Differential perception of sharp pain in patients with borderline personality disorder

Schloss, Natalie; Shabes, Polina; Kuniss, Sarah; Willis, Franziska; Treede, Rolf‐Detlef; Schmahl, Christian; Baumgärtner, Ulf

doi:10.1002/ejp.1411

Cited by 7 publications

(8 citation statements)

References 65 publications

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“…Together, this supports the assumption of altered affective somatosensory processing in BPD. Interestingly, similar to our results on altered qualitative touch experiences, a recent study found alterations in qualitative pain ratings in BPD, in terms of a specific loss of the pain component sharpness [ 60 ]. Qualitatively changed somatosensory perception might be due to altered evaluation of negative [ 60 ] and positive somatosensory stimuli and related cognitive processes.…”

Section: Discussionsupporting

confidence: 90%

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation

Löffler

Kleindienst

Neukel

et al. 2022

bord personal disord emot dysregul

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Background Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including abnormal evaluation of nociceptive input. However, whether or not perceptual alterations are present for its positive counterpart, i.e. pleasant touch (PT), has not yet been examined. Methods In the present study, we applied standardized PT stimuli to the hands of 25 patients with BPD and 25 healthy controls (HC) and compared their perception. We used the affect-modulated acoustic startle response as a physiological correlate of affective processing. We further explored the effect of PT stimulation on dissociative experiences in BPD. Results Compared to HC, BPD perceived PT as less pleasant and less intense. The effect on perceived valence of touch was large even after controlling for the effect of reduced perceived intensity of touch (ƞ2 = .29). We further found qualitative alterations in touch perception in BPD, who rated the touch as significantly rougher and firmer compared to HC. There was a positive correlation between perceived valence of touch and changes in dissociative experiences in terms of body ownership of the stimulated body part from pre to post stimulation, suggesting that a more negative evaluation of touch is associated with an increase in body-related dissociative experiences, while a positive perception of touch might be related to a reduction of these dissociative experiences. Conclusions Our results confirm BPD-associated disturbances in the processing of affective somatosensory stimuli and indicate that not only pain perception but also pleasant touch perception is diminished in BPD. We discuss the role of altered touch perception for BPD psychopathology and its potential role for new treatment approaches.

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Section: Discussionsupporting

confidence: 90%

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation

Löffler

Kleindienst

Neukel

et al. 2022

bord personal disord emot dysregul

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“…Nevertheless, overall high dissociation levels found among the women herein may render noxious and innocuous stimuli less salient and the women less sensitive to them. The correlation between higher dissociation levels in BPD and attenuated pain‐related default mode network signal (Kluetsch et al, ) as well as between attenuated pain responsiveness in BPD, increased dissociation levels and negative emotions (Bohus et al, ; Ludäscher et al, ; Russ et al, ) or reduced affective reaction (Schloss et al, ), support this suggestion.…”

Section: Discussionmentioning

confidence: 94%

“…The authors reported that although pain ratings of individuals with BPD and controls were similar during capsaicin application, those of BPD decreased faster in the minutes after the application. Similarly, Schloss et al (2019) reported that following blade incision, pain intensity ratings of BPD patients returned significantly faster to baseline than of controls. In other words, individuals with BPD exhibited more efficient ability to recuperate from noxious insults.…”

Section: Increased Pain Modulation In Bpdmentioning

confidence: 90%

“…BPD is characterized by disturbed processing and regulation of emotions, behaviour and interpersonal interactions (Leichsenring, Leibing, Kruse, New, & Leweke, 2011;Sanislow et al, 2002). A core feature of BPD is hyposensitivity to pain (Schmahl & Baumgärtner, 2015), manifested in reduced pain ratings (Bekrater-Bodmann et al, 2015;Bohus et al, 2000;Bungert et al, 2015;Niedtfeld et al, 2010;Pavony & Lenzenweger, 2014;Russ, Campbell, Kakuma, Harrison, & Zanine, 1999;Schloss et al, 2019;Schmahl et al, 2006;Schmahl, Vermetten, Elzinga, & Bremner, 2004) and increased pain thresholds (Bekrater-Bodmann et al, 2015;Bohus et al, 2000;Cardenas-Morales et al, 2011;Ludäscher, Bohus, & Lieb, 2007;Ludäscher et al, 2009Ludäscher et al, , 2015Magerl, Burkart, Fernandez, Schmidt, & Treede, 2012;Schmahl et al, 2010Schmahl et al, , 2004. One of the most frequent dysfunctional behaviours in BPD, a non-suicidal self-injury (Bohus et al, 2000;Schmahl & Baumgärtner, 2015) may be regarded as an additional sign of pain hyposensitivity (Koenig, Thayer, & Kaess, 2016;Prossin, Love, Koeppe, Zubieta, & Silk, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Enhanced pain modulation capacity among individuals with borderline personality disorder: A possible mechanism underlying their hypoalgesia

Defrin

Sagy

Biran

et al. 2019

European Journal of Pain

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Background Ample evidence suggests that individuals with borderline personality disorder (BPD) exhibit hyposensitivity to pain. Since the underlying mechanism of the pain hyposensitivity is unknown, we tested here for the first time whether this hyposensitivity is pain specific or exists also for innocuous sensation, and whether it is associated with enhanced descending pain modulation capabilities. Methods Participants were 55 women; 22 patients with BPD and 33 matched healthy controls. Testing included the measurement of warmth sensation threshold (WST), heat‐pain threshold (HPT), pain adaptation, conditioned pain modulation (CPM) and temporal summation of heat‐pain (TSP). The level of dissociation was also evaluated. Results Women with BPD had higher WST and HPT compared with healthy controls. Moreover, women with BPD had greater magnitude of pain adaptation and CPM as well as higher dissociation level compared to controls. In neither the BPD nor the control group did WST and HPT correlate with pain adaptation, CPM or dissociation. In the BPD group only, HPT inversely correlated with the magnitude of TSP. Conclusions Women with BPD present generalized hyposensitivity to both innocuous and noxious stimuli. Furthermore, women with BPD exhibit more efficient pain inhibition capabilities than healthy controls. While efficient pain modulation may underlie pain hyposensitivity in BPD, both traits may exist independently from each other, or may be moderated by another factor such as dissociation. Significance On the basis of testing pronociceptive and antinociceptive components among individuals with BPD and healthy controls, this study reveals enhanced ability to inhibit pain among woman with borderline personality disorder (BPD) which may underlie hyposensitivity to both noxious and innocuous stimuli and perhaps also self‐injurious behaviour among these individuals. The study contributes novel information on possible mechanisms involved in BPD manifestations.

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“…Although to date there are no systematic studies investigating the physiological correlates of C-fibres in self harm behaviour, it is possible to assume that, in self-harm patients, this system may be altered. We know, in fact, that C-fibres are involved in the processing of stimuli that cause deep pain 51 and that a specific class of C-fibres, namely the CT system, is devoted to process pleasant tactile stimuli (i.e. Affective Touch).…”

Section: Regionmentioning

confidence: 99%

Disorganized Attachment pattern affects the perception of Affective Touch

Spitoni

Zingaretti²,

Giovanardi

et al. 2020

Sci Rep

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Touch, such as affective caress, can be interpreted as being pleasant. The emotional valence that is assigned to touch is related to certain bottom-up factors, such as the optimal activation of C-tactile (CT) afferents. Tactile processing with a hedonic or emotional component has been defined as affective touch-a component that CT fibers are likely to convey. Tactile deficiencies are frequent in the psychiatric population but also in healthy people with disorganized attachment; accordingly, it is likely that affective difficulties in adults with disorganized attachment are reflected in altered perception of affective touch. To test this hypothesis, we combined methods from clinical psychology, psychophysics, and neuroimaging. We found that people with a history of traumatic parental bonds and a disorganized attachment pattern perceive a "caress-like" stimulus as being unpleasant, whereas participants with organized attachment consider the same tactile stimulation to be pleasant. Further, unlike in organized adults, the responses of disorganized adults to CT and non-CT stimulation activated limbic and paralimbic structures in a fight-or-flight manner, suggesting that early experiences with parental deficiencies shape the physiological responses of peripheral CT fibers and central nervous networks. In humans, touch is the first sensory system to develop 1,2. The earliest sensations that we experience are tactile. At 12 weeks of gestation, the cutaneous receptors and somatosensory functions have matured 3 , and the fetus is able to make movements when their lips are touched 4 ; in contrast, other sensory modalities, such as hearing and vision, develop later. The early emergence of tactile functions in fetal growth suggests that its initial tactile experiences are crucial for the development and maturation of an organism. This hypothesis has been demonstrated in several developmental pathways, from biological growth 1 and psychological maturity 5 to achievements in social skills 6. Sigmund Freud, whose background was in neurophysiology, defined the skin as the "first psychological organ" 7. Despite the evidence that has posited the primacy of touch in human development, we owe the first attempts to link the sense of touch to social, cognitive, and affective domains to studies on animals, among which research by Harlow 8,9 on rhesus monkeys remains a cornerstone. In his famous studies, Harlow demonstrated that infant rhesus monkeys preferred to cling to a surrogate wire mother that was covered in warm cloth than to one that provided milk but comprised only wires. Harlow also observed that on experiencing a sudden frightening stimulus, the cloth model was again preferred to the wire mother, wherein the monkeys sought immediate physical contact with the cloth model, after which their fear subsided. Based on these findings, Harlow suggested that the absence of comforting touch led to psychological stress in the monkeys. Likely, these studies provided the seminal evidence of the influential function of bodily contact in t...

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Differential perception of sharp pain in patients with borderline personality disorder

Cited by 7 publications

References 65 publications

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation

Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation

Enhanced pain modulation capacity among individuals with borderline personality disorder: A possible mechanism underlying their hypoalgesia

Disorganized Attachment pattern affects the perception of Affective Touch

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