Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder

Ludäscher, Petra; Bohus, Martin; Lieb, Klaus; Philipsen, Alexandra; Jochims, Anja; Schmahl, Christian

doi:10.1016/j.psychres.2005.04.009

Cited by 142 publications

(129 citation statements)

References 19 publications

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“…19 Furthermore, the current study provides strong evidence that reduced pain sensitivity is a somatic marker of dissociative states in patients with BPD.…”

Section: Discussionmentioning

confidence: 52%

“…In terms of the sensory aspects of dissociation in BPD, we found significant inverse correlations of subjective pain sensitivity with aversive inner tension and dissociation in patients with BPD but not in healthy controls. 19 Subjective analgesia is closely correlated with the level of the dissociative state in BPD. 19 Thus, the assessment of pain processing can be used to operationalize and quantify the level of acute dissociation independent from subjective experience and report.…”

Section: Introductionmentioning

confidence: 99%

“…19 Subjective analgesia is closely correlated with the level of the dissociative state in BPD. 19 Thus, the assessment of pain processing can be used to operationalize and quantify the level of acute dissociation independent from subjective experience and report. We found significant activation of the dorsolateral prefrontal cortex and significant deactivation of the right amygdala and perigenual anterior cingulate gyrus during pain stimulation in BPD.…”

Section: Introductionmentioning

confidence: 99%

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Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

Self Cite

108

112

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Background: Stress-induced dissociative states involving analgesia are a common feature of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Our aim was to investigate the psychologic, somatosensory (pain sensitivity) and neural correlates of dissociative states in patients with these disorders. Methods: We included 15 women with BPD who were not taking medication; 10 of these women had comorbid PTSD. While undergoing functional magnetic resonance imaging at 1.5 Tesla, participants were exposed to a script describing a personalized dissociation-inducing situation and a personalized script describing a neutral situation. We assessed dissociative psychopathology and pain sensitivity. Results: Dissociative psychopathology scores were significantly higher and pain sensitivity was lower after the dissociation-inducing script was read compared with the neutral script. The blood oxygen level-dependent (BOLD) signal was significantly increased in the left inferior frontal gyrus (Brodmann area [BA] 9) during the presentation of the dissociationinducing script. Regression analyses revealed positive correlations between BOLD signal and dissociative psychopathology in the left superior frontal gyrus (BA 6) and negative correlations in the right middle (BA 21) and inferior temporal gyrus (BA 20). In the subgroup of participants with comorbid PTSD, we also found increased activity in the left cingulate gyrus (BA 32) during script-driven imagery-induced dissociation, a positive correlation between dissociation scores and activity in the right and left insula (BA 13) and a negative correlation in the right parahippocampal gyrus (BA 35). Limitations: The main limitation of this pilot study is the absence of a control group. Therefore, the results may also reflect the neural correlates of non-BPD/PTSD specific dissociative states or the neural correlates of emotionally stressful or "loaded" memories. Another limitation is the uncorrected statistical level of the functional magnetic resonance imaging results. Conclusion: Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD. These states were characterized by reduced pain sensitivity and a fronto limbic activation pattern, which resembles the findings in participants with PTSD while in dissociative states.

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“…19 Furthermore, the current study provides strong evidence that reduced pain sensitivity is a somatic marker of dissociative states in patients with BPD.…”

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

Self Cite

108

112

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show abstract

“…In particular, pain thresholds significantly increase when individuals with BPD are distressed and have a desire to self-injure (Bohus et al 2000). Additionally, there is a strong connection between negative emotional arousal and increased pain thresholds in patients with BPD, as well as increased dissociative symptoms (Ludascher et al 2007). Furthermore, it has also been shown that individuals with BPD who selfinjure have difficulty differentiating between mildly painful and moderately painful hypothetical situations (Russ et al 1996).…”

Section: Pain and Nssimentioning

confidence: 99%

Invited Commentary: Understanding Brain Mechanisms of Pain Processing in Adolescents’ Non-Suicidal Self-Injury

Ballard

Bosk

Pao

2009

J Youth Adolescence

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Whereas non-suicidal self injury (NSSI) is reported in 13-23% of adolescents and is an increasingly studied topic, there has been little investigation into the pathophysiology behind self-injury. This commentary examines recent research into pain and emotional distress to discuss implications for the manner we should understand, research, and treat NSSI in the future. Research indicates that adolescents may be particularly vulnerable to NSSI behaviors due to neurodevelopmental changes in the processing of distress and pain. Additionally, emotional distress and physical pain neural pathways may have been altered in these individuals, leading to the development of NSSI behaviors during adolescence when changes in ongoing brain development may lead to further emotional dysregulation and poor impulse control. Further studies that directly characterize the relationship between emotional distress and physical pain in adolescence, as well as the neural differences between self-injurers and non-selfinjurers, are needed.

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“…Significantly higher pain thresholds have been reported for both adult patients (75) and adolescent patients (76) with BPD. No differences from healthy subjects were found with regard to thermal detection thresholds or indices for alterations of somatosensory functioning.…”

Section: Pain Perceptionmentioning

confidence: 90%

Neurobiological Findings in Youth with Borderline Personality Disorder

Brunner

Henze

Richter

et al. 2014

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processingparticularly involving negative stimuli-may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamicpituitary-adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.

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Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder

Cited by 142 publications

References 19 publications

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Invited Commentary: Understanding Brain Mechanisms of Pain Processing in Adolescents’ Non-Suicidal Self-Injury

Neurobiological Findings in Youth with Borderline Personality Disorder

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