Psychological pain

The adjective 'psychological' is thought to encompass the functions of beliefs, thoughts, feelings, and behaviors,[16] which may be seen as an indication for the many sources of psychological pain. One way of grouping these different sources of pain was offered by Shneidman, who stated that psychological pain is caused by frustrated psychological needs.[1] For example, the need for love, autonomy, affiliation, and achievement, or the need to avoid harm, shame, and embarrassment. Psychological needs were originally described by Henry Murray in 1938 as needs that motivate human behavior.[17] Shneidman maintained that people rate the importance of each need differently, which explains why people's level of psychological pain differs when confronted with the same frustrated need. This needs perspective coincides with Patrick David Wall's description of physical pain that says that physical pain indicates a need state much more than a sensory experience.[18]

In the fields of social psychology and personality psychology, the term social pain is used to denote psychological pain caused by harm or threat to social connection; bereavement, embarrassment, shame and hurt feelings are subtypes of social pain.[19] From an evolutionary perspective, psychological pain forces the assessment of actual or potential social problems that might reduce the individual's fitness for survival.[20] The way we display our psychological pain socially (for example, crying, shouting, moaning) serves the purpose of indicating that we are in need.

Borderline personality disorder (BPD) has long been believed to be the one psychiatric disorder that produced the most intense emotional pain, agony, and distress in those who suffer with this condition. Studies have shown that borderline patients experience chronic and significant emotional suffering and mental agony.[21][22] Borderline patients may feel overwhelmed by negative emotions, experiencing intense grief instead of sadness, shame and humiliation instead of mild embarrassment, rage instead of annoyance, and panic instead of nervousness.[23] People with BPD are especially sensitive to feelings of rejection, isolation and perceived failure.[24] Both clinicians and laymen alike have witnessed the desperate attempts to escape these subjective inner experiences of these patients. Borderline patients are severely impulsive and their attempts to alleviate the agony are often very destructive or self-destructive. Suicidal ideation, suicide attempts, eating disorders (anorexia nervosa, binge eating disorder, and bulimia nervosa), self-harm (cutting, overdosing, starvation, etc.), compulsive spending, gambling, sex addiction, violent and aggressive behaviour, sexual promiscuity and deviant sexual behaviours, are desperate attempts to escape. The intrapsychic pain experienced by those diagnosed with BPD has been studied and compared to normal healthy controls and to others suffering from major depression, bipolar disorder, substance use disorder, schizophrenia, other personality disorders, and a range of other conditions. The excruciatingly painful inner experience of the borderline patient is both unique and perplexing. In clinical populations, the rate of suicide of patients with borderline personality disorder is estimated to be 10%, a rate far greater than that in the general population and still considerably greater than for patients with schizophrenia and bipolar disorder. However, since 60–70% of patients with borderline personality disorder make suicide attempts; suicide attempts are far more frequent than completed suicides in patients with borderline personality disorder.[25]

The intense dysphoric states which patients diagnosed with borderline personality disorder (BPD) endure on a regular basis distinguishes them from those suffering from other personality disorders, major depressive disorder, bipolar disorder, and virtually all known Axis I and Axis II conditions. In a 1998 study entitled "The Pain of Being Borderline: Dysphoric States Specific to Borderline Personality Disorder", one hundred and forty six diagnosed borderline patients took a 50-item self-report measure test. The conclusions from this study suggest "that the subjective pain of borderline patients may be both more pervasive and more multifaceted than previously recognized and that the overall “amplitude” of this pain may be a particularly good marker for the borderline diagnosis".[26]

Research suggests that physical pain and psychological pain may share some underlying neurological mechanisms.[27][28][29][30] Brain regions that were consistently found to be implicated in both types of pain are the anterior cingulate cortex and prefrontal cortex (some subregions more than others), and may extend to other regions as well. Brain regions that were also found to be involved in psychological pain include the insular cortex, posterior cingulate cortex, thalamus, parahippocampal gyrus, basal ganglia, and cerebellum. Some advocate that, because similar brain regions are involved in both physical pain and psychological pain, we should see pain as a continuum that ranges from purely physical to purely psychological.[31] Moreover, many sources mention the fact that we use metaphors of physical pain to refer to psychological pain experiences.[8][12][32] Further connection between physical and psychological pain has been supported through proof that acetaminophen, an analgesic, can suppress activity in the anterior cingulate cortex and the insular cortex when experiencing social exclusion, the same way that it suppresses activity when experiencing physical pain.[33][34] and reduces the agitation of people with dementia.[35][36] However use of paracetamol for more general psychological pain remains disputed.[37]

Religious Perspectives

Many religious traditions, such as the Noble Eightfold Path in Buddhism, have attempted or managed to provide treatment of psychological suffering. Meditation has mental health benefits.[38][39] The most common form of meditative practice as therapy is mindfulness, but breath focused exercises are also used for dealing with the stresses and anxiety related to emotional pain, reducing physiological symptoms.

• Emotion
• Psychogenic pain
• Psychological trauma