Chronic pain syndromes and borderline personality

Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, USA.
Innovations in Clinical Neuroscience 01/2012; 9(1):10-4.
Source: PubMed


The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individuals with borderline personality disorder report higher levels of pain than those without this personality dysfunction; older, rather than younger, patients with borderline personality disorder are more likely to have higher pain levels; patients with borderline personality disorder in remission use significantly less pain medications; medical disability status in chronic pain does not necessarily differ between those with versus without borderline personality disorder; and the first-degree relatives of individuals with borderline personality disorder demonstrate statistical coaggregation with somatoform pain disorder. Why might chronic pain demonstrate associations with borderline personality disorder? Perhaps chronic pain is simply another manifestation of the inability of individuals with borderline personality disorder to self-regulate (i.e., the inability to regulate pain). In addition, pain symptoms may function as an interpersonal means of eliciting caring responses from others. Regardless, the assessment and treatment implications of these comorbid patients suggest a challenging scenario for both mental health and primary care clinicians.

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    • "Due to the inflexible, pervasive and maladaptive behaviors of the patient with BPD and the high health service utilization, the BPD patient is often described as a 'difficult patient' [9]. To date, research has been limited: specifically, a recent review found only eight studies on the association between BPD and chronic pain from 1994 to 2011 [2] and only a few have examined medication non-adherence and dependence [2]. Another concern is the high rates of suicidal behaviors in both chronic pain and BPD. "
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    ABSTRACT: Borderline personality disorder (BPD) is common in patients with chronic non-cancer pain (CNCP). BPD patients often report worse pain and are more likely to abuse opioid medication. Although the prevalence of suicidality is high in both CNCP patients and those with BPD, no studies have examined the interrelationship of BPD, CNCP and suicidality. This article aims to examine the prevalence and associations of BPD in a large community sample of CNCP patients and the association with medication problems and suicidality. Data from a national sample of 978 CNCP patients prescribed pharmaceutical opioids for CNCP. The screener from the International Classification of Diseases, version 10, International Personality Disorder Examination was used to identify patients with symptoms of BPD. One in five CNCP patients (19.1%) screened positive for BPD. BPD was associated with a number of demographic and clinical features, such as daily benzodiazepine use, and was independently associated with lifetime pharmaceutical opioid dependence [odds ratio (OR) 2.49, 95% confidence interval (95% CI) 1.42-4.38], past 12-month suicidal thoughts (OR 2.9, 95% CI 1.90-4.39) and lifetime suicide attempts (OR 3.19, 95% CI 2.16-4.72). BPD symptoms were prevalent among people prescribed opioids for CNCP and are associated with a number of adverse consequences. Further, those screening positive were at elevated risk of suicidal behaviors. Careful opioid prescription monitoring and appropriate referrals by clinicians are warranted in BPD with CNCP. Copyright © 2015. Published by Elsevier Inc.
    General Hospital Psychiatry 05/2015; 37(5). DOI:10.1016/j.genhosppsych.2015.05.004 · 2.61 Impact Factor
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    • "Mental defeat (a psychological construct which includes catastrophising) increases distress and disability from pain [23,24]. Patients with borderline personalities report higher pain levels than other pain patients [25]. A recent study by Taiminen et al. [1] of 63 patients with burning mouth syndrome or atypical facial pain supported these findings. "
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    ABSTRACT: Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
    The Journal of Headache and Pain 04/2013; 14(1):37. DOI:10.1186/1129-2377-14-37 · 2.80 Impact Factor
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    ABSTRACT: Cluster B personality disorders are associated with behaviour and lifestyle that cause significant problems not only for the personality disordered individual but for society as well. Despite the fact that cluster B personality disorders have attracted a lot of research interest recently, their association with medical (physical health) problems is less studied, though it is anticipated that personality is clinically important and influences the outcome of somatic disease illnesses. Cluster B personality disorders are associated with Axis I psychiatric disorders such as addiction that have serious and life-threatening physical comorbidity. Lifestyle and health behaviours associated with cluster B personality disorders lead to medical problems and enhance preexisting physical problems. Furthermore, personality traits associated with cluster B personality disorders disrupt both medical treatment and follow-up, influencing negatively life expectancy and quality of life. It is imperative that clinicians of all medical specialties are aware of the influence personality disorders and certain personality traits such as impulsivity can have on the outcome of the illness. Further research on the interaction between personality disorders and medical illness is needed.
    Current opinion in psychiatry 06/2012; 25(5):398-404. DOI:10.1097/YCO.0b013e3283558491 · 3.94 Impact Factor
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