Borderline personality (BP) is estimated to affect between 1.5% and 6% of people in the United States. Core features of BP include black-and-white, all-or-nothing thinking, intense, rapidly shifting emotions and difficulties with emotion regulation, challenges in relationships and with self-image, and a tendency toward impulsivity.
All of these can exacerbate distress, decrease coping, and make it harder to function socially, at work, and in general. Furthermore, the prevalence of BP in people with chronic pain is significantly greater than in the general population (30%) and is linked to increased pain severity and poorer coping with pain.
Non-suicidal self-injury is a tool frequently used by those with borderline personality in an effort to decrease emotional pain and induce calm. Those who have BP often report both the absence of pain and an increase in well-being or feelings of euphoria when engaging in self-harm, both of which may reinforce the tendency to continue self-harming as a way of coping.
The Pain Paradox
The relationship between pain, self-injury, and BP is complex. Between 70% and 80% of those diagnosed with BP engage in self-injury to distance themselves from painful emotions and distressing thoughts. On the surface, it is perplexing that BP predisposes individuals to not only higher pain tolerance in the face of acute (short-duration) and self-inflicted pain, but lower pain tolerance, as well as greater pain severity and poorer coping, in response to chronic (ongoing) pain.
The Overlap of Emotional and Physical Pain
Contrary to popular belief, there is no one “pain center” in the brain; multiple brain structures are responsible for the experience of pain. A complex and multifaceted experience, “pain” refers to sensing the location of discomfort, assessing pain severity, registering the quality of pain (e.g., piercing, hot, throbbing, intermittent, etc.), linking to memories related to pain, the emotional response to pain, beliefs one has about the potential for coping with pain, and the ability to devise and follow through with a plan for pain management, among others.
The current and rapidly growing body of research on pain has found that distressing cognitive responses, such as catastrophizing (“I can’t handle this pain; I’m never going to get better!”) and emotional responses, such as depression and anxiety, can worsen both pain severity and coping, as well as challenge one’s ability to stick with a pain management plan that may require patience, persistence, and possibly a temporary increase in pain severity (such as with physical therapy).
Why Is Borderline Personality Common in People with Chronic Pain?
There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population. Because pain is a complex, mind-brain-body phenomenon, one hypothesis is that pain that feels random or beyond one’s control may induce feelings of depression, hopelessness, helplessness, anger, and anxiety—all of which amp up pain. Invalidation by ill-informed providers is more likely to elicit poor coping, particularly in those who may struggle with coping already.
Reports of increased severity of pain and other bodily symptoms in those with BP are correlated with greater levels of anxiety and depression. When researchers have statistically controlled for anxiety and depression in those who have both BP and pain, symptom severity has been similar to that of those without BP.
Related Courses of Interest:
Living a Better Life with Chronic Pain: Eliminating Self-Defeating Behaviors is a 5-hour online CE course by Robert E. Hardy, EdD. Certainly no one would choose a pain-filled body over a healthy, pain-free body. Yet every day, people unwittingly choose actions and attitudes that contribute to pain or lead to other less-than-desirable consequences on their health, relationships or ability to function. These actions and attitudes are what are called self-defeating behaviors (SDBs) and they keep us from living life to the fullest—if we let them. This course is a self-instructional module that “walks” readers through the process of replacing their self-defeating chronic pain issues with healthy, positive, and productive life-style behaviors. It progresses from an analysis of the emotional aspects of living with chronic pain to specific strategies for dealing more productively with it. Through 16 guided exercises, readers will learn how to identify their self-defeating behaviors (SDBs), analyze and understand them, and then replace them with life-giving actions that lead to permanent behavioral change. Course #50-12 | 2014 | 49 pages | 35 posttest questions
Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders is a 5-hour online CE course by the US Department of Health and Human Services. Medication for chronic pain is addictive; therefore, the treatment of individuals with both substance abuse disorders and pain presents particular challenges. This course is based on a document from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services, Managing Chronic Pain in Adults With or in Recovery from Substances Use Disorders: A Treatment Improvement Protocol (SAMHSA Tip 54). Intended for all healthcare providers, this document explains the close connections between the neurobiology of pain and addiction, assessments for both pain and addiction, procedures for treatment of chronic pain management (both pharmaceutical and non-pharmaceutical), side effects and symptoms of tolerance and withdrawal from pain medication, managing risk of addiction to pain medication and nonadherence to treatment protocols, maintaining patient relationships, documentation, and safety issues. Written by panel consensus, SAMHSA TIP 54 provides a good introduction to pain management issues and also a good review for experienced clinicians. Course #50-06 | 2012 | 120 pages | 34 posttest questions
Assessing Substance Abuse in Patients with Chronic Pain is a 3-hour online CE course by Ellen Lavin, PhD. This course will demystify the diagnosis and treatment of chronic pain, the role and limitations of pain medications, and how to identify when pain relieving drugs may be harmful to clients. Participants will understand how to conduct a complete evaluation of clients with a pain disorder, chronic pain syndrome and co-morbid psychiatric diagnoses. Although the majority of chronic pain patients do not abuse pain medications, mental health practitioners need skills to assess when active substance abuse is present and develop appropriate treatment objectives. This course will also give special attention to specific clinical challenges for mental health professionals who treat clients with chronic pain, including suicide assessment and treatment non-adherence. Closeout Course #30-35 | 2006 | 34 pages | 20 posttest questions
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (#5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).