Pills, Pain, And Personality Disorders

  1. Pain and Personality Disorders
  2. Self-Regulation
  3. Pills and Personality Disorders
  4. Coping Strategies to Deal with Pain

Defining Personality Disorders

Personality disorders can be understood as a consistent pattern of inner experience and behavior that significantly deviates from cultural expectations or norms. These patterns of behavior lead to disruptions in interpersonal, occupational, or other important areas of functioning. Personality disorders typically become recognizable in adolescence or early adult life and remain relatively stable over time.1
Defining Personality Disorders

Examples of Personality Disorders

It is important to note that, to some degree, we all contain features of certain personality disorders. It is only when these features become extreme, exaggerated, or substantially impair our daily life, do they become labeled as a “clinical” disorder.

Examples of Personality Disorders:

For more detailed information on personality disorders, visit the personality disorders topic center.


Pain and Personality Disorders

There appears to be a relationship between personality disorders and chronic pain.2, 3 There are various perspectives on why this might be the case. We will explore this relationship through the lens of “self-regulation” in the context of one specific personality disorder, Borderline Personality Disorder (BPD).

Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is characterized by a continuous pattern of instability in relationships, self-image, and emotions. It is also marked by impulsivity and difficulties in emotion regulation.1 For detailed explanations of BPD, visit the borderline personality disorder article and related topics.

Individuals with BPD tend to experience chronic pain at a higher prevalence than the normal population.4 Although some may dismiss it as a “way to receive attention” or a “fabrication,” it is important to acknowledge that their pain is just as real as anyone else’s.

The question is, why do individuals with BPD experience more pain? One perspective suggests that this is related to difficulties with self-regulation.


Self-Regulation

Self-regulation refers to our capacity to find “homeostasis,” or balance, in the nervous system.

  • A threat - whether it is a saber-toothed tiger (for our ancestors), a dark alley at night, or the anticipation of a public speech - activates our sympathetic nervous system, or the “fight-or-flight” part of our body.
  • At some point, when the threat is gone, we need to be able to turn off this sympathetic activity, and turn on the parasympathetic branch- the “rest, digest, and heal” part of our body.

Our ability to regulate these physiological processes (in addition to our emotions and cognitions) within an appropriate context is what is meant by self-regulation.

  • Consistent sympathetic activity causes “wear and tear” on the body, leading to poorer mental and physical health.
  • Eventually, this can lead to the experience of chronic pain due to the inability to shut off stress-related adaptations of the nervous, endocrine, and immune systems.
  • Blunting or "shutting down" these processes, too, hinders our ability to function on a healthy emotional, cognitive, and social level.
  • We need to have a balanced, flexible, and context-appropriate use of our stress response system.

Borderline Personality Disorder and Pain: The Link is Self-Regulation

borderline personality disorder
Because individuals with BPD have difficulties regulating their physiology, emotions, and thoughts, they can become stuck in either an "on" or "off" state.

Being stuck "on" means that the sympathetic nervous system is dominant, leading to behaviors like aggression. Being stuck "off" means that there is a "shut down" of physiological or emotional activity, leading to behaviors like social withdrawal and depression. Neither state allows for a truly parasympathetic response to kick in, which would normally allow relaxation and healing.

"The Pain Paradox" of Borderline Personality Disorder

Sansone & Sansone (2007) point out what they call the “the pain paradox” in BPD: there is often an insensitivity to acute (short-term) pain (e.g., self-harming behaviors), in addition to a hypersensitivity to chronic (long-term) pain. Their perspective is summarized below.5

  • Individuals with BPD have difficulties “regulating” the pain sensation in their bodies.
    • In other words, they have a difficult time “dialing it down” or shifting their attention away from the internal sensation.
  • Sometimes there are “co-occurring” disorders or features- like anxiety or posttraumatic stress disorder (PTSD). This may cause a “hypervigilance” towards threatening internal bodily sensations.
    • Thus, not only do external circumstances chronically appear as a “threat,” but now uncomfortable internal sensations also become a “threat.”
  • In some cases, receiving attention or care for one’s pain becomes reinforcing, increasing the likelihood of that behavior (or sensation) repeating.
    • Given the interpersonal difficulties in BPD, this may be a subtle way of maintaining connection or care.

Individuals with BPD often have felt like a victim at some point in childhood. Many of us continue to reenact our childhood roles throughout life. Being a pain patient is one way of maintaining one’s identity as victim.


Pills and Personality Disorders

Given our in-depth exploration of BPD (or personality disorders in general) and pain, we now have an idea as to why individuals with personality disorders might use pills:

  1. A real, and elevated, degree of pain may exist. Taking pain pills may feel like the only way to decrease these sensations.
  2. Given difficulties with self-regulation in BPD and other personality disorders, it becomes habitual to turn to these fixes as a means to help regulate, diminish, or abolish uncomfortable emotions and sensations- instead of using coping strategies (see below examples), which take time to master.

Coping Strategies to Deal with Pain

These strategies may help you deal with pain more effectively and reduce your reliance on pills (if that is your goal). Progress takes time. Practice these consistently. Be patient, curious, and self-compassionate. Regardless of what strategies you use, if any at all, treat yourself with kindness and acceptance.

Coping Techniques

Helpful Information Sheets

More on the fight or flight response: http://psychology.tools/fight-or-flight-response.html


References

  1. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA, American Psychiatric Association.
  2. Conrad, R., Schilling, G., Bausch, C., Nadstawek, J., Wartenberg, H. C., Wegener, I., ... & Liedtke, R. (2007). Temperament and character personality profiles and personality disorders in chronic pain patients. PAIN®, 133(1), 197-209.
  3. Dersh, J., Polatin, P. B., & Gatchel, R. J. (2002). Chronic pain and psychopathology: research findings and theoretical considerations.Psychosomatic medicine, 64(5), 773-786.
  4. Sansone, R. A., Whitecar, P., Meier, B. P., & Murry, A. (2001). The prevalence of borderline personality among primary care patients with chronic pain. General Hospital Psychiatry, 23(4), 193-197.
  5. Sansone, R. A., Sansone, L. A. (2007). Borderline personality and the pain paradox. Psychiatry, 4, 40-46.