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Hurts so good -- neural clues to the calming effects of self-harm

The notion that cutting or burning oneself could provide relief from emotional distress is difficult to understand for most people, but it is an experience reported commonly among people who compulsively hurt themselves.

Individuals with borderline personality disorder experience intense emotions and often show a deficiency of emotion regulation skills. This group of people also displays high prevalence rates of self-injurious behavior, which may help them to reduce negative emotional states.

Niedtfeld and colleagues studied the effects of emotional stimuli and a thermal stimulus in people either with or without borderline personality disorder. They conducted an imaging study using picture stimuli to induce negative, positive, or neutral affect and thermal stimuli to induce heat pain or warmth perception. The painful heat stimuli were administered at an individually-set temperature threshold for each subject.

In patients with borderline personality disorder, they found evidence of heightened activation of limbic circuitry in response to pictures evocative of positive and negative emotions, consistent with their reported emotion regulation problems. Amygdala activation also correlated with self-reported deficits in emotion regulation. However, the thermal stimuli inhibited the activation of the amygdala in these patients and also in healthy controls, presumably suppressing emotional reactivity.

Dr. John Krystal, Editor of Biological Psychiatry, commented, "These data are consistent with the hypothesis that physically painful stimuli provide some relief from emotional distress for some patients with borderline personality disorder because they paradoxically inhibit brain regions involved in emotion. This process may help them to compensate for deficient emotional regulation mechanisms."

The authors note that these results are in line with previous findings on emotional hyperactivity in borderline personality disorder and suggest that these individuals process pain stimuli differently depending on their arousal status.

Notes to Editors:

The article is "Affect Regulation and Pain in Borderline Personality Disorder: A Possible Link to the Understanding of Self-Injury" by Inga Niedtfeld, Lars Schulze, Peter Kirsch, Sabine C. Herpertz, Martin Bohus, and Christian Schmahl. Niedtfeld, Bohus, and Schmahl are affiliated with the Department of Psychosomatic Medicine, and Kirsch is affiliated with Department of Clinical Psychology, all at Central Institute of Mental Health Mannheim, University of Heidelberg, Heidelberg, Germany. Schulze is affiliated with the Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany. Herpertz is affiliated with the Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. The article appears in Biological Psychiatry, Volume 68, Issue 4 (August 15, 2010), published by Elsevier.

The authors' disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, M.D. is Chairman of the Department of Psychiatry at the Yale University School of Medicine and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available at

Full text of the article mentioned above is available upon request. Contact Maureen Hunter at to obtain a copy or to schedule an interview.

About Biological Psychiatry

This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.

Biological Psychiatry ( is ranked 4th out of 117 Psychiatry titles and 13th out of 230 Neurosciences titles in the 2009 ISI Journal Citations Reports® published by Thomson Reuters. The 2009 Impact Factor score for Biological Psychiatry has increased to 8.926.

About Elsevier

Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including the Lancet ( and Cell (, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect (, Scopus (, Reaxys (, MD Consult ( and Nursing Consult (, which enhance the productivity of science and health professionals, and the SciVal suite ( and MEDai's Pinpoint Review (, which help research and health care institutions deliver better outcomes more cost-effectively.

A global business headquartered in Amsterdam, Elsevier ( employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (, a world-leading publisher and information provider. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Chris J. Pfister | EurekAlert!
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