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psychalgia
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We have seen from other articles that I have already published on this site that many professionals who work within the field of mental health consider borderline personality disorder (BPD) to be the most psychologically and emotionally painful psychiatric condition there is. On top of this terrible mental suffering, many individuals with BPD also must endure considerable physical pain that is psychogenic in nature i.e. pain that is caused, exacerbated or made chronic due to their underlying mental problems. It is sometimes referred to as psychogenic pain or psychalgia.

Examples of psychogenic pain include:

  • headaches
  • back pain
  • stomach pain
  • muscular pain
  • heartburn

Those with BPD may be particularly prone to the experience of such psychogenic pain in response to highly emotionally charged, traumatic events such as loss and separation e.g. rejection by friends and family or the break-up of a romantic attachment. Psychogenic pain is also associated with emotions such as anger, helplessness, agitation, impatience, feelings of emptiness.

Stress, too, which those with BPD are exquisitely vulnerable to, is fundamentally associated with psychogenic pain (there are myriad ways in which high and chronic levels of stress causes physiological damage to the body and stress, therefore, can not only contribute to psychogenic pain but also to psychosomatic disease (e.g. heart disease).

But Don’t Those With BPD Swing Between Severe Depression And Elation?

According to research conducted by Koenigsberg et al. (2002), suffering from BPD were found to have rapid and dramatic changes in the emotions of anger and anxiety (both associated with feelings of mental pain) and swings between depression and anxiety but were not found to oscillate between depression and elation.

PSYCHOGENIC PAIN SHOULD BE TAKEN JUST AS SERIOUSLY AS PAIN WITH A PATHOPHYSIOLOGICAL CAUSE

It is important to point out, however, that just because a person’s experience of pain is not caused by pathophysiological factors, the subjective experience of such pain can be just as acute, or more acute, than such pain that IS caused by pathophysiology. In other words: IT HURTS JUST AS MUCH. As such, it does not seem fair that there is often such a glaring disparity between how the two types of pain are treated within the medical profession.

It is thought that psychogenic pain can be generated by both conscious psychological problems and by unconscious ones.

DIAGNOSIS

Pain is only diagnosed as psychogenic in nature when all other causes of the pain have been investigated and eliminated. Often, a person suffering from psychogenic pain will also meet the criteria to be diagnosed with depression and/or anxiety.

INFLUENCES ON THE PAIN WE EXPERIENCE

Studies suggest that pain can be:

  • learned
  • affected by our emotional state (as illustrated above)
  • affected by expectations
  • affected by cultural norms
  • affected by neurotransmitter levels e.g. if levels of 5-hydroxyl tryptamine (5HT) levels become too low as a result of interaction with cortisol (known as the ‘stress hormone’) an individual’s pain threshold becomes lower i.e. when suffering from severe, chronic stress, one is likely to be more sensitive to pain (Morris CG and Maisto, Understanding Psychology, Sixth Edition).

Furthermore, extreme shock and fear can decrease feelings of pain. 

TREATMENT

Pain associated with trauma is frequently performed in three stages:

 

You may also wish to read my post: COGNITIVE HYPNOTHERAPY AUDIOS FOR THE RELIEF OF MENTAL PAIN

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

REFERENCES:

Allaverdi, E., Psychosomatic Pain DOI: 10.5772/intechopen.91328. 2020

Koenigsberg HW, Harvey PD, Mitropoulou V, Schmeidler J, New AS, Goodman M, Silverman JM, Serby M, Schopick F, Siever LJ. Characterizing affective instability in borderline personality disorder. Am J Psychiatry. 2002 May;159(5):784-8. doi: 10.1176/appi.ajp.159.5.784. PMID: 11986132.

Morris CG and Maisto, Understanding Psychology, Sixth Edition. Pearson Education (US). 2002.