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

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 http://journals.elsevierhealth.com/webfiles/images/journals/bps/Biological-Psychiatry-Editorial-Disclosures-7-22-10.pdf.

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

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