Pain perception in self-injurious patients with borderline personality disorder

Russ, Mark J.; Roth, Steven D.; Lerman, Alexander; Kakuma, Tatsu; Harrison, Kay; Shindledecker, Richard; Hull, James W.; Mattis, Steven

doi:10.1016/0006-3223(92)90218-o

Cited by 149 publications

(116 citation statements)

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“…Lautenbacher & Krieg, 1994;Russ et al, 1993;Dickens et al, 2003), we conducted exploratory analyses in an attempt to identify whether any of the clinical measures predicted change in cold pressor performance. Three conceptually distinct clusters of predictor variables were examined.…”

Section: Exploratory Analysesmentioning

confidence: 99%

“…derealization, depersonalization, amnesia) and stress-induced analgesia (SIA) do co-occur. Among patients with borderline PD, a positive association has been found between increased insensitivity to pain and dissociative experiences (Russ, Shearin, Clarkin, Harrison, & Hull, 1993;Russ, Clark, Cross, Kemperman, Kakuma, & Harrison, 1996;Bohus et al, 2000), and levels of state dissociation have been found to be elevated during episodes of self-cutting (Kemperman, Russ, & Shearin, 1997). However, no investigations have addressed this relationship in normal subjects.…”

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confidence: 99%

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Dissociation and pain perception: An experimental investigation

Horowitz

Telch

2007

Journal of Traumatic Stress

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Dissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. The authors tested whether experimentally induced increases in state dissociation would cause an analgesic response. Participants (N = 120) were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on pre‐ and postchanges in subjective pain and immersion time in response to a standard cold pressor test. Unexpectedly, the dissociation induction led to small, but significant increases in subjective pain and did not lead to greater immersion time. An exploratory analysis revealed that increases in absorption and derealization significantly predicted increased subjective pain and increased immersion time, respectively.

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Section: Exploratory Analysesmentioning

confidence: 99%

mentioning

confidence: 99%

Dissociation and pain perception: An experimental investigation

Horowitz

Telch

2007

Journal of Traumatic Stress

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“…Temperatures ranged widely, from 0.5° C (Gratz et al, 2011) to 10° C (Russ et al, 1999(Russ et al, , 1994(Russ et al, , 1992. Other work has used thermal (Bresin & Gordon, 2013a;Kemperman et al, 1997;Ludäscher et al, 2009;Niedtfeld et al, 2010) and laser techniques (Schmahl et al, 2004), which apply heat in timed pulses to the skin.…”

Section: Pain Induction Method Pain Threshold and Pain Tolerancementioning

confidence: 99%

“…Third, that improvement in BPD symptomatology results in the normalisation of pain perception. Russ et al, (1992) suggested that the dual presence of altered mood and insensitivity to pain is indicative of neural mechanisms such as the release of endogenous opioids. This is further explored in a later study (Russ et al, 1994), using the opioid antagonist naloxone in an attempt to block the analgesia observed during administration of painful stimuli to individuals with BPD who engage in NSSI.…”

Section: Endogenous Opioidsmentioning

confidence: 99%

“…Five studies cite endogenous opioids as candidate mechanisms for increased pain threshold and tolerance in NSSI (Ludäscher et al, 2009;Schmahl et al, 2004;Kemperman et al, 1997;Russ et al, 1992;, however none test this mechanism directly, such as by measuring endogenous opioid levels with blood plasma sampling or by Positron Emission Tomography (PET) imaging.…”

Section: Candidate Explanatory Mechanisms For Altered Pain Threshold mentioning

confidence: 99%

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Pain and self-harm: A systematic review

Kirtley

O’Carroll

O’Connor

2016

Journal of Affective Disorders

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BackgroundA growing body of research has explored altered physical pain threshold and tolerance in non-suicidal self-injury (NSSI) and suicidal self-harm. The evidence, however, is inconsistent such that the nature of the relationship is unclear, and whether or not this effect is also present in suicidal self-harm is equivocal. MethodsA keyword search of three major psychological and medical databases (PsycINFO, Medline and Web of Knowledge) was conducted, yielding 1,873 records. Following duplicate removal and screening, 25 articles were quality assessed, and included in the final systematic review. ResultsThere is strong evidence for increased pain tolerance in NSSI, and some evidence for this in suicidal individuals, but notably, there were no prospective studies. The review found a lack of substantive focus on psychological correlates of altered pain tolerance in this population. Several candidate explanatory mechanisms were proposed within the reviewed studies. LimitationsThe current review was a narrative systematic review; methods used to assess pain were considered too heterogeneous to conduct a meta-analysis. ConclusionsThe evidence suggests that there is elevated pain tolerance among those who engage in NSSI. Future prospective research should determine if altered pain tolerance is a cause or a consequence of the behaviour. The identification of psychological correlates of increased pain tolerance is a neglected area of research. It could provide opportunities for treatment/intervention development, if mediating or moderating pathways can be identified. Too few studies have directly investigated candidate explanatory mechanisms to draw definitive conclusions.

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Alterations in Default Mode Network Connectivity During Pain Processing in Borderline Personality Disorder

Kluetsch

Schmahl

Niedtfeld

et al. 2012

Arch Gen Psychiatry

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Context Recent neuroimaging studies have associated activity in the default mode network (DMN) with self-referential and pain processing, both of which are altered in borderline personality disorder (BPD). In patients with BPD, antinociception has been linked to altered activity in brain regions involved in the cognitive and affective evaluation of pain. Findings in healthy subjects indicate that painful stimulation leads to blood oxygenation level-dependent (BOLD) signal decreases and changes in the functional architecture of the DMN. Objective To connect the previously separate research areas of DMN connectivity and altered pain perception in BPD and explore DMN connectivity during pain processing in patients with BPD. Design Case-control study Setting A university hospital Participants Twenty-five women with BPD, 92 percent with a history of self-harm, and 22 age-matched controls. Interventions Psychophysical assessment and functional MRI (fMRI) during painful heat versus neutral temperature stimulation. Main Outcome Measure DMN connectivity as assessed via independent component analysis and psychophysiological interaction analysis. Results Compared to controls, patients with BPD showed less integration of the left retrosplenial cortex and left superior frontal gyrus into the DMN. Higher BPD symptom severity and trait dissociation were associated with an attenuated signal decrease of the DMN in response to painful stimulation. During “pain” versus “neutral”, BPD patients exhibited less posterior cingulate cortex seed region connectivity with the left dorsolateral prefrontal cortex. Conclusion Patients with BPD showed significant alterations in DMN connectivity, with differences in spatial integrity and temporal characteristics. These alterations may reflect a different cognitive and affective appraisal of pain as less self-relevant and aversive, and a deficiency in the switching between baseline and task-related processing. This deficiency may be related to everyday difficulties of BPD patients to regulate their emotions, focus mindfully on one task at a time, and efficiently shift their attention from one task to another.

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Pain perception in self-injurious patients with borderline personality disorder

Cited by 149 publications

References 20 publications

Dissociation and pain perception: An experimental investigation

Dissociation and pain perception: An experimental investigation

Pain and self-harm: A systematic review

Alterations in Default Mode Network Connectivity During Pain Processing in Borderline Personality Disorder

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