Department of Psychiatric Emergencies and Post Emergencies, Lapeyronie Hospital, Academic Hospital of Montpellier, UM1 University of Montpellier, INSERM U1061, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France,
Curr Psychiatry Rep. 2014 May;16(5):443. doi: 10.1007/s11920-014-0443-2.
Borderline personality disorder (BPD) is a common psychiatric disorder, the core features of which are affective dysregulation, identity disturbances, and problems in social interaction, with an intense fear of loss, abandonment, or rejection by social partners. Self-injurious behaviors (SIB), such as superficial cutting, occur in 70-80 % of BPD patients, which are associated with emotional relief. Intriguingly, the majority of BPD patients report reduced or no pain associated with SIB, whereas BPD patients are over-represented in chronic pain patients. Thus, studying pain perception in such patients may help to understand the pathophysiology of BPD, but also the interaction between affective and physical dimensions of pain. We conducted a systematic review dealing with physical and social pains in BPD patients, with a special focus on neuroimaging data. SIB appear to be an inadequate strategy to regulate negative emotions that may be related to social/psychological pain, by increasing dorsolateral prefrontal cortex activation in order to regulate amygdala activation. In addition, abnormal hyperactivation of the insula is a possible trait marker of BPD, and might contribute to modified pain sensitivity. When considering psychological pain in BPD patients, neuroanatomical studies have shown a hyper-responsive subcortical limbic network and a deficient regulatory control system operating through anterior brain regions. Promising therapeutic strategies should target neuroanatomical and neurobiological dysfunctions, which lead to altered pain perception in BPD patients.
边缘型人格障碍（BPD）是一种常见的精神疾病，其核心特征为情感调节障碍、身份障碍和社交互动问题，伴有对社交伙伴丧失、抛弃或拒绝的强烈恐惧。自我伤害行为（SIB），如浅表切割，发生在 70-80%的 BPD 患者中，与情绪缓解有关。有趣的是，大多数 BPD 患者报告与 SIB 相关的疼痛减轻或消失，而 BPD 患者在慢性疼痛患者中所占比例过高。因此，研究此类患者的疼痛感知可能有助于理解 BPD 的病理生理学，以及情感和身体疼痛维度之间的相互作用。我们进行了一项系统综述，涉及 BPD 患者的身体和社交疼痛，特别关注神经影像学数据。SIB 似乎是一种调节负面情绪的不充分策略，可能与社交/心理疼痛有关，通过增加背外侧前额叶皮层的激活来调节杏仁核的激活。此外，岛叶的异常过度激活可能是 BPD 的一个特征性标记，可能导致疼痛敏感性改变。在考虑 BPD 患者的心理疼痛时，神经解剖学研究表明，边缘系统下皮质网络反应过度，而通过前脑区域的调节控制系统功能不足。有前途的治疗策略应针对神经解剖学和神经生物学功能障碍，这些功能障碍导致 BPD 患者的疼痛感知改变。
