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Physical and Social Pains in Borderline Disorder and Neuroanatomical Correlates: A Systematic Review

  • Personality Disorders (C Schmahl, Section Editor)
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Abstract

Borderline personality disorder (BPD) is a common psychiatric disorder, the core features of which are affective dysregulation, identity disturbances, and problems in social interaction, with an intense fear of loss, abandonment, or rejection by social partners. Self-injurious behaviors (SIB), such as superficial cutting, occur in 70–80 % of BPD patients, which are associated with emotional relief. Intriguingly, the majority of BPD patients report reduced or no pain associated with SIB, whereas BPD patients are over-represented in chronic pain patients. Thus, studying pain perception in such patients may help to understand the pathophysiology of BPD, but also the interaction between affective and physical dimensions of pain. We conducted a systematic review dealing with physical and social pains in BPD patients, with a special focus on neuroimaging data. SIB appear to be an inadequate strategy to regulate negative emotions that may be related to social/psychological pain, by increasing dorsolateral prefrontal cortex activation in order to regulate amygdala activation. In addition, abnormal hyperactivation of the insula is a possible trait marker of BPD, and might contribute to modified pain sensitivity. When considering psychological pain in BPD patients, neuroanatomical studies have shown a hyper-responsive subcortical limbic network and a deficient regulatory control system operating through anterior brain regions. Promising therapeutic strategies should target neuroanatomical and neurobiological dysfunctions, which lead to altered pain perception in BPD patients.

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Acknowledgments

We would like to thank Valerie Macioce for her careful reading of the manuscript.

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Conflict of Interest

Déborah Ducasse declares that she has no conflict of interest.

Philippe Courtet has been a board member of Servier and Lundbeck. He also has received expert testimony honoraria from Servier. He also has received honoraria and paid travel accommodations from Astra Zeneca, BMS, Otsuka, Lundbeck, Janssen Cilag, Lilly, Pfizer, and Servier.

Emilie Olié has received grants from Astra Zeneca, honoraria from Astra Zeneca, BMS-Otsuka, Euthérapie, and Lundbeck, and payment for manuscript preparation from Astra Zeneca, and Ardix. She has also received paid travel and accommodation from Euthérapie, Otsuka, and Lundbeck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Psychiatric Emergencies and Post Emergencies, Lapeyronie Hospital, Academic Hospital of Montpellier, UM1 University of Montpellier, INSERM U1061, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France

    Déborah Ducasse, Philippe Courtet & Emilie Olié

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  1. Déborah Ducasse
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Correspondence to Déborah Ducasse.

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This article is part of the Topical Collection on Personality Disorders

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Ducasse, D., Courtet, P. & Olié, E. Physical and Social Pains in Borderline Disorder and Neuroanatomical Correlates: A Systematic Review. Curr Psychiatry Rep 16, 443 (2014). https://doi.org/10.1007/s11920-014-0443-2

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