Top

Published in:

01-08-2013 | Psychiatric Management of Pain (M Clark, Section Editor)

Borderline Personality Disorder and Chronic Pain: A Practical Approach to Evaluation and Treatment

Authors: Vicki Kalira, Glenn J. Treisman, Michael R. Clark

Published in: Current Pain and Headache Reports | Issue 8/2013

Abstract

Patients with chronic pain present a spectrum of complexity that can be overwhelming for the individual practitioner. These patients require thoughtful care and a comprehensive treatment plan. This complexity should be acknowledged, not avoided, and the patient should be engaged, not shunned. A practical approach will assist in developing expertise and proceeding empathically. The presence of a superimposed personality disorder significantly increases the difficulty of caring for these patients. Studies investigating the prevalence of borderline personality disorder in patients with chronic pain averaged 30 %, highlighting the importance of being able to effectively treat this patient population. Appropriate management of these patients should focus on a collaboration to practice productive behaviors despite intense emotional distress. Longitudinal research provides a foundation for an optimistic prognosis that can be enhanced with this rehabilitative approach.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Press Inc.; 1994.

Wasan AD, Wootton J, Jamison RN. Dealing with difficult patients in your pain practice. Reg Anesth Pain Med. 2005;30:184–92.PubMed

Stern A. Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanal Q. 1938;7:467–89.

Norman WT. Toward an adequate taxonomy of personality attributes: replicated factors structure in peer nomination personality settings. J Abnorm Soc Psychol. 1963;66:574–83.PubMedCrossRef

Costa PT, McCrae RR. The NEO personality inventory manual. Orlando: Psychological Assessment Resources; 1985.

Widiger TA, Lowe JR. Five-factor model assessment of personality disorder. J Pers Assess. 2007;89:16–29.PubMedCrossRef

Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50:975–90.PubMedCrossRef

Svrakic DM, Whitehead C, Przybeck TR, et al. Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Arch Gen Psychiatry. 1993;50:991–9.PubMedCrossRef

Hirano S, Sato T, Narita T, et al. Evaluating the state dependency of the temperament and character inventory dimensions in patients with a major depression: a methodological contribution. J Affect Disord. 2002;69:31–8.PubMedCrossRef

10.

Grucza RA, Przybeck TR, Spitznagel EL, et al. Personality and depressive symptoms: a multi-dimensional analysis. J Affect Disord. 2003;74:123–30.PubMedCrossRef

11.

Nestadt G, Costa Jr PT, Hsu FC, et al. The relationship between the five-factor model and latent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder dimensions. Compr Psychiatry. 2008;49:98–105.PubMedCrossRef

12.

Terracciano A, Costa Jr PT, McCrae RR. Personality plasticity after age 30. Pers Soc Psychol Bull. 2006;32:999–1009.PubMedCrossRef

13.

Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry. 2006;163:827–32.PubMedCrossRef

14.

Skodol AE, Gunderson JG, Shea MT, et al. The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. J Personal Disord. 2005;19:487–504.CrossRef

15.

Costa Jr PT, Patriciu NS, McCrae RR. Lessons from longitudinal studies for new approaches to the DSM-V: the FFM and FFT. J Personal Disord. 2005;19:533–9.CrossRef

16.

Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64:773–86.PubMedCrossRef

17.

Vendrig AA, Derksen JJ, de Mey HR. MMPI-2 Personality Psychopathology Five (PSY-5) and prediction of treatment outcome for patients with chronic back pain. J Pers Assess. 2000;74:423–38.PubMedCrossRef

18.

Weisberg JN. Personality and personality disorders in chronic pain. Curr Rev Pain. 2000;4:60–70.PubMedCrossRef

19.

Weisberg JN, Vaillancourt PD. Personality factors and disorders in chronic pain. Semin Clin Neuropsychiatry. 1999;4:155–66.PubMed

20.

Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69(4):533–45.PubMedCrossRef

21.

Hathaway SR, McKinley JC. Minnesota multiphasic personality inventory manual (rev ed). New York: Psychological Corporation; 1967.

22.

Turk DC, Fernandez E. Personality assessment and the Minnesota Multiphasic Personality Inventory in chronic pain: underdeveloped and overexposed. Pain Forum. 1995;4:104–7.CrossRef

23.

Vendrig AA. The Minnesota Multiphasic Personality Inventory and chronic pain: a conceptual analysis of a long-standing but complicated relationship. Clin Psychol Rev. 2000;20:533–59.PubMedCrossRef

24.

Sternbach RA. Psychological aspects of pain and the selection of patients. Clin Neurosurg. 1974;21:323–33.PubMed

25.

Riley 3rd JL, Robinson ME. Validity of MMPI-2 profiles in chronic back pain patients: differences in path models of coping and somatization. Clin J Pain. 1998;14:324–35.PubMedCrossRef

26.

Fishbain DA, Cole B, Cutler RB, et al. Chronic pain and the measurement of personality: do states influence traits? Pain Med. 2006;7:509–29.PubMedCrossRef

27.

Loranger AW, Lenzenweger MF, Gartner AF, et al. Trait-State artifacts and the diagnosis of personality disorders. Arch Gen Psychiatry. 1991;48:720–8.PubMedCrossRef

28.

Bronisch T, Klerman G. Personality functioning: change and stability in relationship to symptoms and psychopathology. J Personal Disord. 1991;5:307–17.CrossRef

29.

Stuart S. Are personality assessments valid in acute major depression? J Affect Disord. 1992;24:281–90.PubMedCrossRef

30.

Hellerstein DJ, Kocsis JH, Chapman D, et al. Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: effects on personality. Am J Psychiatry. 2000;157:1436–44.PubMedCrossRef

31.

Gatchel RJ, Mayer TG, Eddington A. MMPI disability profile: the least known, most useful screen for psychopathology in chronic occupational spinal disorders. Spine. 2006;31:2973–8.PubMedCrossRef

32.

Applegate KL, Keefe FJ, Siegler IC, et al. Does personality at college entry predict number of reported pain conditions at mid-life? A longitudinal study. J Pain. 2005;6:92–7.PubMedCrossRef

33.

Malmgren-Olsson EB, Bergdahl J. Temperament and character personality dimensions in patients with nonspecific musculoskeletal disorders. Clin J Pain. 2006;22:625–31.PubMedCrossRef

34.

Conrad R, Schilling G, Bausch C, et al. Temperament and character personality profiles and personality disorders in chronic pain patients. Pain. 2007;133:197–209.PubMedCrossRef

35.

Greenberg J, Burns JW. Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity? Behav Res Ther. 2003;41:223–40.PubMedCrossRef

36.

Lethem J, Slade PD, Troup JDG, et al. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther. 1983;21:401–8.PubMedCrossRef

37.

Reis S. Expectancy theory of fear, anxiety, and panic. Clin Psychol Rev. 1991;11:141–53.CrossRef

38.

Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.PubMedCrossRef

39.

Zvolensky MJ, Goodie JL, McNeil DW, et al. Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population. Behav Res Ther. 2001;39:683–96.PubMedCrossRef

40.

Asmundson GJG, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999;19:97–119.PubMedCrossRef

41.

McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003;106:127–33.PubMedCrossRef

42.

Sansone RA, Sinclair JD, Wiederman MW. Borderline personality among outpatients seen by a pain management specialist. Int J Psychiatry Med. 2009;39:341–4.PubMedCrossRef

43.

•• Sansone RA, Sansone LA. Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 2012;9(1):10–4. Comprehensively demonstrates the impact of borderline personality disorder on chronic pain.PubMed

44.

Tragesser SL, Bruns D, Disorbio JM. Borderline personality disorder features and pain: the mediating role of a negative affect in a pain patient sample. Clin J Pain. 2010;26:348–53.PubMedCrossRef

45.

Hasenbring M, Hallner D, Klasen B. Psychological mechanisms in the transition from acute to chronic pain: over- or underrated? Schmerz. 2001;15:442–7.PubMedCrossRef

46.

Severeijns R, Vlaeyen JW, van den Hout MA, et al. Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain. 2001;17:165–72.PubMedCrossRef

47.

Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17:52–64.PubMedCrossRef

48.

Folkman S, Lazarus RS, Gruen RJ, et al. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50:571–9.PubMedCrossRef

49.

Jensen MP, Turner JA, Romano JM, et al. Coping with chronic pain: a critical review of the literature. Pain. 1991;47:249–83.PubMedCrossRef

50.

Sansone RA, Sansone LA. Chronic pain syndromes and borderline personality. Innov Clin Neurosci. 2012;9(1):10–4.PubMed

51.

Waddell G, Newton M, Henderson I, et al. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–68.PubMedCrossRef

52.

Mannion AF, Muntener M, Taimela S, et al. A randomized clinical trial of three active therapies for chronic low back pain. Spine. 1999;24:2435–48.PubMedCrossRef

53.

Mannion AF, Junge A, Taimela S, et al. Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine. 2001;26:920–9.PubMedCrossRef

54.

Vowles KE, Gross RT. Work-related beliefs about injury and physical capability for work in individuals with chronic pain. Pain. 2003;101:291–8.PubMedCrossRef

55.

Fordyce W, Fowler R, Lehmann J, et al. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil. 1973;54:399–408.PubMed

56.

Prevedini AB, Presti G, Rabitti E, et al. Acceptance and commitment therapy (ACT): the foundation of the therapeutic model and an overview of its contribution to the treatment of patients with chronic physical diseases. G Ital Med Lav Ergon. 2011;33(1 Suppl A):A53–63.PubMed

57.

Buchi S, Buddeberg C, Klaghofer R, et al. Preliminary validation of PRISM (Pictorial Representation of Illness and Self Measure) – A brief method to assess suffering. Psychother Psychosom. 2002;71:333–41.PubMedCrossRef

58.

McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74:21–7.PubMedCrossRef

59.

Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford; 1999.

60.

Karaklic D, Bungener C. Course of borderline personality disorder: literature review. Encephale. 2010;36(5):373–9.PubMedCrossRef

61.

Sansone RA, Sinclair JD, Wiederman MW. Disability and borderline personality in chronic pain patients. Pain Res Manag. 2010;15:369–70.PubMed

62.

• Bellino S, Rinaldi C, Bozzatello P, Bogetto F. Pharmacotherapy of borderline personality disorder: a systematic review for publication purpose. Curr Med Chem. 2011;18(22):3322–9. One of the first articles to provide an overview of medication options in treating borderline personality disorder.PubMedCrossRef

63.

Stoffers JM, Völlm BA, Rücker G, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2012;15(8):CD005652.

64.

Moen R, Freitag M, Miller M, et al. Efficacy of extended-release divalproex combined with “condensed” dialectical behavior therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24(4):255–60.PubMed

65.

Rifkin A, Quitkin F, Carrillo C, et al. Lithium carbonate in emotionally unstable character disorders. Arch Gen Psychiatry. 1972;27:519–23.PubMedCrossRef

66.

Stein DJ, Hollander E, Liebowitz MR. Neurobiology of impulsivity and the impulse control disorders. J Neuropsychiatry Clin Neurosci. 1993;5:9–17.PubMed

67.

American Psychiatric Association, Practice guidelines for the treatment of patients with borderline personality disorder. Arlington, Virginia, 2001.

68.

NICE. Borderline personality disorder: treatment and management. London: National Institute for Health and Clinical Excellence; 2009.

69.

Rizvi SL. Treatment failure in Dialectical Behavior Therapy. Cogn Behav Pract. 2011;18:403–12.CrossRef

70.

Bedics JD, Atkins DC, Comtois KA, et al. Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus nonbehavioral psychotherapy experts for borderline personality disorder. J Consult Clin Psychol. 2012;80(1):66–77.PubMedCrossRef

71.

Gutteling BM, Montagne B, Nijs M, et al. Dialectical behavior therapy: is outpatient psychotherapy an effective alternative to individual psychotherapy? Compr Psychiatry. 2012;53:1161–8.PubMedCrossRef

Title: Borderline Personality Disorder and Chronic Pain: A Practical Approach to Evaluation and Treatment
Authors: Vicki Kalira
Glenn J. Treisman
Michael R. Clark
Publication date: 01-08-2013
Publisher: Springer US
Published in: Current Pain and Headache Reports / Issue 8/2013
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-013-0350-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Borderline Personality Disorder and Chronic Pain: A Practical Approach to Evaluation and Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2013

The Role of Vitamin D in Pathophysiology and Treatment of Fibromyalgia

Worldwide Epidemiology of Fibromyalgia

Physiologic Effects of Dry Needling

Complementary Therapies for Fibromyalgia Syndrome – A Rational Approach

Clinical Implication of Latent Myofascial Trigger Point

Migraine-Related Symptoms in Childhood