Is Borderline Personality Disorder Affecting Your Chronic Pain Management?

Stress from the COVID pandemic can worsen both chronic pain and mental health. A possible personality disorder – more common in those with pain conditions – can make treatment more challenging to navigate. But there are ways to get an accurate diagnosis and care plan.

While research shows that up to 10% of the general population has at least one personality disorder, not many know the rates are as high as 60% among those living with certain chronic pain conditions.1,2 Even physicians sometimes fail to recognize this relationship.

Borderline Personality Disorder affects around 1.6% of the general population. It is more common among those with chronic pain. (Image: iStock: digitalskillet)


What Kind of Personality Disorders Are We Talking About Here?

A personality disorder is a type of mental health disorder which influences your personality in negative ways. For example, how you view yourself and others. People with personality disorders more often report poor health, dissatisfaction with their medical care – and you guessed it, chronic pain.The exact cause of personality disorders is unclear but experts believe the environment, genetics, and changes in brain chemicals such as serotonin may all play a role.3-5

Borderline Personality Disorder (BPD), in particular, is a type of disorder with specific personality traits that affect around 1.6% of the general population.6 It is more common among those with chronic pain.2

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) – the doctor’s go-to guide for diagnoses of all kinds – signs and symptoms of BPD can include:3

  • poor self-image
  • fear of abandonment
  • a pattern of troubled relationships
  • impulsive behavior
  • mood swings
  • a history of suicidal or self-harming behavior.

If you or a loved one is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support. If you need immediate help call 911 right away.


Diagnosing Borderline Personality Disorder as Part of Chronic Pain Management Can Be Quite Complicated

Studies show those with chronic pain have up to a 30% higher incidence of BPD.7 However, getting an accurate diagnosis is not clear-cut.

In fact, borderline personality disorder is the most misdiagnosed mental health condition.8 This is because BPD can resemble other mood disorders and can co-exist with other mental health disorders, including: depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), substance use disorder, attention deficit/hyperactivity disorder (ADHD), and others.4

It is also harder for people living with both BPD and chronic pain conditions to access treatment and manage their health, often because of poor self-coping skills that stem from BPD symptoms and behavior traits. Some medical practices have reported feeling challenged by “disruptive” or “difficult” behavior, which then leads to missing BPD as a potential cause of that behavior.

BPD can also be mistaken for bipolar disorder because the conditions have similar behavioral symptoms. But there are key differences in the frequency of mood cycling that sets them apart. Those struggling with BPD have frequent, often daily, changes in mood and behavior which is long-lasting. In contrast, bipolar symptoms have longer timeframes linked with mood shifts, with long periods of stability.10,11

Adding chronic pain management to the BPD mix can further complicate personal and professional relationships. These conflicts may lead to anxiety, stress, agitation, and depression, worsening one's overall mental health. Studies show that people with BPD and chronic pain may struggle with substance use disorder, suicide risk, and poor self-care, which can lead to problems with medical management.12-14


Is Covid-19 Stress Making Chronic Pain Worse?

In a word, yes. A report published in June 2020 by pain psychologists and researchers at Tufts University and Harvard Medical School discusses the negative impact of stress and the COVID pandemic on people already trying to manage chronic pain with borderline personality disorder.12 Scientists believe some individuals with chronic pain may be more vulnerable to developing BPD symptoms and stress makes their BPD symptoms worse.15

Stress stemming from chronic pain can also trigger BPD symptoms in those with underlying biological and psychological risk factors such as childhood trauma or a family history of mental illness. Currently, the collective challenges from COVID – such as social isolation, fear of infection, and worry over livelihood – are increasing stress and worsening chronic pain.12

In addition, the coronavirus pandemic has created bigger hurdles for people trying to access treatment and manage a host of symptoms. According to an April 2020 survey by the US Pain Foundation, 77% of people living with chronic pain surveyed said they had trouble getting medical care due to the pandemic and were experiencing increased pain.16

It's true that many medical practices have delayed evaluations or starting new treatments, which is distressing for everyone. For those with BPD and chronic pain who may already have experienced difficulty accessing care, the uncertainty of COVID is an added burden.

Together with BPD symptoms, pain management can get even more challenging to navigate. (Image: Istock: Nopphon Pattanasri)


Why Asking for a Personality Disorder Screening May Improve Your Health

Experts believe that doctors may be unaware of the presence of BPD among those with diagnosed chronic pain conditions, which can lead to treatment failures and frustration for both the patient and the doctor.12 It is well known that those living with chronic pain face difficulties in pain management – there is a tremendous amount of trial and error and it can take years to even get an accurate diagnosis. In fact, 79% of pain patients report dissatisfaction with pain care.17

These reasons are exactly why people with chronic pain and concerns about mental health need to push for a screening. According to experts, screening for personality disorders, as well as for anxiety and depression (which are also common among people with chronic pain) can be an important tool to help doctors provide you with more targeted chronic pain treatment, as well as mental health support.12

If you have experienced treatment-resistant chronic pain that is influencing your behavior and mood negatively, consider talking with your doctor about a BPD screening. The Tufts University researchers mentioned above recommend the McLean Screening Instrument for BPD (MSI-BPD) because it is a short questionnaire compared to other much longer screening tools.12

While there are no medications to treat BPD specifically, there are medications that can help with some symptoms of BPD, such as antidepressants, anti-anxiety drugs, and other medications for specific symptoms. Alternative treatments that might be helpful include cognitive behavioral therapy (CBT), which you can do at home with some upfront guidance.

Overall, it’s important to communicate with your doctor about any symptoms you may be experiencing to help them develop a more complete treatment plan that fits your needs and improves your overall health.


Take Advantage of Telehealth for Self-Care

And don’t forget that you still have options for care even while you’re stuck at home. Several private insurance companies and the Centers for Medicare and Medicaid Services (CMS) have expanded telemedicine benefits to increase flexibility so those who need care can access it. Many of these benefits may extend beyond the pandemic closures.

Telehealth services can include both physical and mental healthcare. There are several methods, ranging from phone, video, to apps, used to deliver care.

Examples of services include:

  • Screenings and assessments
  • Virtual communication with doctors, or other health professionals about your treatment
  • Evaluations with specialists
  • Guided physical therapy with home exercise regimens
  • CBT and other behavioral or mindfulness strategies you can implement at home
  • Apps to help with mood, anxiety, stress
  • Home-based pain-relieving and stress management devices



Check with your provider to see if you have telemedicine coverage and access to virtual health services.

For Medicare, you can call 1-800-MEDICARE for more information.

Also, consider practicing coping strategies such as mindfulness and self-care to help relieve stress, anxiety, and emotional pain triggers.

Here are some great resources and apps to help you get started in your daily self-care:

Updated on: 07/14/20