Pain perception and nonsuicidal self-injurious behavior

Zinchuk M.S.; Avedisova A.S.; Voinova N.I.; Kustov G.V.; Pashnin E.V.; Gulyaeva N.V.; Guekht A.B.

doi:https://doi.org/10.17116/jnevro2020120121144

Close metadata

Recommended articles:

Epidemiology of suicidal behavior in children and adolescents worldwide. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11-2):16-26

Auto- and heteroaggressive behavior of minors with extremist and terrorist orientation of illegal acts, the influence of destructive content. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11-2):36-42

Non-suicidal self-injury and eating disorders: clinical and dynamic patterns in adolescence, young and middle age. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11-2):43-50

Surgical treatment of secondary trigeminal neuralgia. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):203-209

A case of rare hereditary Siddiqi syndrome with novel neuropsychiatric signs. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):171-176

Mental health protection in the primary health care: medico-social effectiveness. Russian Journal of Preventive Medicine. 2024;(10):29-35

Efficacy and safety of metamizole sodium for pain syndrome in adults and children: a systematic review. Russian Journal of Pain. 2024;(4):65-80

Experimental modeling, prevention, and treatment of endometriosis-associated adhesion formation in NIH/3T3 fibroblast cell line using bovhyaluronidase azoximer (in vitro). Russian Journal of Human Reproduction. 2024;(6):61-72

Acute postoperative pain in pediatric neurosurgery: state of the problem and effectiveness of modern pain relief methods. Russian Journal of Anesthesiology and Reanimatology. 2025;(1):30-35

Experience with the use of amitriptyline for chronic pelvic pain associated with endometriosis. Russian Journal of Human Reproduction. 2025;(1):86-93

Abstract:

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

Keywords:

nonsuicidal self-injurious behavior

pain

borderline personality disorder

mental disorders

Authors:

Zinchuk M.S.

Moscow Research and Clinical Centre for Neuropsychiatry

ORCID: 0000-0002-2538-3314

Avedisova A.S.

Serbsky National Medical Research Centre for Psychiatry and Narcology, the Ministry of Health of the Russian Federation

SPIN RSCI: 4339-6749
Scopus AuthorID: 6602410560

Voinova N.I.

Scientific and Practical Psychoneurological Center

Kustov G.V.

Moscow Research and Clinical Centre for Neuropsychiatry

ORCID: 0000-0001-7755-1175

Pashnin E.V.

Scientific and Practical Psychoneurological Center

Gulyaeva N.V.

Scientific and Practical Psychoneurological Center;
Institute of Higher Nervous Activity and Neurophysiology of RAS

Guekht A.B.

Moscow Research and Clinical Centre for Neuropsychiatry;
Pirogov Russian National Research Medical University

SPIN RSCI: 7691-3288
Scopus AuthorID: 7003326363
ResearcherID: Y-6725-2018
ORCID: 0000-0002-1170-6127

Received:

10.09.2020

Accepted:

10.09.2020

Close metadata

References:

James S, Abate D, Abate K, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990—2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858. https://doi.org/10.1016/s0140-6736(18)32279-7
Goffaux P, Léonard G, Lévesque M. Pain Perception in Mental Health: An Overview. In: Marchand S, Saravane D, Gaumond I, eds. Mental Health and Pain. Springer; 2014. p. 33-45. https://doi.org/10.1007/978-2-8178-0414-9_4
Katz J, Pagé M, Fashler S, et el. Chronic Pain and the Anxiety Disorders: Epidemiology, Mechanisms and Models of Comorbidity, and Treatment. In: Marchand S, Saravane D, Gaumond I, eds. Mental Health and Pain. Springer; 2014. p. 119-155. https://doi.org/10.1007/978-2-8178-0414-9_8
Hooten W. Chronic Pain and Mental Health Disorders. Mayo Clin Proc. 2016;91(7):955-970. https://doi.org/10.1016/j.mayocp.2016.04.029
Pompili M, Di Cosimo D, Innamorati M, et al. Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain. 2009;10(4):283-290. https://doi.org/10.1007/s10194-009-0134-2
Diagnostic and statistical manual of mental disorders [Internet]. 5th ed. American Psychiatric Association; 2013. Accessed Dec 4, 2020. https://doi.org/10.1176/appi.books.9780890425596
Nitkowski D, Petermann F. Selbstverletzendes Verhalten und komorbide psychische Störungen: ein Überblick. Fortschritte der Neurologie Psychiatrie. 2010;79(01):9-20. https://doi.org/10.1055/s-0029-1245772
Bentley K, Cassiello-Robbins C, Vittorio L, et al. The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clin Psychol Rev. 2015;37:72-88. https://doi.org/10.1016/j.cpr.2015.02.006
Koyanagi A, Stickley A, Haro J. Psychotic-Like Experiences and Nonsuidical Self-Injury in England: Results from a National Survey. PLoS One. 2015;10(12):e0145533. https://doi.org/10.1371/journal.pone.0145533
Victor S, Klonsky E. Correlates of suicide attempts among self-injurers: A meta-analysis. Clin Psychol Rev. 2014;34(4):282-297. https://doi.org/10.1016/j.cpr.2014.03.005
Zinchuk MS, Avedisova AS, Guekht AB. Non-suicidal self-injurious behavior in non-psychotic mental disorders: epidemiology, social and clinical risk factors. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2019;119(3):108-119. (In Russ.). https://doi.org/10.17116/jnevro2019119031108
Rizvi S, Iskric A, Calati R, Courtet P. Psychological and physical pain as predictors of suicide risk. Curr Opin Psychiatry. 2017;30(2):159-167. https://doi.org/10.1097/yco.0000000000000314
Kim D, Blossom S, Delgado P, et al. Examination of pain threshold and neuropeptides in patients with acute suicide risk. Prog Neuropsychopharmacol Biol Psychiatry. 2019;95:109705. https://doi.org/10.1016/j.pnpbp.2019.109705
Kirtley O, O’Carroll R, O’Connor R. Pain and self-harm: A systematic review. J Affect Disord. 2016;203:347-363. https://doi.org/10.1016/j.jad.2016.05.068
Koenig J, Rinnewitz L, Niederbäumer M, et al. Longitudinal development of pain sensitivity in adolescent non-suicidal self-injury. J Psychiatr Res. 2017;89:81-84. https://doi.org/10.1016/j.jpsychires.2017.02.001
Hamza C, Willoughby T, Armiento J. A laboratory examination of pain threshold and tolerance among nonsuicidal self-injurers with and without self-punishing motivations. Arch Sci Psychol. 2014;2(1):33-42. https://doi.org/10.1037/arc0000008
Kemperman I, Russ M, Crawford Clark W, et al. Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Res. 1997;70(3):175-183. https://doi.org/10.1016/s0165-1781(97)00034-6
McCoy K, Fremouw W, McNeil D. Thresholds and Tolerance of Physical Pain Among Young Adults Who Self-Injure. Pain Res Manag. 2010;15(6):371-377. https://doi.org/10.1155/2010/326507
Hooley J, Ho D, Slater J, Lockshin A. Pain perception and nonsuicidal self-injury: A laboratory investigation. Personal Disord. 2010;1(3):170-179. https://doi.org/10.1037/a0020106
Weinberg A, Klonsky E. The effects of self-injury on acute negative arousal: A laboratory simulation. Motiv Emot. 2011;36(2):242-254. https://doi.org/10.1007/s11031-011-9233-x
Schmahl C, Greffrath W, Baumgärtner U, et al. Differential nociceptive deficits in patients with borderline personality disorder and self-injurious behavior: laser-evoked potentials, spatial discrimination of noxious stimuli, and pain ratings. Pain. 2004;110(1):470-479. https://doi.org/10.1016/j.pain.2004.04.035
St. Germain S, Hooley J. Aberrant pain perception in direct and indirect non-suicidal self-injury: An empirical test of Joiner’s interpersonal theory. Compr Psychiatry. 2013;54(6):694-701. https://doi.org/10.1016/j.comppsych.2012.12.029
Koenig J, Rinnewitz L, Parzer P, et al. Resting cardiac function in adolescent non-suicidal self-injury: The impact of borderline personality disorder symptoms and psychosocial functioning. Psychiatry Res. 2017;248:117-120. https://doi.org/10.1016/j.psychres.2016.12.024
Ludäscher P, Greffrath W, Schmahl C, et al. A cross-sectional investigation of discontinuation of self-injury and normalizing pain perception in patients with borderline personality disorder. Acta Psychiatr Scand. 2009;120(1):62-70. https://doi.org/10.1111/j.1600-0447.2008.01335.x
Bekrater-Bodmann R, Chung B, Richter I, et al. Deficits in pain perception in borderline personality disorder. Pain. 2015;156(10):2084-2092. https://doi.org/10.1097/j.pain.0000000000000275
Gratz K, Hepworth C, Tull M, et al. An experimental investigation of emotional willingness and physical pain tolerance in deliberate self-harm: the moderating role of interpersonal distress. Compr Psychiatry. 2011;52(1):63-74. https://doi.org/10.1016/j.comppsych.2010.04.009
Koenig J, Thayer J, Kaess M. A meta-analysis on pain sensitivity in self-injury. Psychol Med. 2016;46(8):1597-1612. https://doi.org/10.1017/S0033291716000301
Schmahl C, Baumgärtner U. Pain in Borderline Personality Disorder. Mod Trends Pharmacopsychiatry. 2015;30:166-175. https://doi.org/10.1159/000435940
Schmahl C, Bohus M, Esposito F, et al. Neural Correlates of Antinociception in Borderline Personality Disorder. Arch Gen Psychiatry. 2006;63(6):659. https://doi.org/10.1001/archpsyc.63.6.659
Niedtfeld I, Schulze L, Kirsch P, et al. Affect Regulation and Pain in Borderline Personality Disorder: A Possible Link to the Understanding of Self-Injury. Biol Psychiatry. 2010;68(4):383-391. https://doi.org/10.1016/j.biopsych.2010.04.015
Reitz S, Kluetsch R, Niedtfeld I, et al. Incision and stress regulation in borderline personality disorder: Neurobiological mechanisms of self-injurious behaviour. Br J Psychiatry. 2015;207(2):165-172. https://doi.org/10.1192/bjp.bp.114.153379
Westlund Schreiner M, Klimes-Dougan B, Mueller B, et al. Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity. J Affect Disord. 2017;221:47-55. https://doi.org/10.1016/j.jad.2017.06.004
Wager T, Atlas L, Lindquist M, et al. An fMRI-Based Neurologic Signature of Physical Pain. N Engl J Med. 2013;368(15):1388-1397. https://doi.org/10.1056/nejmoa1204471
Bonenberger M, Plener P, Groschwitz R, et al. Differential neural processing of unpleasant haptic sensations in somatic and affective partitions of the insula in non-suicidal self-injury (NSSI). PPsychiatry Res. 2015;234(3):298-304. https://doi.org/10.1016/j.pscychresns.2015.10.013
Gu X, Hof P, Friston K, Fan J. Anterior insular cortex and emotional awareness. J Comp Neurol. 2013;521(15):3371-3388. https://doi.org/10.1002/cne.23368
Kluetsch R, Schmahl C, Niedtfeld I, et al. S.02.01 Alterations in default mode network connectivity during pain processing in borderline personality disorder. European Neuropsychopharmacology. 2013;23(Suppl 2):112. https://doi.org/10.1016/s0924-977x(13)70126-3
Perini I, Gustafsson P, Hamilton J, et al. Brain-based Classification of Negative Social Bias in Adolescents With Nonsuicidal Self-injury: Findings From Simulated Online Social Interaction. EClinicalMedicine. 2019;13:81-90. https://doi.org/10.1016/j.eclinm.2019.06.016
Kross E, Egner T, Ochsner K, et al. Neural Dynamics of Rejection Sensitivity. J Cogn Neurosci. 2007;19(6):945-956. https://doi.org/10.1162/jocn.2007.19.6.945
Ducasse D, Courtet P, Olié E. Physical and Social Pains in Borderline Disorder and Neuroanatomical Correlates: A Systematic Review. Curr Psychiatry Rep. 2014;16(5):443. https://doi.org/10.1007/s11920-014-0443-2
Vega D, Ripollés P, Soto À, et al. Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury. Brain Imaging Behav. 2017; 12(1):217-228. https://doi.org/10.1007/s11682-017-9687-x
Helmchen C, Mohr C, Erdmann C, et al. Neural activity related to self- versus externally generated painful stimuli reveals distinct differences in the lateral pain system in a parametric fMRI study. Hum Brain Mapp. 2006;27(9):755-765. https://doi.org/10.1002/hbm.20217
Dellinge-Ness L, Handler L. Self-injurious behavior in human and non-human primates. Clin Psychol Rev. 2006;26(5):503-514. https://doi.org/10.1016/j.cpr.2006.03.004
Balcombe J, Ferdowsian H, Durham D. Self-Harm in Laboratory-Housed Primates: Where Is the Evidence That the Animal Welfare Act Amendment Has Worked? J Appl Anim Welf Sci. 2011;14(4):361-370. https://doi.org/10.1080/10888705.2011.600667
Devine D. Non-Suicidal Self-Injury: Neurobiological Findings From Animal Models. Biol Psychiatry. 2019;85(10):61-62. https://doi.org/10.1016/j.biopsych.2019.03.162
Serafini G, Canepa G, Adavastro G, et al. The Relationship between Childhood Maltreatment and Non-Suicidal Self-Injury: A Systematic Review. Front Psychiatry. 2017;8:149. https://doi.org/10.3389/fpsyt.2017.00149
Bloom C, Holly S, Miller A. Self-Injurious Behavior vs. Nonsuicidal Self-Injury. Crisis. 2012;33(2):106-112. https://doi.org/10.1027/0227-5910/a000127
Maciejewski D, Creemers H, Lynskey M, et al. Overlapping Genetic and Environmental Influences on Nonsuicidal Self-injury and Suicidal Ideation. JAMA Psychiatry. 2014; 71(6):699. https://doi.org/10.1001/jamapsychiatry.2014.89
Bellivier F, Chaste P, Malafosse A. Association between the TPH gene A218C polymorphism and suicidal behavior: A meta-analysis. Am J Med Genet B. 2004;124B(1):87-91. https://doi.org/10.1002/ajmg.b.20015
Lin P, Tsai G. Association between serotonin transporter gene promoter polymorphism and suicide: results of a meta-analysis. Biol Psychiatry. 2004; 55(10):1023-1030. https://doi.org/10.1016/j.biopsych.2004.02.006
Kruger L, Light AR, eds. Translational Pain Research. From Mouse to Man. 1st ed. CRC Press; 2009 456 p. https://doi.org/10.1201/9781439812105
Hermans L, Van Oosterwijck J, Goubert D, et al. Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review. Pain Practice. 2015;16(6):758-769. https://doi.org/10.1111/papr.12305
Bresin K, Sima Finy M, Verona E. Childhood emotional environment and self-injurious behaviors: The moderating role of the BDNF Val66Met polymorphism. J Affect Disord. 2013;150(2):594-600. https://doi.org/10.1016/j.jad.2013.01.050
Cai X, Shi X, Zhang X, et al. The association between brain-derived neurotrophic factor gene polymorphism and migraine: a meta-analysis. J Headache Pain. 2017;18(1). https://doi.org/10.1186/s10194-017-0725-2
Azoulay D, Abed S, Sfadi A, et al. Low brain-derived neurotrophic factor protein levels and single-nucleotide polymorphism Val66Met are associated with peripheral neuropathy in type II diabetic patients. Acta Diabetol. 2020;57(7):891-898. https://doi.org/10.1007/s00592-020-01508-6
Russ M, Roth S, Lerman A, et al. Pain perception in self-injurious patients with borderline personality disorder. Biol Psychiatry. 1992;32(6):501-511. https://doi.org/10.1016/0006-3223(92)90218-o
Bresin K, Gordon K. Endogenous opioids and nonsuicidal self-injury: A mechanism of affect regulation. Neurosci Biobehav Rev. 2013;37(3):374-383. https://doi.org/10.1016/j.neubiorev.2013.01.020
Kirtley O, O’Carroll R, O’Connor R. The role of endogenous opioids in non-suicidal self-injurious behavior: Methodological challenges. Neurosci Biobehav Rev. 2015;48:186-189. https://doi.org/10.1016/j.neubiorev.2014.11.007
Blasco-Fontecilla H, Fernández-Fernández R, Colino L, et al. The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry. 2016;7:8. https://doi.org/10.3389/fpsyt.2016.00008
Stanley B, Sher L, Wilson S, et al. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord. 2010;124(1-2):134-140. https://doi.org/10.1016/j.jad.2009.10.028
Tordjman S, Anderson G, Botbol M, et al. Pain Reactivity and Plasma β-Endorphin in Children and Adolescents with Autistic Disorder. PLoS One. 2009;4(8):e5289. https://doi.org/10.1371/journal.pone.0005289
Turner B, Austin S, Chapman A. Treating Nonsuicidal Self-Injury: A Systematic Review of Psychological and Pharmacological Interventions. Can J Psychiatry. 2014;59(11):576-585. https://doi.org/10.1177/070674371405901103
Bresin K, Gordon K. Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personal Disord. 2013;4(1):62-66. https://doi.org/10.1037/a0025736
Reichl C, Brunner R, Bender N, et al. Adolescent nonsuicidal self-injury and cortisol response to the retrieval of adversity: A sibling study. Psychoneuroendocrinology. 2019;110:104460. https://doi.org/10.1016/j.psyneuen.2019.104460
Nock M, Prinstein M. A Functional Approach to the Assessment of Self-Mutilative Behavior. J Consult Clin Psychol. 2004;72(5):885-890. https://doi.org/10.1037/0022-006x.72.5.885
Franklin J, Hessel E, Aaron R, et al. The functions of nonsuicidal self-injury: Support for cognitive — affective regulation and opponent processes from a novel psychophysiological paradigm. J Abnorm Psychol. 2010;119(4):850-862. https://doi.org/10.1037/a0020896
Bresin K, Kling L, Verona E. The effect of acute physical pain on subsequent negative emotional affect: A meta-analysis. Personal Disord. 2018;9(3):273-283. https://doi.org/10.1037/per0000248
Koenig J, Rinnewitz L, Warth M, et al. Psychobiological response to pain in female adolescents with nonsuicidal self-injury. J Psychiatry Neurosci. 2017;42(3):189-199. https://doi.org/10.1503/jpn.160074
Armey M, Crowther J, Miller I. Changes in Ecological Momentary Assessment Reported Affect Associated With Episodes of Nonsuicidal Self-Injury. Behav Ther. 2011;42(4):579-588. https://doi.org/10.1016/j.beth.2011.01.002
Andrewes H, Hulbert C, Cotton S, et al. Ecological momentary assessment of nonsuicidal self-injury in youth with borderline personality disorder. Personal Disord. 2017;8(4):357-365. https://doi.org/10.1037/per0000205
Solomon R. The opponent-process theory of acquired motivation: The costs of pleasure and the benefits of pain. Am Psychol. 1980;35(8):691-712. https://doi.org/10.1037/0003-066x.35.8.691
Franklin J, Lee K, Hanna E, Prinstein M. Feeling Worse to Feel Better. Psychol Sci. 2013;24(4):521-529. https://doi.org/10.1177/0956797612458805
Selby E, Joiner T. Cascades of Emotion: The Emergence of Borderline Personality Disorder from Emotional and Behavioral Dysregulation. Rev Gen Psychol. 2009;13(3):219-229. https://doi.org/10.1037/a0015687
Ford J, Gómez J. The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review. J Trauma Dissociation. 2015;16(3):232-271. https://doi.org/10.1080/15299732.2015.989563
Franzke I, Wabnitz P, Catani C. Dissociation as a Mediator of the Relationship Between Childhood Trauma and Nonsuicidal Self-Injury in Females: A Path Analytic Approach. J Trauma Dissociation. 2015;16(3):286-302. https://doi.org/10.1080/15299732.2015.989646
Abugova MA. Measurment of pain sensitivity thresholds as an objective method to assess the effectiveness of depersonalization therapy. Obozrenie psikhiatrii i meditsinskoj psikhologii imeni V.M. Bekhtereva. 1996;(3-4):120-122. (In Russ.).
Abugova MA. Changes in pain thresholds in patients with depersonalization depend on the effect of therapy. Sotsial’naya i klinicheskaya psikhiatriya. 2001;11(3):15-17. (In Russ.).
Klonsky E. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007;27(2):226-239. https://doi.org/10.1016/j.cpr.2006.08.002
Nock M, Holmberg E, Photos V, Michel B. Self-Injurious Thoughts and Behaviors Interview: Development, reliability, and validity in an adolescent sample. Psychol Assess. 2007;19(3):309-317. https://doi.org/10.1037/1040-3590.19.3.309
Gratz K. Risk factors for deliberate self-harm among female college students: The role and interaction of childhood maltreatment, emotional inexpressivity, and affect intensity/reactivity. Am J Orthopsychiatry. 2006;76(2):238-250. https://doi.org/10.1037/0002-9432.76.2.238
Fisher H, Moffitt T, Houts R, et al. Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ. 2012;344:e2683. https://doi.org/10.1136/bmj.e2683
Levesque C, Lafontaine M, Bureau J, et al. The Influence of Romantic Attachment and Intimate Partner Violence on Non-Suicidal Self-Injury in Young Adults. J Youth Adolesc. 2009;39(5):474-483. https://doi.org/10.1007/s10964-009-9471-3