Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, University of Heidelberg, Heidelberg, Germany.
Biol Psychiatry. 2010 Aug 15;68(4):383-91. doi: 10.1016/j.biopsych.2010.04.015. Epub 2010 May 26.
Patients with borderline personality disorder (BPD) experience intense emotions and often show a deficiency of emotion regulation skills. Moreover, they display high prevalence rates of self-injurious behavior. Patients report engaging in self-injurious behavior due to its immediate relief effects of emotional tension. Pain in BPD has further been observed to lead to a reduction in neural activity in the amygdala and anterior cingulate cortex, which may be attributed to patients' perception of relaxation.
To investigate the potential role of self-inflicted pain as a means of affect regulation in patients with BPD, we conducted a functional magnetic resonance imaging study using picture stimuli to induce negative (vs. neutral) affect and thermal stimuli to induce heat pain (vs. warmth perception). The painful heat stimuli were administrated at an individual temperature for each subject. Twenty patients with BPD and 23 healthy control subjects were included in the study.
Both negative and neutral pictures led to stronger activation of the amygdala, insula, and anterior cingulate cortex in patients with BPD than in healthy control subjects. Amygdala activation correlated with self-reported deficits in emotion regulation. During the sensory stimulation, we found decreased amygdala and anterior cingulate cortex activation, which was independent of painfulness.
The results are in line with previous findings on emotional hyperactivity in BPD and suggest that pain stimuli in BPD are processed differently depending on the arousal status. Finally, we can preliminarily support the idea of a general mechanism of attentional shift underlying the soothing effect of pain in BPD.
边缘型人格障碍（BPD）患者会体验到强烈的情绪，且通常表现出情绪调节技能的缺乏。此外，他们自残行为的发生率也很高。患者报告称，他们会进行自残行为，是因为这种行为可以立即缓解情绪紧张。进一步观察到，BPD 患者的疼痛会导致杏仁核和前扣带皮层的神经活动减少，这可能归因于患者的放松感。
为了研究自伤作为 BPD 患者情绪调节手段的潜在作用，我们使用图片刺激来诱发负面（与中性相比）情绪，并使用热刺激来诱发热痛（与温暖感觉相比），进行了一项功能磁共振成像研究。对每个受试者，使用个体温度来施加疼痛的热刺激。研究纳入了 20 名 BPD 患者和 23 名健康对照受试者。
负面和中性图片均会导致 BPD 患者的杏仁核、岛叶和前扣带皮层的激活比健康对照组更强。杏仁核的激活与自我报告的情绪调节缺陷相关。在感觉刺激过程中，我们发现杏仁核和前扣带皮层的激活减少，且与疼痛无关。
这些结果与 BPD 中情绪过度活跃的先前发现一致，并表明 BPD 中的疼痛刺激会根据唤醒状态而以不同的方式被处理。最后，我们可以初步支持疼痛的舒缓作用背后存在注意力转移的一般机制的观点。
