Emotion Regulation and Pain in Borderline Personality Disorder

Patients with Borderline Personality Disorder (BPD) experience intense emotions and show a deficient repertoire of emotion regulation skills at the same time. Moreover, they display high prevalence rates of self-injurious behavior, which they report to engage in due to its effect of immediate relief of emotional tension. Exploring the mechanisms behind these core symptoms, we review previous research indicating that BPD is characterized by a specific pattern of emotion dysregulation, manifested in hyperreactivity of limbic structures (bottom-up processes) paralleled by deficient prefrontal control mechanisms (top-down processes). This issue will be integrated into existing theories of emotion regulation. As a novel aspect in this field, we provide an overview of the interaction between somatosensory pain and affect regulation. According to our own research it can be assumed that patients with BPD show reduced pain perception compared to healthy controls, which is caused by an alteration of the affective-motivational pain component rather than sensorydiscriminative deficits. By virtue of the discussed findings we reason that self-injurious behavior may compensate for a lack of emotion regulation strategies by causing an attentional shift away from unwanted emotions. Finally, open research questions which can be derived from the theoretical considerations will be briefly discussed.