Bohus M, Limberger M, Ebner U, Glocker F X, Schwarz B, Wernz M, Lieb K
Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Hauptstr. 5, D-79104, Freiburg, Germany.
Psychiatry Res. 2000 Sep 11;95(3):251-60. doi: 10.1016/s0165-1781(00)00179-7.
Self-mutilation occurs in 70-80% of patients who meet DSM-IV criteria for borderline personality disorder. Approximately 60% of these patients report that they do not feel pain during acts of self-mutilation such as cutting or burning. Findings of recent studies measuring pain perception in patients with BPD are difficult to interpret since variables such as distress, dissociation or relevant psychotropic medication have not been controlled. The Cold Pressor Test (CPT) and the Tourniquet Pain Test (TPT) were administered to 12 female patients with BPD who reported analgesia during self-mutilation and 19 age-matched healthy female control subjects. All subjects were free of psychotropic medication. The patients were studied on two occasions: during self-reported calmness and during intensive distress (strong urge to cut or burn themselves). Even during self-reported calmness, patients with BPD showed a significantly reduced perception of pain compared to healthy control subjects in both tests. During distress, pain perception in BPD patients was further significantly reduced as compared with self-reported calmness. The present findings show that self-mutilating patients with BPD who experience analgesia during self-injury show an increased threshold for pain perception even in the absence of distress. This may reflect a state-independent increased pain threshold which is further elevated during stress. Interpretation of these findings is limited by their reliance upon self-reports.
在符合《精神疾病诊断与统计手册》第四版（DSM-IV）边缘型人格障碍标准的患者中，70%-80%会出现自我伤害行为。这些患者中约60%报告称，在诸如割伤或烧伤等自我伤害行为过程中他们感觉不到疼痛。由于诸如痛苦、解离或相关精神药物等变量未得到控制，近期测量边缘型人格障碍患者疼痛感知的研究结果难以解释。对12名报告在自我伤害时有痛觉缺失的边缘型人格障碍女性患者以及19名年龄匹配的健康女性对照受试者进行了冷加压试验（CPT）和止血带疼痛试验（TPT）。所有受试者均未服用精神药物。对患者进行了两次研究：在自我报告的平静状态下以及在强烈痛苦状态下（强烈的割伤或烧伤自己的冲动）。即使在自我报告的平静状态下，边缘型人格障碍患者在两项测试中与健康对照受试者相比，疼痛感知也显著降低。在痛苦状态下，与自我报告的平静状态相比，边缘型人格障碍患者的疼痛感知进一步显著降低。目前的研究结果表明，在自我伤害时有痛觉缺失的边缘型人格障碍自我伤害患者，即使在没有痛苦的情况下，疼痛感知阈值也会升高。这可能反映了一种与状态无关的疼痛阈值升高，在压力状态下会进一步升高。这些研究结果的解释因依赖自我报告而受到限制。
