] samples. Likewise, another study of nonclinical participants showed that the link between borderline PD features and pain interference was highest among those with high distress and emotional avoidance [43].…”

Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations

“…With respect to this physical disease, Sansone and Sansone (2012) summarized results of eight studies showing that roughly 30% of patients with chronic pain met the criteria for BPD and, individuals with BPD consistently reported higher levels of pain than those without this disorder. More recently, several empirical studies have replicated the significant association between BPD and chronic pain (e.g., Reynolds et al, 2018;Reynolds and Tragesser, 2019;Johnson et al, 2020).…”

Emotion Regulation Difficulties and Repetitive Negative Thinking in Patients With Tension Headaches and Migraine

“…Reynolds et al found that negative thinking and emotion sensitivity are associated with pain severity and interfering pain with daily activities [14]. Lutza et al highlighted the relationship between emotion regulation and chronic pain [27].…”

“…ER can change the capacity, severity, and time course of responses to the ac-tivated emotion and also affects physiological responses [12]. Successful emotion regulation as an essential component of human health and wellbeing has several dimensions, such as awareness, acceptance of emotions, modulation of emotional arousal, and the ability to act in desired ways regardless of emotional state regulation [13,14]. Maladaptive emotion regulation not only affects the range of emotional processing but also interferes with the biological and psychological flexibility [10].…”