Acute Pain Sensitivity in Individuals With Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Public Health Significance Statement The present study shows robust differences in acute pain processing between individuals with BPD and healthy controls. Though overall findings support state-independent or dispositional insensitivity to pain stimuli, evidence also suggests that pain tolerance may be enhanced under conditions of emotional distress. These findings complement previous reports of analgesia during self-injury in patients with BPD. Borderline personality disorder (BPD) has been associated with insensitivity to pain during self-injury. This review examined responses to experimentally-induced acute pain among BPD compared to healthy control participants. Literature searches yielded 27 studies involving 637 BPD and 562 healthy control participants. Significant effects were found for lower pain ratings and higher pain thresholds among BPD than control participants under emotionally neutral (g = -55, 95% CI [-.78, -.32] and g = .90, 95% CI [.72, 1.09]) and distress conditions (g = -.34, 95% CI [-.61, -.07] and g = 1.15, 95% CI [.63, 1.67]). Under emotional distress but not neutral conditions, higher pain tolerance was found among BPD compared to control subjects (g = .53, 95% CI [.05, 1.01]). Patterns of sensitivity to acute pain under different conditions may inform future research regarding the mechanisms that underlie these effects. Study findings are interpreted considering potential biases, heterogeneity of samples and methodology, and inconsistency in reporting quality.