Skip to main content
Log in

Pain perception in female adolescents with borderline personality disorder

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Borderline personality disorder (BPD) is a severe and often debilitating psychiatric disorder that begins during adolescence. Core features of BPD are affective dysregulation, dysfunctional self-concepts, and difficulties in social interactive domains. A widely accepted marker for severe emotion dysregulation in adult BPD is decreased pain sensitivity. Until now it is unclear whether this characteristic feature of BPD is already present during adolescence. Thus, this study aims to investigate pain sensitivity in adolescent patients meeting DSM-IV criteria for BPD. 20 female adolescent patients with BPD (mean age 16.4 years) and 20 healthy age-matched control participants were investigated. Detection and pain thresholds for thermal stimuli were assessed on both hands. Furthermore, self-rating instruments were used to assess overall psychopathology, dissociation, and depression. We found significantly higher pain thresholds in patients with BPD than in healthy controls. Patients with BPD had higher intensities of depression, overall psychopathology, and dissociative symptoms, but there was no correlation between pain sensitivity and any of these measures of psychopathology. These findings are in line with previous findings in adult BPD patients concerning lower pain sensitivity as compared to healthy controls. This provides support for the idea that disturbed pain processing is not only a consequence of chronic BPD but is already present in early stages of BPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84. doi:10.1016/S0140-6736(10)61422-5

    Article  PubMed  Google Scholar 

  2. Pompili M, Girardi P, Ruberto A, Tatarelli R (2005) Suicide in borderline personality disorder: a meta-analysis. Nord J Psychiatry 59:319–324. doi:10.1080/08039480500320025

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. 4th ed. text rev. American Psychiatric Association, Washington, DC

  4. Tackett JL, Balsis S, Oltmanns TF, Krueger RF (2009) A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Dev Psychopathol 21:687–713. doi:10.1017/S095457940900039X

    Article  PubMed Central  PubMed  Google Scholar 

  5. Chanen AM, McCutcheon LK, Jovev M, Jackson HJ, McGorry PD (2007) Prevention and early intervention for borderline personality disorder. Med J Aust 187:S18–S21

    PubMed  Google Scholar 

  6. Miller AL, Muehlenkamp JJ, Jacobson CM (2008) Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev 28:969–981. doi:10.1016/j.cpr.2008.02.004

    Article  PubMed  Google Scholar 

  7. Chanen AM, Kaess M (2012) Developmental pathways to borderline personality disorder. Curr Psychiatry Rep 14:45–53. doi:10.1007/s11920-011-0242-y

    Article  PubMed  Google Scholar 

  8. Chanen AM, Velakoulis D, Carison K, Gaunson K, Wood SJ, Yuen HP, Yücel M, Jackson HJ, McGorry PD, Pantelis C (2008) Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder. Psychiatry Res 163:116–125. doi:10.1016/j.pscychresns.2007.08.007

    Article  PubMed  Google Scholar 

  9. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G, Weinberg I, Gunderson JG (2008) The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand 117:177–184. doi:10.1111/j.1600-0447.2008.01155.x

    Article  CAS  PubMed  Google Scholar 

  10. Kaess M, von Ceumern-Lindenstjerna I-A, Parzer P, Chanen A, Mundt C, Resch F, Brunner R (2013) Axis I and II comorbidity and psychosocial functioning in female adolescents with borderline personality disorder. Psychopatholgy 46:55–62. doi:10.1159/000338715

    Article  Google Scholar 

  11. Leibenluft E, Gardner DL, Cowdry RW (1987) Special feature the inner experience of the borderline self-mutilator. J Personal Disord 1:317–324. doi:10.1521/pedi.1987.1.4.317

    Article  Google Scholar 

  12. Russ MJ, Roth SD, Lerman A, Kakuma T, Harrison K, Shindledecker RD, Hull J, Mattis S (1992) Pain perception in self-injurious patients with borderline personality disorder. Biol Psychiatry 32:501–511

    Article  CAS  PubMed  Google Scholar 

  13. Schmahl C, Greffrath W, Baumgärtner U, Schlereth T, Magerl W, Philipsen A, Lieb K, Bohus M, Treede R (2004) Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain 110:470–479. doi:10.1016/j.pain.2004.04.035

    Article  PubMed  Google Scholar 

  14. Ludäscher P, Bohus M, Lieb K, Philipsen A, Jochims A, Schmahl C (2007) Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res 149:291–296. doi:10.1016/j.psychres.2005.04.009

    Article  PubMed  Google Scholar 

  15. Bohus M, Limberger M, Ebner U, Glocker F, Schwarz B, Wernz M, Lieb K (2000) Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior. Psychiatry Res 95:251–260

    Article  CAS  PubMed  Google Scholar 

  16. Fydrich T, Renneberg B, Schmitz B, Wittchen H (1997) Strukturiertes Klinisches Interview für DSM-IV: Achse II: Persönlichkeitsstörungen (SKID-II). Hogrefe, Goettingen

    Google Scholar 

  17. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) SCID-II (for DSM-IV). American Psychiatric Press, Washington DC

    Google Scholar 

  18. Kaess M, Parzer P, Mattern M, Plener PL, Bifulco A, Resch F, Brunner R (2012) Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Res. doi:10.1016/j.psychres.2012.10.012

    PubMed  Google Scholar 

  19. Lloyd E, Kelley ML, Hoppe T (1997) Self mutilation in a community sample of adolescents: descriptive characteristics and provisional prevalence rates. Paper presented at the Annual meeting of the Society for Behavioral Medicine, New Orleans, Louisiana

  20. Guertin T, Lloyd-Richardson E, Spirito A, Donaldson D, Boergers J (2001) Self-mutilative behavior in adolescents who attempt suicide by overdose. J Am Acad Child Adolesc Psychiatry 40:1062–1069

    Article  CAS  PubMed  Google Scholar 

  21. Kaess M, Parzer P, Mattern M, Resch F, Bifulco A, Brunner R (2011) Childhood experiences of care and abuse (CECA)—validation of the German version of the questionnaire and interview, and results of an investigation of correlations between adverse childhood experiences and suicidal behaviour. Z Kinder Jugendpsychiatr Psychother 39:243–252. doi:10.1024/1422-4917/a000115

    Article  PubMed  Google Scholar 

  22. Paykel ES, Myers JK, Lindenthal JJ, Tanner J (1974) Suicidal feelings in the general population: a prevalence study. Br J Psychiatry 124:460–469

    Article  CAS  PubMed  Google Scholar 

  23. Franke G (1995) SCL-90-R-Die Symptom-Checkliste von Derogatis. Hogrefe, Goettingen

    Google Scholar 

  24. Derogatis LR, Cleary PA (1977) Confirmation of the dimensional structure of the scl-90: A study in construct validation. J Clin Psychol 33:981–989. doi:10.1002/1097-4679(197710)33:4<981:AID-JCLP2270330412>3.0.CO;2-0

    Article  Google Scholar 

  25. Brunner R, Parzer P, Schuld V, Resch F (2000) Dissociative symptomatology and traumatogenic factors in adolescent psychiatric patients. J Nerv Ment Dis 188:71–77

    Article  CAS  PubMed  Google Scholar 

  26. Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR (1997) Development and validation of a measure of adolescent dissociation: the adolescent dissociative experiences scale. J Nerv Ment Dis 185:491–497

    Article  CAS  PubMed  Google Scholar 

  27. Treede R, Lankers J, Frieling A, Zangemeister W, Kunze K, Bromm B (1991) Cerebral potentials evoked by painful, laser stimuli in patients with syringomyelia. Brain 114(Pt 4):1595–1607

    Article  PubMed  Google Scholar 

  28. Yarnitsky D, Sprecher E, Zaslansky R, Hemli JA (1995) Heat pain thresholds: normative data and repeatability. Pain 60:329–332

    Article  CAS  PubMed  Google Scholar 

  29. Kemperman I, Russ MJ, Clark WC, Kakuma T, Zanine E, Harrison K (1997) Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Res 70:175–183

    Article  CAS  PubMed  Google Scholar 

  30. Brunner R, Parzer P, Haffner J, Steen R, Roos J, Klett M, Resch F (2007) Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolesc Med 161:641–649. doi:10.1001/archpedi.161.7.641

    Article  PubMed  Google Scholar 

  31. Ludäscher P, Greffrath W, Schmahl C, Kleindienst N, Kraus A, Baumgärtner U, Magerl W, Treede R-D, Bohus M (2009) A cross-sectional investigation of discontinuation of self-injury and normalizing pain perception in patients with borderline personality disorder. Acta Psychiatr Scand 120:62–70. doi:10.1111/j.1600-0447.2008.01335.x

    Article  PubMed  Google Scholar 

  32. Stanley B, Sher L, Wilson S, Ekman R, Huang Y, Mann JJ (2010) Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord 124:134–140. doi:10.1016/j.jad.2009.10.028

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Prossin AR, Love TM, Koeppe RA, Zubieta J-K, Silk KR (2010) Dysregulation of regional endogenous opioid function in borderline personality disorder. Am J Psychiatry 167:925–933. doi:10.1176/appi.ajp.2010.09091348

    Article  PubMed  Google Scholar 

  34. Lautenbacher S, Krieg JC (1994) Pain perception in psychiatric disorders: a review of the literature. J Psychiatr Res 28:109–122

    Article  CAS  PubMed  Google Scholar 

  35. Riley JL 3rd, Robinson ME, Wise EA, Price DD (1999) A meta-analytic review of pain perception across the menstrual cycle. Pain 81:225–235

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all patients for participating in the study.

Conflict of interests

None to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Romuald Brunner.

Additional information

P. Ludäscher and C. von Kalckreuth have contributed equally.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ludäscher, P., von Kalckreuth, C., Parzer, P. et al. Pain perception in female adolescents with borderline personality disorder. Eur Child Adolesc Psychiatry 24, 351–357 (2015). https://doi.org/10.1007/s00787-014-0585-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-014-0585-0

Keywords

Navigation