Psychological pain

Psychological pain
Other namesSuffering, mental agony, mental pain, emotional pain, algopsychalia, psychic pain, social pain, spiritual pain, soul pain
Vincent van Gogh's 1890 painting
Sorrowing old man ('At Eternity's Gate'), where a man weeps due to the unpleasant feelings of psychological pain.
SpecialtyPsychiatry, psychology
MedicationAntidepressant medication, Analgesic medication

Psychological pain, mental pain, or emotional pain is an unpleasant feeling (a suffering) of a psychological, non-physical origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment."[1] There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia,[2] but it may also be called mental pain,[3][4] emotional pain,[5] psychic pain,[6][7] social pain,[8] spiritual or soul pain,[9] or suffering.[10][11] While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling.[12] Psychological pain is widely believed to be an inescapable aspect of human existence.[13]

Other descriptions of psychological pain are "a wide range of subjective experiences characterized as an awareness of negative changes in the self and in its functions accompanied by negative feelings",[14] "a diffuse subjective experience ... differentiated from physical pain which is often localized and associated with noxious physical stimuli",[15] and "a lasting, unsustainable, and unpleasant feeling resulting from negative appraisal of an inability or deficiency of the self."[12]

Cause

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 people display their psychological pain socially (for example, crying, shouting, moaning) serves the purpose of indicating that they are in need.

Neuropsychology

Physical pain and psychological pain share common underlying neurological mechanisms.[21][15][22][23] 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, pain should be seen as a continuum that ranges from purely physical to purely psychological.[24] Moreover, many sources mention the fact that many metaphors of physical pain are used to refer to psychologically painful experiences.[8][12][25] 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,[26][27] and reduces the agitation of people with dementia.[28][29] However, use of paracetamol for more general psychological pain remains disputed.[30]

Borderline personality disorder

Borderline personality disorder (BPD) has long been believed to be a disorder that produces the most intense emotional pain and distress in those who have this condition. Studies have shown that borderline patients experience chronic and significant emotional suffering and mental agony.[31][32] 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.[33] People with BPD are especially sensitive to feelings of rejection, isolation and perceived failure.[34] 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 behavior, sexual promiscuity and deviant sexual behaviors, are desperate attempts to escape this pain.

The intrapsychic pain experienced by those diagnosed with BPD has been studied and compared to normal healthy controls and to others with major depression, bipolar disorder, substance use disorder, schizophrenia, other personality disorders, and a range of other conditions. Although the excruciatingly painful inner experience of the borderline patient is both unique and perplexing, it is often linked to severe childhood trauma of abuse and neglect. 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, 60–70% of patients with borderline personality disorder make suicide attempts, so suicide attempts are far more frequent than completed suicides in patients with BPD.[35]

The intense dysphoric states which patients diagnosed with BPD endure on a regular basis distinguishes them from those with other personality disorders: major depressive disorder, bipolar disorder, and virtually all known DSM-IV Axis I and Axis II conditions. In a 1998 study entitled "The Pain of Being Borderline: Dysphoric States Specific to Borderline Personality Disorder", 146 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 recognised and that the overall "amplitude" of this pain may be a particularly good marker for the borderline diagnosis".[36]

Feelings of emptiness are a central problem for patients with personality disturbances. In an attempt to avoid this feeling, these patients employ defences to preserve their fragmentary selves. Feelings of emptiness may be so painful that suicide is considered.[37]

See also

References

  1. 1 2 Shneidman ES (1996). "Appendix A Psychological Pain Survey". The Suicidal Mind. Oxford University Press. p. 173. ISBN 9780195118018.
  2. ↑ Psychalgia: mental distress. Merriam-Webster's Medical Dictionary. But see also psychalgia in the sense of psychogenic pain.
  3. ↑ Weiss E (1934). "Bodily pain and mental pain". The International Journal of Psychoanalysis. 15: 1–13.
  4. ↑ Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P (2003). "Mental pain and its relationship to suicidality and life meaning". Suicide & Life-Threatening Behavior. 33 (3): 231–41. doi:10.1521/suli.33.3.231.23213. PMID 14582834.
  5. ↑ Bolger EA (1999). "Grounded theory analysis of emotional pain". Psychotherapy Research. 9 (3): 342–62. doi:10.1080/10503309912331332801.
  6. ↑ Joffe WG, Sandler J (1967). "On the concept of pain, with special reference to depression and psychogenic pain". Journal of Psychosomatic Research. 11 (1): 69–75. doi:10.1016/0022-3999(67)90058-X. PMID 6049033.
  7. ↑ Shattell MM (May 2009). "Why does "pain management" exclude psychic pain?" (PDF). Issues in Mental Health Nursing. 30 (5): 344. doi:10.1080/01612840902844890. PMID 19437255. S2CID 29799238.
  8. 1 2 Macdonald G, Leary MR (March 2005). "Why does social exclusion hurt? The relationship between social and physical pain" (PDF). Psychological Bulletin. 131 (2): 202–23. doi:10.1037/0033-2909.131.2.202. PMID 15740417. S2CID 10540325. Archived from the original (PDF) on 2014-03-01.
  9. ↑ Spiritual pain: 60,000 Google results. Soul pain: 237,000 Google results.
  10. ↑ Morse JM (September 2001). "Toward a praxis theory of suffering". Advances in Nursing Science. 24 (1): 47–59. doi:10.1097/00012272-200109000-00007. PMID 11554533.
  11. ↑ Rehnsfeldt A, Eriksson K (September 2004). "The progression of suffering implies alleviated suffering". Scandinavian Journal of Caring Sciences. 18 (3): 264–72. doi:10.1111/j.1471-6712.2004.00281.x. PMID 15355520.
  12. 1 2 3 Meerwijk EL, Weiss SJ (2011). "Toward a unifying definition of psychological pain". Journal of Loss & Trauma. 16 (5): 402–12. doi:10.1080/15325024.2011.572044. S2CID 144462525.
  13. ↑ Wille RS (2011). "On the capacity to endure psychic pain". The Scandinavian Psychoanalytic Review. 34: 23–30. doi:10.1080/01062301.2011.10592880. S2CID 144997538.
  14. ↑ Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E (2003). "Mental pain: a multidimensional operationalization and definition". Suicide & Life-Threatening Behavior. 33 (3): 219–30. doi:10.1521/suli.33.3.219.23219. PMID 14582833.
  15. 1 2 Mee S, Bunney BG, Reist C, Potkin SG, Bunney WE (December 2006). "Psychological pain: a review of evidence". Journal of Psychiatric Research. 40 (8): 680–90. doi:10.1016/j.jpsychires.2006.03.003. PMID 16725157.
  16. ↑ Covington EC (December 2000). "Psychogenic pain-what it means, why it does not exist, and how to diagnose it". Pain Medicine. 1 (4): 287–94. doi:10.1046/j.1526-4637.2000.00049.x. PMID 15101873.
  17. ↑ Murray HA (2008). Explorations in personality (70 ed.). New York, NY: Oxford University Press. ISBN 978-0-19-530506-7.
  18. ↑ Wall PD (1979). "On the relation of injury to pain". Pain. 6 (3): 253–64. doi:10.1016/0304-3959(79)90047-2. PMID 460933. S2CID 6412475.
  19. ↑ MacDonald G, Philip J (2009). "Social Pain and Hurt Feelings" (PDF). In Corr PJ, Matthews G (eds.). Cambridge Handbook of Personality Psychology. Cambridge UK: Cambridge University Press. ISBN 9780521680516.
  20. ↑ Thornhill R, Thornhill NW (1989). "The Evolution of Psychological Pain". In Bell RW, Bell NJ (eds.). Sociobiology and the Social Sciences. Lubbock, Texas: Texas Tech University Press. ISBN 978-0-89672-161-6.
  21. ↑ Eisenberger NI (2012). "The neural bases of social pain: evidence for shared representations with physical pain". Psychosomatic Medicine. 74 (2): 126–35. doi:10.1097/PSY.0b013e3182464dd1. PMC 3273616. PMID 22286852.
  22. ↑ Eisenberger NI, Lieberman MD (July 2004). "Why rejection hurts: a common neural alarm system for physical and social pain". Trends in Cognitive Sciences. 8 (7): 294–300. doi:10.1016/j.tics.2004.05.010. PMID 15242688. S2CID 15893740.
  23. ↑ Meerwijk EL, Ford JM, Weiss SJ (March 2013). "Brain regions associated with psychological pain: implications for a neural network and its relationship to physical pain". Brain Imaging and Behavior. 7 (1): 1–14. doi:10.1007/s11682-012-9179-y. PMID 22660945. S2CID 8755398.
  24. ↑ Biro D (December 2010). "Is there such a thing as psychological pain? And why it matters". Culture, Medicine and Psychiatry. 34 (4): 658–67. doi:10.1007/s11013-010-9190-y. PMC 2952112. PMID 20835887.
  25. ↑ Flaskerud JH (2011). "Heartbreak and physical pain linked in brain". Issues in Mental Health Nursing. 32 (12): 789–91. doi:10.3109/01612840.2011.583714. PMID 22077752. S2CID 12451262.
  26. ↑ Dewall CN, Macdonald G, Webster GD, Masten CL, Baumeister RF, Powell C, Combs D, Schurtz DR, Stillman TF, Tice DM, Eisenberger NI (July 2010). "Acetaminophen reduces social pain: behavioral and neural evidence". Psychological Science. 21 (7): 931–7. doi:10.1177/0956797610374741. PMID 20548058. S2CID 13800603.
  27. ↑ Randles D, Heine SJ, Santos N (June 2013). "The common pain of surrealism and death: acetaminophen reduces compensatory affirmation following meaning threats". Psychological Science. 24 (6): 966–73. doi:10.1177/0956797612464786. PMID 23579320. S2CID 2890442.
  28. ↑ Husebo BS, Ballard C, Sandvik R, Nilsen OB, Aarsland D (July 2011). "Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial". BMJ. 343: d4065. doi:10.1136/bmj.d4065. PMC 3137923. PMID 21765198.
  29. ↑ "Reducing agitation through pain relief - Living with dementia magazine October 2011 - Alzheimer's Society". alzheimers.org.uk.
  30. ↑ "Don't take paracetamol for painful emotions". www.nhs.uk. 2013-04-22.
  31. ↑ Fertuck EA, Jekal A, Song I, Wyman B, Morris MC, Wilson ST, et al. (December 2009). "Enhanced 'Reading the Mind in the Eyes' in borderline personality disorder compared to healthy controls". Psychological Medicine. 39 (12): 1979–88. doi:10.1017/S003329170900600X. PMC 3427787. PMID 19460187.
  32. ↑ Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association. 1994. ISBN 978-0-89-042061-4.
  33. ↑ Linehan M (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press. p. 44. ISBN 978-0-89862-183-9.
  34. ↑ Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M (May 2005). "Aversive tension in patients with borderline personality disorder: a computer-based controlled field study". Acta Psychiatrica Scandinavica. 111 (5): 372–9. doi:10.1111/j.1600-0447.2004.00466.x. PMID 15819731. S2CID 30951552.
  35. ↑ Oldham JM (January 2006). "Borderline personality disorder and suicidality". The American Journal of Psychiatry. 163 (1): 20–6. doi:10.1176/appi.ajp.163.1.20. PMID 16390884.
  36. ↑ Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG (1998). "The pain of being borderline: dysphoric states specific to borderline personality disorder". Harvard Review of Psychiatry. 6 (4): 201–7. doi:10.3109/10673229809000330. PMID 10370445. S2CID 10093822.
  37. ↑ Singer M (1977). "The Experience of Emptiness in Narcissistic and Borderline States: II. The Struggle for a Sense of Self and the Potential for Suicide". International Review of Psycho-Analysis. 4 (4): 471–479. Retrieved 25 February 2021.
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