Borderline personality and the pain paradox.

Clinical observations and empirical studies indicate that patients with borderline personality are both sensitive and insensitive to pain. This dichotomy may be explained by the context of the pain. For acute self-induced pain, borderline patients seem to experience attenuated pain responses. For chronic endogenous pain, borderline patients appear pain intolerant. In this paper, we explain this unusual paradox. We then discuss the psychiatric assessment of chronic pain, emphasizing the importance of initially determining the patient's status with regard to borderline personality disorder. For those chronic pain patients who have comorbid borderline personality disorder, we recommend a specific pain-management strategy that addresses the self-regulation difficulties of these patients and minimizes the risks of treatment.