Background & Aims
Non suicidal self injurious behavior (NSSI), like e.g. cutting, is a typical way in female patients with borderline personality disorder (BPD), a disease of emotional dysregulation, to release aversive stress (Zanarini et al. 2005). We did show recently, that a pain stimulus under experimental conditions leads to stress release at short term (minutes) even without tissue injury (Willis et al 2017) and even though BPD patients give lower pain ratings than healthy volunteers (Schloss et al. 2019). We now set out to test, whether seeing blood in the context of application of the pain stimulus has an additional effect and whether it plays a role, if the patient inflicts the stimulus by herself on the degree of stress release.
Methods
86 patients with BPD participated in this study. Stress was induced with a personalized script, followed by a non-invasive pain stimulus with a blunt blade (Shabes et al. 2018), either self-inflicted or other-inflicted. Half of the patients received an application of a few drops of artificial blood of 37°C at the application site (forearm) directly after the pain stimulus, the others a colorless liquid. For the evaluation of stress and pain, subjective (arousal, urge for NSSI and pain) and objective (heart rate) parameters were measured, and group differences were analysed using hierarchical linear modelling (HLM). A second order analysis was performed in the subset of patients only, who used cutting as method of NSSI.
Results
For arousal, pain intensity and urge for NSSI, no significant differences between different perspectives were found. Heart rate (HR) showed a delayed/less decrease if the stimulus was inflicted by the patients themselves. Similarly, no main effect of the HLM analysis was found for the factor blood, even though at the time point directly after application of the pain stimulus there was a trend for earlier/stronger decrease of the stress level for the blood condition.
In the subgroup of patients who used cutting as method of NSSI, the HLM analysis revealed a significant effect of time, group (blood vs. no blood), and most importantly interaction time * group (p=0.03).
Conclusions
Taken together, no significant effect across all patients could be demonstrated neither for the factor “seeing blood” together with the pain stimulus nor for the perspective. The delayed decrease of heart rate in the “self” condition may be related to a higher heart rate during the active action, in which patients were involved when applying the stimulus to themselves and a higher sympathetic vegetative tone. The finding of a significant “group * blood” interaction in the subgroup of patients with cutting behavior may point to more specific effects of e.g. mechanisms of implicit learning.
References
Schloss, N., P. Shabes, S. Kuniss, F. Willis, R. D. Treede, C. Schmahl, and U. Baumgärtner. 2019. ‘Differential perception of sharp pain in patients with borderline personality disorder’, Eur J Pain, 23: 1448-63.
Shabes, P., N. Schloss, W. Magerl, C. Schmahl, R. D. Treede, and U. Baumgartner. 2016. ‘A novel human surrogate model of noninjurious sharp mechanical pain’, Pain, 157: 214-24.
Willis, F., S. Kuniss, N. Kleindienst, J. Naoum, S. Reitz, S. Boll, M. Bohus, R. D. Treede, U. Baumgartner, and C. Schmahl. 2017. ‘The role of nociceptive input and tissue injury on stress regulation in borderline personality disorder’, Pain, 158: 479-87.
Zanarini, M. C., F. R. Frankenburg, D. B. Reich, G. Fitzmaurice, I. Weinberg, and J. G. Gunderson. 2008. ‘The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects’, Acta Psychiatr Scand, 117: 177-84.
Presenting Author
Ulf Baumgaertner
Poster Authors
Ulf Baumgaertner
Dr med
Medical School Hamburg
Lead Author
Anna Görtz
MD
Department of Paediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Lead Author
Ardita Sulejmani
MD
Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Lead Author
Nikolaus Kleindienst
PhD
Clinic for Psychosomatic and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
Lead Author
Christian Schmahl
MD
Clinic for Psychosomatic and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial