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Borderline Personality Disorder and Chronic Pain: Prevalence in a Rehabilitation Setting

Borderline Personality Disorder and Chronic Pain: Prevalence in a Rehabilitation Setting. Nicole Gooding Dr. Regan Shercliffe Dr. Tom Robinson Shahlo Mustafaeva. Outline. Background Research Design and Methods Results Implications. BACKGROUND. Background. Physician. 30%. REHAB.

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Borderline Personality Disorder and Chronic Pain: Prevalence in a Rehabilitation Setting

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  1. Borderline Personality Disorder and Chronic Pain: Prevalence in a Rehabilitation Setting Nicole Gooding Dr. Regan Shercliffe Dr. Tom Robinson Shahlo Mustafaeva

  2. Outline • Background • Research Design and Methods • Results • Implications

  3. BACKGROUND

  4. Background Physician 30% REHAB PT Psychologist OT 6-8 weeks

  5. Rationale 30% (failures) symptoms of BPD ORGANIC PROBLEMS NO IDENTIFIABLE PHYSICAL PATHOLOGY

  6. Borderline Personality Disorder • Frantic efforts to avoid abandonment • Unstable and intense relationships • Identity disturbances • Impulsivity • Suicidal behavior • Emotional instability • Chronic feelings of emptiness • Intense (inappropriate) anger • Transient, stress-related paranoia or dissociation heterogeneous

  7. Borderline Personality Disorder • Prevalence: • 0.5%- 2% (American Psychiatric Association; Samuels et al., 2002; Torgersen, Kringlen & Cramer, 2001) • Disproportionately use health care services • Treatment

  8. Chronic Pain • Unpleasant physical sensation or emotional experience resulting from actual or possible damage to body tissues or nerves (IASP, 1979) • Subjective experience • Most frequent form of disability

  9. BPD and Chronic Pain • Polatin and colleagues (1993): • 21% met criteria for one Axis II disorder • 20% met criteria for two Axis II disorders • Burton, Polatin, and Gatchel (1997): • BPD was among most frequently diagnosed • BPD was only disorder to impact return-to-work • BPD in chronic pain population • Range of 1%-17%

  10. BPD and Chronic Pain Purpose: Investigate the presence of BPD in the chronic pain population

  11. METHODOLOGY

  12. Participants • 381 consecutive referrals recruited from the Functional Rehabilitation Program • Females and males between ages of 18 and 72 • WCB and SGI • Suffer from chronic pain • Medical and psychological data available in the form of archival data

  13. Measures • Multidimensional Pain Inventory (Section 1; Kerns, Turk, & Rudy, 1985) • Perception of pain intensity • Perception of interference of pain on activity • Perception of control over pain

  14. Measures • Borderline Evaluation of Severity over Time (Pfolm & Blum, 1997) • Personality Assessment Inventory (Morey,1991) • Borderline scale • Center for Epidemiological Studies – Depression Scale (Radloff, 1977)

  15. Hypotheses • Hypothesis 1: base-rate of BPD symptoms will be higher in the chronic pain population • Hypothesis 2: Higher scores of BPD will be associated with: • Greater perception of pain intensity • Greater perception of interference of pain • Lower perception of control over pain

  16. FINDINGS

  17. Prevalence • Clinical range • 6% • Subthreshold • 7% • Mild symptoms • 28.6% • Moderate symptoms • 4.8%

  18. BPD and Perceptions of Pain • Perception of Control • Both measures • Perception of Interference • Both measures • Perception of Pain Intensity • One measure

  19. Possible Explanations • Psychological risk factors for development of chronic pain • Excessive emotional reaction (Craig, 2009)

  20. Borderline Personality Disorder • Frantic efforts to avoid abandonment • Unstable and intense relationships • Identity disturbances • Impulsivity • Suicidal behavior • Emotional instability • Chronic feelings of emptiness • Intense (inappropriate) anger • Transient, stress-related paranoia or dissociation heterogeneous

  21. BPD and Chronic Pain • Psychological risk factors for development of chronic pain • Excessive emotional reaction (Craig, 2009) • Coping skills • Persons with personality disorders have reduced coping skills (Millon, 1981)

  22. Implications • Dimensional vs categorical conceptualization • Two subpopulations • Somatic vs psychological symptoms • Awareness of unique needs • Realistic explanations • Monitoring of outcomes

  23. Why Was This Study Important? • Diagnostic label vs symptoms on a continuum • Inconsistency in prevalence rates • Small number of studies • Methodological weaknesses of previous studies • Small/unrepresentative sample size • Pre-screening of participants • Outdated findings • Findings inapplicable to North American population

  24. Future Directions • Unique features of BPD • Other measures of BPD • Clusters of symptoms • Standardized measures of outcome • Treatment matching

  25. Questions

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