I recently had to write a paper about a topic I picked in psychology, and I picked this article. While only the abstract is available if you don't have a subscription to the academic journal it was published in, it does give the basic rundown. You can read it [here](https://pubmed.ncbi.nlm.nih.gov/28604278/). It's titled, "Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression," by  Katherine L Dixon-Gordon, Christopher R Berghoff, and Michael J McDermott. This is a peer-reviewed article, which means the findings and discussion of findings has been vetted by peers in their field of research.

I'm not sure if this is allowed, but I'd like to share my thoughts on the article and some of the findings I wrote about in my paper. I wasn't sure what to flair this post with, as I was unable to flair it with the Information flair. I'm not exactly a Veteran Borderline, but I have done quite a bit of searching here and there for information regarding BPD, and I think I have a good grasp on the disorder. I hope that others can find comfort in better understanding BPD, as I have. 

Bear in mind that I simplified some of this to make it more readable and left out a bulk of the article in order to sum up what I found the most compelling and relevant. I'm including parts of my paper so I can do less redundant writing. I also assume here that the audience has a bit of knowledge on BPD. This is a long post, so feel free to skim. I didn't put a TLDR because I got too tired after writing this (but also because some of the things I find important to share *cannot* be understood without all the information I'm providing). 

If you have any questions after reading, go ahead and ask. I may or may not be able to answer. If this is still a little too complicated, I can also try to simplify it a little more.   


**Some background first:**

BPD is an incredibly painful condition to live with. Past research shows a strong correlation between BPD and chronic pain conditions. BPD symptoms are also associated with greater self-reported pain and somatic complaints.  Somatic symptoms are the distress a person feels from their physical pain or fatigue. A longitudinal study also found that BPD symptoms were linked to the development of health problems eight months later because of emotional dysregulation. 

And finally, a past research study found that BPD symptoms were associated with the use of avoidance or suppression as emotional regulation techniques. However, the effects of using these techniques on the individuals involved was not studied.   


**Research focus**

Researchers investigated if emotional suppression while a person is undergoing extreme distress is linked to higher pain severity and interference in daily life. Researchers also examined whether the relation between emotional suppression and pain a person with BPD underwent changed depending on the level of BPD symptoms (how strong the symptoms were).

They were prompted to investigate this because so far, there has been little research on the contributing factors to the pain that individuals with BPD experience.  


**Research methods**

Here are the statistics/demographics of the college students who participated in this research study.

* All college students
* Most full-time and single
* Average age 20.09
* 89 participants, 85.39% female
* Majority white with Asian, Black, multiracial, Latino/a and other races
* 26.97% received treatment for psychiatric disorder
* 22.47% reported taking medications to treat psychiatric disorder

Here are the questionnaires they used to measure the variables of the study.

* Personality Assessment Inventory-Borderline Features Scale (PAIBFS)
* Depression Anxiety Stress Scales-21 (DASS-21)
* Brief Pain Inventory (BPI)

The PAIBFS measures the individual for BPD features in four domains: affective instability, identity problems, negative relationships, and self-harm. 

The DASS-21 measures depression, anxiety, and stress on subscales within the scale. 

The internal consistency for the first two scales was high, meaning that they are accurate in measuring what they’re supposed to measure.

The BPI measures pain severity and interference. Pain severity is the degree of pain the person feels. Pain interference is when the pain interferes with your functioning in day-to-day life. Usually the BPI is to be taken weekly, but it was adjusted to be taken every 24 hours for this study. 

The participants also completed a survey about their use of emotion regulation strategies after remembering the most stressful events of the day each day. But in this study, the researchers primarily studied the item measuring the use of emotional suppression.   


**Research Findings/Discussion**

The main finding here?

People with high BPD features who use emotional suppression as a response to social stressors would experience greater pain interference.

This is particularly significant in that they did not experience greater interference when suppressing their emotions in response to nonsocial stressors. This suggests people with BPD’s vulnerability and affectability to social stressors. Past research found that people with BPD report higher anger and more aggressive behaviors in response to social stressors, so this falls in line nicely. 

As a side note, people with BPD also experience greater pain severity and interference daily, which is shown in this research study and supported by past research. 

*What does this mean?*

People with strong BPD symptoms who suppress their emotions when faced with a socially stressful situation tend to experience greater inference functioning in life from pain.

Let's break this down with an example.

Person A, who has strong BPD features meets Person B, who they have a volatile relationship with. When Person B unknowingly says something that is hurtful to Person A, they suppress their emotions and thoughts related to those emotions. Person A tends to have more difficulty functioning because of this pain. Maybe they can't finish their work on time, or they can't concentrate on work because of the pain. This is the pain interference aspect. Again, pain interference interferes with a person's functioning and carrying out of their daily responsibilities.

*How does this relate to past research?*

Past research suggested that anger suppression may contribute to greater pain experienced. The ironic process theory tells us that suppressing an emotion may make it stronger. When we suppress an emotion, we devote mental resources to doing two things: 1.) scanning for the relevant emotions/thoughts to make sure we're not experiencing it and 2.) avoiding the emotions/thoughts. This actually may make these emotions and thoughts stronger by comparison because it reminds us of the emotions every time we scan for it and try to actively avoid it. It comes to our mind because we're trying to avoid it.

This is like how when someone tells you not to think about something, you keep thinking of it. 

Let's try it now. Do not think about a polar bear. Now you're trying to avoid thinking about it, but at the same time, you're automatically examining your thoughts for the existence of the polar bear. 

In other research, they also found that anger suppression leads to greater pain sensitivity. Previous research found that study participants rated their pain severity as higher in the anger-specific domains.

This combination of findings regarding anger suppression and ironic process theory really shows how these processes and experiences may relate to BPD, as people who have BPD often report high anger, which may contribute to the experience of increased pain.  


**My thoughts**

The researcher’s findings are convincing and well-sustained by the support of past research. 

People with BPD usually either have a biological predisposition or, often, come from an early invalidating environment, meaning that their feelings were invalidated early on in life--and so often the environment is the home or family environment. They also are described as having emotional 3rd degree burns by leading BPD expert, Marsha Linehan, due to their extreme sensitivity to emotional turmoil and pain. 

The ironic process theory previously referenced may be a factor that contributes to the making of a BPD constitution: individuals with BPD may be told that they react out of proportion to the stressor they are faced with, particularly social stressors, or be in an invalidating environment early in life. They then turn to suppression of those unwanted, strong emotions because others guide them into believing their emotions and behavior is inappropriate, regardless of if it really is. 

This culminates in the amplification of the original unwanted feeling, which is likely to be anger, and it elevates the pain experienced as well as heightens the individual's sensitivity to pain. They then become more sensitive to and more aware of the feeling and the pain they are experiencing. They continue to try to use emotional suppression as they go forward because their feelings are continually dismissed as dramatic, overreacting, and overwhelming. But it continues to increase their pain interference and pain sensitivity. This pulls an individual with BPD into a cycle of further, greater pain and emotional turmoil. Hence, why I say this toxic cycle may be one contributing factor to a person’s BPD constitution. 

While people with BPD are responsible for their actions and how it affects the people around them, this might bring some light to why they say they feel they cannot control their reactions, due to the sheer intensity of the feelings and resulting pain they experience.   


**How the study could be improved**

However, the study would benefit from a larger sample size and a greater diversity of participants in age and ethnicity, which would allow for the researchers to examine how cultural influences and the maturation of the brain regions may interact with BPD features and the use of suppression. Certain cultures may facilitate the use of suppression in emotional regulation. Also, perhaps if the incentives for participating in the study were greater and or a larger sample of participants were recruited to begin with, there would be a greater and more consistent resulting population to draw results from. Since the participants were all college students, too, more diversity in the participant population would be appreciated.

While professionals cannot make diagnoses for people younger than 18 years, people may still have BPD symptoms from a young age. Thus, the changing and developing of the brain and how it affects BPD (and vice-versa) would be of great interest to me. At what age people with BPD learn to use emotional repression as a tool for regulating mood would also be a great future study subject.   


**Work Referenced**

Dixon-Gordon, K. L., Berghoff, C. R., &amp; Mcdermott, M. J. (2018). Borderline Personality Disorder

Symptoms and Pain in College Students: The Role of Emotional Suppression. Journal of

Personality Disorders, 32(2), 277-288. doi:10.1521/pedi\_2017\_31\_300