Tissue Damage and Pain - Modelling Cutting Behavior in BPD

• Applicants: Professor Dr. Ulf Baumgärtner; Professorin Dr. Gabriele Ende; Professor Dr. Christian Schmahl
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: from 2011 to 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 190034061

• Final Report Year: 2019

Final Report Abstract

This project aimed to elucidate the mechanism of non-suicidal self-injury in BPD, particularly the interaction between pain processing and stress regulation. We could confirm earlier findings that different painful stimuli are perceived as less intense than in healthy controls. We developed a sharp, non-tissuedamaging stimulus as a surrogate for an incision. This blade stimulus activates the nociceptive network in the brain, in particular the sensory pain system more than thermal stimuli. In BPD patients, less activation of the affective pain system (e.g. amygdala) was found. To determine the role of tissue injury, we compared scalpel incision with the blade stimulus. In patients with current BPD, reduction of subjective stress levels was equally strong following incision and blade stimulation. Hence, pain appears to be the most relevant factor in stress relief through NSSI, although it is perceived as less intense and less threatening. This pain-related stress regulation was less pronounced in patients with remitted BPD but could also be demonstrated in male BPD patients. Other aspects of the NSSI mechanisms, i.e. the role of seeing blood and the role of the perspective of pain infliction, were also tested experimentally. Seeing artificial blood had a short-lasting influence by increasing heart rate reduction after pain infliction. An obtained satisfaction in the self-inflicted group may lead to a stronger decrease in the urge for NSSI. In terms of neurochemical correlates of pain processing, the glutamate/GABA ratio in the posterior insula correlates positively with the painfulness rating of the painful pinprick stimulation. However, this mechanism does not explain the differences in pain perception between BPD patients and HC. Arterial Spin Labelling (ASL) was found to be an innovative neuroimaging method for pain research as it produced significant functional activation after application of only a single block of painful stimulation as long as 90 seconds.

Publications

• (2015). Incision and stress regulation in borderline personality disorder: Neurobiological mechanisms of self-injurious behaviour. British Journal of Psychiatry, 207(2), 165-172
  Reitz, Sarah; Kluetsch, Rosemarie; Niedtfeld, Inga; Knorz, Teresa; Lis, Stefanie; Paret, Christian; Kirsch, Peter; Meyer-Lindenberg, Andreas; Treede, Rolf-Detlef; Baumgärtner, Ulf; Bohus, Martin & Schmahl, Christian
  
• (2015). Pain in borderline personality disorder. In Pain in Psychiatric Disorders (Vol. 30, pp. 166-175): Karger Publishers
  Schmahl, Christian & Baumgärtner, Ulf
  
• (2016). A novel human surrogate model of noninjurious sharp mechanical pain. Pain, 157(1), 214-224
  Shabes, Polina; Schloss, Natalie; Magerl, Walter; Schmahl, Christian; Treede, Rolf-Detlef & Baumgärtner, Ulf
  
• (2016). The role of seeing blood in non-suicidal self-injury in female patients with borderline personality disorder. Psychiatry Research, 246, 676-682
  Naoum, Janina; Reitz, Sarah; Krause-Utz, Annegret; Kleindienst, Nikolaus; Willis, Franziska; Kuniss, Sarah; Baumgärtner, Ulf; Mancke, Falk; Treede, Rolf-Detlef & Schmahl, Christian
  
• (2017). The role of nociceptive input and tissue injury on stress regulation in borderline personality disorder Pain, 158(3), 479-487
  Willis, Franziska; Kuniss, Sarah; Kleindienst, Nikolaus; Naoum, Janina; Reitz, Sarah; Boll, Sabrina; Bohus, Martin; Treede, Rolf-Detlef; Baumgärtner, Ulf & Schmahl, Christian
  
• (2018). Posterior insular GABA levels inversely correlate with the intensity of experimental mechanical pain in healthy subjects. Neuroscience, 387, 116-122
  Thiaucourt, Margot; Shabes, Polina; Schloss, Natalie; Sack, Markus; Baumgärtner, Ulf; Schmahl, Christian & Ende, Gabriele
  
• (2018). Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain and Behavior, 8(2), e00909
  Willis, Franziska; Kuniss, Sarah; Kleindienst, Nikolaus; Lis, Stefanie; Naoum, Janina; Jungkunz, Martin; Neukel, Corinne; Bohus, Martin; Treede, Rolf‐Detlef; Baumgärtner, Ulf & Schmahl, Christian
  
• (2018). Effects of a painful stimulus on stress regulation in male patients with borderline personality disorder: A pilot study. Journal of Personality Disorders, 1-19
  Naoum, Janina; Kleindienst, Nikolaus; Baumgärtner, Ulf; Willis, Franziska; Mancke, Falk; Treede, Rolf-Detlef; Bohus, Martin & Schmahl, Christian