Stress reactivity and pain‐mediated stress regulation in remitted patients with borderline personality disorder

Abstract

ObjectivePatients with borderline personality disorder (BPD) use nonsuicidal self‐injury (NSSI) to cope with states of elevated inner tension. It is unclear to what extent remitted BPD patients experience these states and whether the experience of pain still regulates emotion. The purpose of this study was the investigation of baseline stress levels, stress reactivity, and pain‐mediated stress regulation in remitted BPD patients.MethodSubjective and objective stress parameters were assessed in 30 remitted BPD patients, 30 current BPD patients, and 30 healthy controls. After stress induction, a non‐nociceptive tactile stimulus, a tissue‐injuring, or a noninvasive pain stimulus was applied to the right volar forearm.ResultsBaseline stress levels of remitted BPD patients lie in between the stress levels of current BPD patients and healthy controls. Urge for NSSI increased significantly more in current than remitted BPD patients. The experience of pain led to a greater decrease of arousal in current compared to remitted BPD patients and healthy controls.ConclusionsStates of increased tension still seem to appear in remitted BPD patients. The role of pain‐mediated stress regulation appears to be reduced in remitted patients.

Dissociation proneness and pain hyposensitivity in current and remitted borderline personality disorder

“…IPDE ≥ 5 criteria) once in their life and who fulfilled three or less criteria throughout 2 years prior to participation were considered rBPD. Particularly, self‐harming behaviour must not have been shown more than twice within the last 2 years (in the present rBPD sample, only one patient reported such behaviour in the last 12 months, whereas all cBPD patients answered this question in the affirmative, according to a custom‐made self‐rating questionnaire for the assessment of NSSI behaviour (Kleindienst et al, 2008; Reitz et al, 2015; Willis et al, 2018). The validity of the criteria for symptomatic remission was confirmed by a previous longitudinal BPD study (Zanarini et al, 2014).…”

“…The present data, however, indicate that stress-responses other than dissociation might play a role for this relationship: when the disorder is in its remitted stage, we found stress-associated hyposensitivity in rBPD which cannot completely be explained by still enhanced dissociation proneness. Enhanced stress reactivity in rBPD and associated increase in the urge for NSSI (Willis et al, 2018) might reflect the stability of learned dysfunctional coping behaviour beyond the disorder's current stage. This interpretation, together with the present's studies results regarding altered stress-related pain sensitivity in rBPD, might be of importance for therapeutic considerations for individuals in the remitted stage.…”

“…Pain perception, at least to a certain degree, returns to normal when BPD is remitted (Bekrater‐Bodmann et al, 2015), with heat pain thresholds (HPT) no longer being statistically different from those of healthy controls (HC). However, recent findings revealed enhanced stress responsivity in remitted BPD compared to HC, as remitted BPD patients react with an increased urge for self‐injurious behaviour to the induction of stress (Willis et al, 2018). Thus, despite symptomatic remission, stress regulation deficits may still exist in remitted BPD.…”

“…Thus, despite symptomatic remission, stress regulation deficits may still exist in remitted BPD. However, while previous studies investigated the stress‐relieving effect of pain (Willis et al, 2018) in current (cBPD) and remitted BPD (rBPD) patients, it remains open whether pain perception in both groups is differentially influenced by dissociation proneness. The responses in rBPD are of particular importance in this context, because these might give insight into the nature of still existing stress regulation deficits in symptomatic BPD remission.…”

Neuronale Korrelate unangenehmer somatosensorischer Stimulation bei Patienten mit Borderline-Persönlichkeitsstörung und Depression

“…Während des NSSVs berichten Patienten mit BPS wiederum häufig von einer Hypo-oder Analgesie [14]. Andererseits klagen Patienten mit BPS vermehrt über chronische und beeinträchtigende Schmerzen [34] Stimuli wiederum vergleichbar gut einschätzen. Bei Patienten mit BPS waren jedoch etwas höhere Stimulusintensitäten erforderlich, damit diese als vergleichbar unangenehm empfunden worden waren.…”