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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    No preview · Article · May 2015 · General Hospital Psychiatry
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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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