Association Between Borderline Personality Features and Temporal Summation of Second Pain: A Cross-Sectional Study

ABSTRACT Individuals with greater borderline personality features may be vulnerable to chronic pain. Because pain is an unpleasant sensory and emotional experience, affect dysregulation as the core personality feature may be linked to pain hypersensitivity. Studies have found that greater borderline features are associated with increased intensity in clinical and experimental pain, and that depression mediates this increase. The current study further examined the association between borderline features and heat pain sensitivity, the contribution of affect dysregulation and the other borderline personality factors (identity problems, negative relationships, self-harming/impulsivity) to the association, and depression as a mediator. Additionally, we examined whether blunted sympathetic responses mediate the association between borderline features and temporal summation of second pain (TSSP). Thermal pain threshold, thermal TSSP and aftersensations pain were assessed in 79 healthy individuals with varying degrees of borderline features. TSSP is a proxy measure for central sensitization and refers to the gradual increase in pain to repeated nociceptive stimuli. A regression analysis showed that greater borderline features predicted greater TSSP (β = .22, p = .050, R2 = .05). Borderline features were unrelated to pain threshold and TSSP decay. A stepwise regression showed greater TSSP in individuals with greater borderline features was accounted for by the negative relationships factor rather than the affect dysregulation factor. The results of mediational analyses showed depression and blunted sympathetic skin conductance responses mediated the positive association between TSSP and borderline features.

[1]  J. Coan,et al.  A Developmental Neuroscience of Borderline Pathology: Emotion Dysregulation and Social Baseline Theory , 2012, Journal of abnormal child psychology.

[2]  J. Gunderson,et al.  Disturbed relationships as a phenotype for borderline personality disorder. , 2007, The American journal of psychiatry.

[3]  M. Brüne,et al.  Borderline Personality Disorder , 2016, Evolution, medicine, and public health.

[4]  M. Tull,et al.  Multimodal assessment of emotional reactivity in borderline personality pathology: the moderating role of posttraumatic stress disorder symptoms. , 2013, Comprehensive psychiatry.

[5]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[6]  K. Davis,et al.  Effects of temperature on heat pain adaptation and habituation in men and women , 2010, PAIN®.

[7]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[8]  Timothy J Trull,et al.  Categorical and dimensional models of personality disorder. , 2005, Annual review of clinical psychology.

[9]  T. Trull,et al.  The pain paradox: borderline personality disorder features, self-harm history, and the experience of pain. , 2015, Personality disorders.

[10]  G. Juckel,et al.  Loudness dependence of auditory evoked potentials in patients with borderline personality disorder—Impact of psychopathology , 2012, Psychiatry Research.

[11]  F. Félix,et al.  Fibromyalgia and Related Medically Unexplained Symptoms: A Lost Link Between Cardiovascular and Nociception Modulation , 2009 .

[12]  E. Benarroch,et al.  Pain-autonomic interactions , 2006, Neurological Sciences.

[13]  Blair H. Smith,et al.  A classification of chronic pain for ICD-11 , 2015, Pain.

[14]  G. Juckel,et al.  Association between wind-up ratio and central serotonergic function in healthy subjects and depressed patients , 2011, Neuroscience Letters.

[15]  S. Herpertz,et al.  Affective responsiveness in borderline personality disorder: a psychophysiological approach. , 1999, The American journal of psychiatry.

[16]  M. Meagher,et al.  The Personality Assessment Inventory with chronic pain patients: Psychometric properties and clinical utility. , 2005, Journal of clinical psychology.

[17]  Michael Feuerstein,et al.  Environmental stressors and chronic low back pain: Life events, family and work environment , 1985, Pain.

[18]  K. Lyons-Ruth,et al.  BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model. , 2008, Journal of personality disorders.

[19]  C. Power,et al.  Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British Birth Cohort Study , 2009, Pain.

[20]  G. Fitzmaurice,et al.  Pain in patients with borderline personality disorder. , 2014, Personality and mental health.

[21]  A. Hamm,et al.  Emotional Vulnerability in Borderline Personality Disorder Is Cue Specific and Modulated by Traumatization , 2011, Biological Psychiatry.

[22]  M. Bradley,et al.  Measuring emotion: the Self-Assessment Manikin and the Semantic Differential. , 1994, Journal of behavior therapy and experimental psychiatry.

[23]  H. Flor,et al.  Emotional learning during dissociative states in borderline personality disorder. , 2009, Journal of psychiatry & neuroscience : JPN.

[24]  D. McNeil,et al.  Development of the Fear of Pain Questionnaire-III , 1998, Journal of Behavioral Medicine.

[25]  A. Dickenson,et al.  Descending serotonergic facilitation mediated through rat spinal 5HT3 receptors is unaltered following carrageenan inflammation , 2004, Neuroscience Letters.

[26]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[27]  J. Levine,et al.  The contributions of interpersonal conflict to chronic pain in the presence or absence of organic pathology , 1991, Pain.

[28]  Sheldon Cohen.  Perceived stress in a probability sample of the United States , 1988 .

[29]  F. Glocker,et al.  Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior , 2000, Psychiatry Research.

[30]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[31]  T. Trull.  Borderline personality disorder features in nonclinical young adults: 1. Identification and validation. , 1995 .

[32]  N. Pole,et al.  Heterogeneity of defensive responses after exposure to trauma: blunted autonomic reactivity in response to startling sounds. , 2013, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[33]  M. Jovev,et al.  The relationship of borderline personality disorder, life events and functioning in an Australian psychiatric sample. , 2006, Journal of personality disorders.

[34]  C. Glenn,et al.  Emotion dysregulation as a core feature of borderline personality disorder. , 2009, Journal of personality disorders.

[35]  Lars Arendt-Nielsen,et al.  Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. , 2009, The journal of pain : official journal of the American Pain Society.

[36]  J. Levine,et al.  Stress in the Adult Rat Exacerbates Muscle Pain Induced by Early-Life Stress , 2013, Biological Psychiatry.

[37]  Klaus Lieb,et al.  Borderline personality disorder , 2004, The Lancet.

[38]  C. Woolf.  Central sensitization: Implications for the diagnosis and treatment of pain , 2011, PAIN.

[39]  Leslie C. Morey,et al.  Personality Assessment Inventory (PAI) , 2015 .

[40]  C. Vierck,et al.  Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients , 2002, PAIN.

[41]  Walter Magerl,et al.  Depression and changed pain perception: Hints for a central disinhibition mechanism , 2008, PAIN.

[42]  S. Herpertz,et al.  Emotional responses in patients with borderline as compared with avoidant personality disorder. , 2000, Journal of personality disorders.

[43]  Jason G. Craggs,et al.  Brain activity associated with slow temporal summation of C‐fiber evoked pain in fibromyalgia patients and healthy controls , 2008, European journal of pain.

[44]  B. McEwen.  Allostasis and Allostatic Load: Implications for Neuropsychopharmacology , 2000, Neuropsychopharmacology.

[45]  J. Coan,et al.  Social Baseline Theory: The Social Regulation of Risk and Effort. , 2015, Current opinion in psychology.

[46]  J. Kennedy,et al.  Association between serotonin transporter gene and borderline personality disorder. , 2006, Journal of psychiatric research.

[47]  J. Levine,et al.  Repeated sound stress enhances inflammatory pain in the rat , 2005, Pain.

[48]  L. Radloff.  The CES-D Scale , 1977 .

[49]  Laszlo Hejjel,et al.  The corner frequencies of the ECG amplifier for heart rate variability analysis , 2005, Physiological measurement.

[50]  D. Price,et al.  Temporal summation of second pain and its maintenance are useful for characterizing widespread central sensitization of fibromyalgia patients. , 2007, The journal of pain : official journal of the American Pain Society.

[51]  J. Levine,et al.  Early-life stress produces muscle hyperalgesia and nociceptor sensitization in the adult rat , 2011, PAIN.

[52]  J Douglas Bremner,et al.  Psychophysiological reactivity to traumatic and abandonment scripts in borderline personality and posttraumatic stress disorders: a preliminary report , 2004, Psychiatry Research.

[53]  T. Trull,et al.  Borderline personality disorder features in nonclinical young adults: 2. Two-year outcome. , 1997, Journal of abnormal psychology.

[54]  D. Turk,et al.  Stress and Psychophysiological Dysregulation in Patients with Fibromyalgia Syndrome , 2002, Applied psychophysiology and biofeedback.

[55]  Sarah L. Tragesser,et al.  Borderline Personality Disorder Features and Pain: The Mediating Role of Negative Affect in a Pain Patient Sample , 2010, The Clinical journal of pain.

[56]  S. Duschek,et al.  Autonomic cardiovascular control and responses to experimental pain stimulation in fibromyalgia syndrome. , 2011, Journal of psychosomatic research.

[57]  Iasp Subcommittee on Taxonomy.  Pain terms a current list with definitions and notes on usage , 1986, Pain.

[58]  G. Slade,et al.  Role of allostatic load in sociodemographic patterns of pain prevalence in the U.S. population. , 2012, The journal of pain : official journal of the American Pain Society.

[59]  James W. Pennebaker,et al.  The psychology of physical symptoms , 1982 .

[60]  M. Meagher,et al.  Childhood Adversity and Pain Sensitization , 2016, Psychosomatic medicine.

[61]  C. Woolf,et al.  Neuronal plasticity: increasing the gain in pain. , 2000, Science.

[62]  R. R. Abidin.  Psychological Assessment Resources , 1995 .