Schmahl Christian, Baumgärtner Ulf
Mod Trends Pharmacopsychiatry. 2015;30:166-75. doi: 10.1159/000435940. Epub 2015 Sep 18.
Pain processing in patients with borderline personality disorder (BPD) is abnormal primarily with respect to pain thresholds which are typically elevated or perception of phasic nociceptive stimuli which is reduced. In spite of this common finding, nonsuicidal self-injury (NSSI), often expressed as cutting, is a hallmark sign of the disease and serves to release aversive inner tension. The question thus arises, how does a painful stimulus release inner tension when these patients feel less pain than healthy people? However, intensity discrimination is normal in these patients. Imaging data have provided evidence that inhibitory top-down modulation is increased in BPD patients, and that processing of the affective-emotional pain component is altered. Recent studies have focused on the role of pain, tissue injury and seeing blood in the context of NSSI. Preliminary findings suggest a significant role of pain irrespective of concomitant tissue injury, and of seeing blood expressed as a stronger immediate stress release. Taken together, BPD patients exhibit altered pain processing that can be assigned to altered processing of nociceptive stimuli in prefrontal and limbic brain areas, which may help to mechanistically explain the clinical behavior.
边缘型人格障碍（BPD）患者的疼痛处理存在异常，主要体现在疼痛阈值通常升高，或对阶段性伤害性刺激的感知降低。尽管有这一常见发现，但非自杀性自伤行为（NSSI），通常表现为割伤，却是该疾病的一个标志性症状，其作用是释放厌恶的内心紧张情绪。于是问题就来了，当这些患者比健康人感觉疼痛更轻时，疼痛刺激是如何释放内心紧张情绪的呢？然而，这些患者的强度辨别能力是正常的。影像学数据表明，BPD患者自上而下的抑制性调节增强，且情感 - 情绪性疼痛成分的处理发生了改变。最近的研究聚焦于疼痛、组织损伤以及在非自杀性自伤行为背景下看到血液所起的作用。初步研究结果表明，无论是否伴有组织损伤，疼痛都起着重要作用，而且看到血液会表现出更强的即时压力释放。综合来看，BPD患者表现出疼痛处理的改变，这可归因于前额叶和边缘脑区伤害性刺激处理的改变，这可能有助于从机制上解释其临床行为。
