Pain Perception and Self Injury - Personality Disorders

One of the common characteristics of Borderline Personality Disorder (BPD) is that people with BPD often intentionally injure and physically hurt themselves. Common forms of self-injurious behaviors include cutting, burning, scratching, or head-banging. Many of the people I work with tell me that they engage in these behaviors in moments when they feel very upset or intensely emotionally overwhelmed. Sometimes, self-injury is a way of translating the intangible emotional pain into a more concrete and tangible physical pain. At other times, people injure themselves in moments when they feel emotionally disconnected, and the physical pain is a way of feeling – something, anything - rather than experiencing numbness inside. For some people it is the only way in which they know to communicate their distress, and for yet another group of people it is a form of self-punishment. The people in the person’s environment are often baffled and very worried by these behaviors. They also tend to have a hard time understanding what is going on. Very frequently, self-injurious behaviors are interpreted as a way of seeking attention. All in all, these behaviors are strategies that are destructive and not particularly effective, which is what lead Marsha Linehan to develop a treatment, Dialectical Behavior Therapy, that teaches people skills that are more effective than self-injurious behaviors.

In recent paper in the professional journal Acta Psychiatrica Scandinavica, the research group around Ludaescher, Schmal and Bohus looked at the connection between pain perception and self-injurious behaviors in people with Borderline Personality Disorder. Previous research reports have shown that about 50-60% of people with Borderline Personality Disorder say that they feel no pain during self-injurious episodes. There are laboratory studies that show that people with BPD who injure themselves are less sensitive pain than people who do not have BPD. The hypothesis is that people with BPD who injure themselves evaluate pain in a different way and react to the perception of pain in a way that is different. In other words, the hypothesis is that BPD patient who injure themselves do notice the pain stimulus, but they may process and react to it in a way that is different. Ludaescher and colleagues assume that one of the reasons for these differences may be the fact that people with BPD tend to dissociate, which means they emotionally shut down, disconnect, and/or feel numb inside.

In their study, Ludaescher and colleagues looked at 24 unmedicated women with BPD, and 24 women without BPD in order to investigate pain perception. The detection and thresholds for pain were measures by using contact thermodes on the back of people’s hands, and by using heat pulses that were emitted by a laser.

The results replicated previous findings: Women with Borderline Personality Disorder who inured themselves lower pain sensitivity than women without BPD. The former group also showed higher scores on a measure of dissociation, which supports the author’s hypothesis. What was of note in this study, though, was that women with Borderline Personality disorder who had stopped injuring themselves for at least 6 months showed pain sensitivity that was between the two groups. This is group also showed a score of dissociation that was between the two groups.

So, what could explain these findings? One explanation is that there could be different pre-existing subgroups of BPD with different pain thresholds. Alternatively, it looks like when people stop injuring themselves, their pain perceptions changes as well and appears to “normalize”. There’s also the fact that there was a slight indication in the study that the severity of Borderline symptoms was related to pain thresholds: People with more severe Borderline symptoms appeared to be less sensitive to pain. All in all, I guess what this means is that all these factors go together, and that there’s hope: Treatments such as DBT, which is geared towards helping with self-injurious behaviors might affect many more factors for a person than just the overt behavior.

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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Im a 24 year old girl who lives at home wit her mother.I myself am a cutter i have been controling myself for 2 months as of nov-3-2009. I have been put in ST.Marys 4th floor for about 3 weeks n total an they gave me a big bottle of pills an sent me home each time. well i havent took any of them 4 very long an right now im off all meds an havent cut. So does tht mean a pill fixed me or tht i finally got over TRY;N 2 GET ATT. Hell no iv'e done it my self . so pills r nt the answer

Sometimes, I listen to beautiful music or read beautiful literature to try to reach through numbness, in hope of experiencing that which I may have an intellectual comprehension but am emotionally disconnected to. For example, reading Moby Dick and identifying with Ahab's tragic self-destruction, in the hope that this alone will motivate me to the constructive action I so strongly resist &/or to try to connect to the seriousness of my predicament - to cut through the numbing, denial, etc. Oddly, while sometimes this feels constructive, or at any rate enjoyable, sometimes I have an intuition that such activity can be "self-injurious" in the sense of being a form of escapism. I'm not really sure if this connects to the theme of self injury, but at least when I began to write, I felt it did, and hope these remarks are of some help to someone.