Persistent antinociception through repeated self-injury in patients with borderline personality disorder
Persistent antinociception through repeated self-injury in patients with borderline personality disorder
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DOI：
10.1016/j.pain.2011.11.021
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发表时间：
2012-03-01
期刊：
影响因子：
7.4
通讯作者：
Treede, Rolf-Detlef
中科院分区：
文献类型：
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作者：
Magerl, Walter;Burkart, Daniela;Treede, Rolf-Detlef
边缘性人格障碍患者（大多数为女性）表现出严重的自我攻击行为，即故意进行的非自杀性自残和严重的疼痛感知迟钝，其机制迄今尚不清楚。由于伤害感受系统表现出高度的可塑性，本研究的目的是分析疼痛感知与自伤行为的关系。根据 DSM-IV 和 22 名年龄和性别匹配的对照，通过定量感觉测试研究了 22 名边缘性人格障碍 (BPD) 患者（15 名女性，7 名男性）对机械和化学伤害性刺激的疼痛感知。 BPD 患者对针刺刺激的疼痛阈值显着较高（比健康对照受试者高 2.7 倍），对机械刺激（针刺，-28%）和化学刺激（辣椒素，-38%）的疼痛等级显着降低。 BPD 患者（tau = 49 秒）中辣椒素引起的疼痛消退速度明显快于对照组（tau = 76 秒）。这些疼痛感知的改变通常存在于女性 BPD 患者中，但不存在于男性 BPD 患者亚组中。对疼痛强度与不愉快程度的分析表明，主要是疼痛体验的不愉快方面减少了。自伤行为的发生时间可以显着预测疼痛感觉的减弱（倍数 r = 0.58）。根据最近的数据，我们认为 BPD 患者因自身造成的多重伤害而产生过度的内源性抗伤害作用。这种夸张的疼痛控制被认为是通过将评估或情绪情感与疼痛的感觉辨别维度分离来实现的。 (C) 2011 年国际疼痛研究协会。由 Elsevier B.V. 出版。保留所有权利。
Patients with borderline personality disorder, mostly female, exhibit severe autoaggressive behavior, namely an intentionally performed, nonsuicidal self-injury and severe blunting of pain perception, the mechanism of which is hitherto not understood. Because the nociceptive system displays a high degree of plasticity, the aim of this study was to analyze the relationship of pain perception to self-injurious behavior. Pain perception of mechanical and chemical noxious stimuli was studied by quantitative sensory testing in 22 patients (15 female, 7 male) with borderline personality disorder (BPD) according to DSM-IV and 22 age- and gender-matched controls. BPD patients exhibited a significantly higher pain threshold to pinprick stimuli (2.7 times higher than healthy control subjects), and significantly lower pain ratings to mechanical (pinprick, -28%) and chemical (capsaicin, -38%) stimulation. Capsaicin-induced pain decayed significantly faster in BPD patients (tau = 49 seconds) than in controls (tau = 76 seconds). These alterations of pain perception were generally present in the female, but not in the male subgroup of BPD patients. Analysis of pain intensity vs unpleasantness suggested that primarily the unpleasantness aspect of the pain experience was reduced. Blunting of pain sensation was significantly predicted by the recency of self-injurious behavior (multiple r = 0.58). In line with recent data, we suggest an excess of endogenous antinociception in BPD patients resulting from self-inflicted multiple injuries. This exaggerated pain control is conceived to operate via an uncoupling of the evaluative or emotional-affective from the sensory-discriminative dimension of pain. (C) 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.