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

Abstract

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.

Dissecting pain processing in adolescents with Non‐Suicidal Self Injury: Could suicide risk lurk among the electrodes?

“…Admittedly, our cohort of adolescent patients, while describing hypoalgesia during self‐harming, did not show the increased pain thresholds observed in BPD adults; therefore, any conclusion may sound speculative. A recent study by Defrin and colleagues ( 2020 ) demonstrated an increased function of the endogenous pain modulation system in adult patients with BPD. The lack of differences between patients with BPD and patients with BPD and self‐injury behaviour led the authors to hypothesize that the enhanced pain modulation could be attributed to dissociation, a peculiar feature of BPD.…”

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

“…In another study by Defrin and colleagues [129], no significant correlation between elevated heat pain thresholds and a measure of trait dissociation (DES) was found in patients with acute BPD. On the other hand, higher trait dissociation (scores on the DES) predicted changes in the default mode network in response to painful heat stimulation in BPD patients with current self-injurious behavior [130].…”

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

“… 16 ], they found no evidence for altered proprioception, exteroception, and two-point discrimination [ 17 ] or warmth perception thresholds [ 9 , 10 ,c.f. 18 ], suggesting that somatosensory dysfunction is limited to affective stimuli. However, it remains unclearwhether altered somatosensory processing in BPD is specific for pain perception or also affects positive affective somatosensation.…”