Abstract
Borderline Personality Disorder (BPD) is a significant mental health condition that affects people across the globe. BPD is of particular interest to physicians because of a curious symptom that manifests in some patients while lacking in others. This symptom relates to pain and how different patients are insensitive to it, while others have extremely low pain sensitivity. Previous research has confirmed that some BPD patients have a higher pain tolerance than others. This research will evaluate pain sensitivity between BPD patients and a controlled group. In particular, a group of one hundred people drawn from the greater Adelaide area will be involved in the study. The individuals will be grouped into two equal groups of fifty people; one group will be the control group, and the other group will be the experimental group. The participants must have BPD to be in the experimental groups and qualify to participate in this study. Further, these groups will participate in answering questionnaires ranking pain tolerance. The data collected will test the hypothesis that BPD patients have greater pain tolerance than the control group.
Introduction
Many people suffer chronic pain, which burdens the healthcare system. Specialty pain management programs have been established in countries such as Australia to deal with the problem. Despite these interventions, chronic pain is a primary healthcare consumer and a major cause of disabilities for people their working age. However, patients with borderline personality disorder (BPD) appear impervious to acute pain in some situations, while they appear to be more sensitive to pain in other circumstances (Mattingley et al., 2022). Mental health professionals are accustomed to treating BPD patients with a high pain tolerance, where most cause self-inflicted injuries. This research will evaluate whether individuals with BPD have a higher pain tolerance compared to control participants.
Literature Review
Borderline Personality Disorder is a cluster B, DSM-5 personality disorder whose symptoms include an inherent inability to control oneâs behavior. Due to the inherent inability to control behavior, the disorder manifests itself through various addictive behaviors such as binge eating disorder, alcohol misuse, and promiscuity, among others (Perrotta, 2020). The inability to regulate behavior also manifests in the form of tolerance to non-malign pain (Jia et al., 2022). In addition to self-regulation issues, the symptoms of this disorder manifest in the form of self-harm behavior, where individuals can react extremely to something by cutting themselves or attempting suicide (Hennings, 2020). According to DSM-5, a diagnosis of BPD has nine clinical features, and five are required for a positive diagnosis (Perrotta, 2020). Thus, because nine symptoms are required for a positive diagnosis, the symptoms of BPD differ from one patient to another (Johnson et al., 2020). The prevalence of this disorder averages 6 per cent, with equal proportions between men and women. Despite its relatively high prevalence rate, researchers have been unable to find its cause and often attribute environmental and genetic factors to the disorder.
Patients with clinical borderline personality disorder are thought to react differently to pain. While some are sensitive to pain, others are completely insensitive. On the other hand, evidence from mental health professionals who have worked with individuals suffering from BPD details that they are sensitive to pain more than people who do not have this condition (Fales et al., 2021). In the past, researchers studied this phenomenon by exposing individuals with BPD to extreme heat and cold, where the discomfort level was measured (Ginzburg et al., 2018). Most of these studies confirm reduced pain for individuals with BPD compared with a control group composed of individuals who do not have BPD (Bohus et al., 2021). The reason for varied responses to pain has never been scientifically established, but several theories over the years have tended to explain the phenomenon.
Over the years, multiple theories have emerged that purport to explain the phenomenon that is pain tolerance among patients with borderline personality disorder. According to McCown and others, pain tolerance for BPD patients results from stress-induced analgesia (Defrin et al., 2020). Russ and others posit that individuals with BPD may interpret pain differently through a dissociation-dependent process (Ebrahimi, & Kaseb, 2022). Kemperman and fellow researchers attributed this phenomenon to inherent neurosensory abnormalities and other underlying psychological and attitudinal abnormalities (Bohus et al., 2021). Other studies have shown that a release of body chemicals during self-harm to be the reason may be why BPD patients have a higher pain tolerance than most people (Nia, 2018). This assertion assumes that self-harm for BPD patients is self-reinforcing.
Some of these theories raise empirical dilemmas because, for example, it is hard to measure dissociation. Nonetheless, studies on the subject have established that most BPD patients experience reduced pain in instances of self-injury. The reasons for this phenomenon are unknown and will not be pursued in this research. Instead, this research will focus on pain experience for people with BPD and a controlled group that does not have the disorder. The aim is to establish the pain tolerance levels of each group and correlate them to borderline personality disorder. The study will also evaluate the differences in pain tolerance between different groups of people with personality disorders.
Various studies show that individuals with borderline personality disorder respond differently to pain. Further, individuals with this disorder have different levels of tolerance to pain, with self-harm being their most tolerant state. As some theories suggest, self-harm could be self-reinforcing and thus elicit pain tolerance response from patients (Conejero et al.,2018). Studies on this subject started in the 1990s with queries that sought to evaluate the psychological configuration of BPD patients who had high pain tolerance (Al-Shamali et al., 2022). At the time, patients also showed signs of depression, dissociation, and anxiety (Chung et al., 2020). This phenomenon has been confirmed severally by exposing BPD patients to actual pain stimuli and gauging their reactions. The hypothesis for this study is that BPD patients with self-harm behavior are more pain tolerant than people without borderline personality disorder. The hypothesis will be tested through experimentation.
Method
Participants
A total of 100 individuals drawn from across the country will participate in this study. This group will be categorized into individuals: 50 individuals with BPD and another 50 without borderline personality disorder. One group of participants will act as the control group, while experiments will be performed on the second group. It is expected that the numbers of males and females will be sixty and forty, respectively, because borderline personality disorder is more prevalent in females than in males. The individuals chosen to participate in this study will be between eighteen and sixty years old because the sample will be collected from people across the country. Participants diagnosed with other mood disorders or any other mental health illness over the last six months will not be included in the study.
Design
The research design adopted is descriptive, where the data collected will be used to test whether individuals with BPD have a higher pain tolerance than individuals who do not have that disorder. Consequently, the research will avoid the experimental component, which would have allowed testing of a cause-and-effect relationship between pain tolerance and BPD. Thus, the existence of pain tolerance in BPD patients will be measured without influencing it because the objective is to establish whether indeed such tolerance exists.
Material
Data for this research will be collected using online surveys because they are easier to develop and administer. Online surveys ensure that people from across the city can participate in the study once because they require a mobile device or computer and an internet connection. Mobile communication and internet connections in Adelaide are high, meaning anyone from across Adelaide can participate in the study. The survey will be used to collect data from the experiment and control group, allowing the appropriate conclusions regarding pain tolerance for BPD patients to be made. Data from the control and experiment groups will be analyzed and compared to test for differences. To ensure the authenticity of the participants, they will be asked to provide information concerning their mobile phones using the application âScreen Time.â
Screen Time collects information such as the mobile number of the participant, the applications on their phones, and how often they use such applications. Additionally, demographic information will be collected from the participants. Under demographics, some of the information that will be collected will include age, education, gender, employment status, physical and mental conditions, and social status. A questionnaire designed to test BPD will be administered to participants with BPD to determine its severity (Selby et al., 2022). These questions will take less than ten minutes.
Procedure
The selected participants will be emailed randomly to participate in the online survey, which will take about fifteen minutes. The final item on the questionnaire will be about granting consent for the study. Once consent is established, the participants will complete the experiment. The participants will be provided a link and asked to complete the study by filling in details depending on their classification as control or experiment group. Participants with BPD will then proceed to fill in another questionnaire that screens BPD to determine the severity of their symptoms (Lisoni et al., 2022). To test whether BPD patients have a higher pain tolerance than people with BPD, the participants will be asked to rate the pain they feel when they go to the doctor; they unintentionally injure themselves (Dixon-Gordon et al., 2018). Further, the experiment group will be asked to rate the pain they feel when they engage in self-harm. The control group will not be asked to rate the pain they feel when they engage in self-harm because they are unlikely to engage in such behavior. The survey will take thirty minutes for the control group and forty minutes for the experiment group.
Analysis Plan
Statistical methods will be used to analyze the data collected from the control and experimental groups. Additionally, the analysis will be done using Microsoft Excel or equivalent software such as IBMâs SPSS (Statistical Package for the Social Sciences). Specifically, charts, graphs, and scatter diagrams will be used to analyze the data collected. A comparison of the experiment and control groups will also be carried out using the independent samples t-test.
Results
Descriptive statistics and Data Screening Plan
Items such as mean, skew, kurtosis, and standard deviation in regard to the hypothesis will be generated to fulfill the requirements for descriptive statistics. The KolmogorovâSmirnov test will be used to screen data for normality, with Z-scores used to detect any outliers. The independent t-test will be used to compare the control and experiment groupâs means to determine whether the control group has a lower pain tolerance than the experiment group. Descriptive statistics for the control and experiment groups will also be reported.
Potential patterns and their meaning
If the results support the hypothesis, the experiment group will show a higher rate of pain tolerance than the control group. Supporting the idea that people with BPD have a higher pain tolerance than people who do not have the condition will confirm the results of previous studies that confirmed the higher pain tolerance for BPD patients, especially in cases of self-harm (Heath et al., 2018). Suppose the results indicate failure to support the hypothesis. In that case, it will mean that individuals with borderline personality disorder feel pain intensity is similar to those without the such disorder. Such results would go against the literature and experiments on the subject. Finally, it is expected that BPD patients with a history of self-harm will show greater pain tolerance than patients who have no record of self-harm.
Discussion/Conclusion
This study aims to demonstrate that patients with borderline personality disorder have a higher pain tolerance than most people. This phenomenon was first observed in the 1990s in BPD patients who tended to self-harm (Jacob et al., 2018). Since then, multiple studies have concluded that BPD patients have a higher pain tolerance. Based on this research that established a link between BPD and higher pain tolerance among some people, it was hypothesized that the control group would show signs of lower pain tolerance compared to the experimental group composed of individuals with BPD. The expectation is that the experiments will conform to the results of the previous studies by showing the existence of this pain tolerance in patients with BPD (Lalouni et al., 2022). However, it is also likely that the results may vary because, in some cases, only BPD patients with self-harm behavior have shown a higher pain tolerance than most.
If the study confirms that BPD patients have a higher pain tolerance than others, it will align with previous research that proved this hypothesis. This confirmation would give credence to the theory that BPD patients process information differently from other people. It would also confirm that self-harm behavior for some BPD patients is self-reinforcing (Dror et al.,2018). Because symptoms for BPD patients are varied, a conformation of pain tolerance would mean that it is a common manifestation of the disorder among BPD patients (Malejko et al., 2022). Consequently, higher pain tolerance could, in the future, be classified as symptoms that a clinical psychologist can screen for when diagnosing suspected BPD cases.
The results will also be compared against the age of the participants. In previous studies, older BPD patients exhibited higher pain tolerance than younger BPD patients. Further, past studies suggest that older patients with recurrent BPD have a higher pain tolerance than younger patients with a short history of BPD (Pan et al., 2022). Thus, differences in pain tolerance among young and older individuals will be expected. Both controlled and experimental group participants will have varied ages, making the expected differences in tolerance to pain apparent.
BPD is a significant mental health disorder that affects people across the globe. Consequently, understanding all its different aspects could lead to better diagnosis, enabling tailored treatments for quick recovery. Thus, this studyâs focus on an area that has for long intrigued researchers. Specifically, some researchers and clinicians have reported different results on pain sensitivity among BPD patients. Some maintain that they have a higher pain tolerance than normal people, while others indicate that they have a lower pain tolerance. The purpose of this research will be to substantiate these claims through experimentation and data gathering.
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