Chronic pain syndromes and borderline personality.

The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individuals with borderline personality disorder report higher levels of pain than those without this personality dysfunction; older, rather than younger, patients with borderline personality disorder are more likely to have higher pain levels; patients with borderline personality disorder in remission use significantly less pain medications; medical disability status in chronic pain does not necessarily differ between those with versus without borderline personality disorder; and the first-degree relatives of individuals with borderline personality disorder demonstrate statistical coaggregation with somatoform pain disorder. Why might chronic pain demonstrate associations with borderline personality disorder? Perhaps chronic pain is simply another manifestation of the inability of individuals with borderline personality disorder to self-regulate (i.e., the inability to regulate pain). In addition, pain symptoms may function as an interpersonal means of eliciting caring responses from others. Regardless, the assessment and treatment implications of these comorbid patients suggest a challenging scenario for both mental health and primary care clinicians.