Psychological pain explained

Field:Psychiatry, psychology
Synonyms:Suffering, mental agony, mental pain, emotional pain, algopsychalia, psychic pain, social pain, spiritual pain, soul pain
Medication:Antidepressant 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."

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. 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]

Unmet psychological needs in youth may cause an inability to meet human needs later in life.[19] As a consequence of neglectful parenting, children with unmet psychological needs may be linked to psychotic disorders in childhood throughout life.[20]

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.[21] From an evolutionary perspective, psychological pain forces the assessment of actual or potential social problems that might reduce the individual's fitness for survival.[22] 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.[23] [15] [24] [25] 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.[26] Moreover, many sources mention the fact that many metaphors of physical pain are used to refer to psychologically painful experiences.[27] 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,[28] [29] and reduces the agitation of people with dementia.[30] [31] However, use of paracetamol for more general psychological pain remains disputed.[32]

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.[33] [34] 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.[35] People with BPD are especially sensitive to feelings of rejection, isolation and perceived failure.[36] 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, though studies on suicidality in bipolar subjects have found that 4-19% of bipolar patients (mostly untreated) commit suicide.[37] 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.[38]

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".[39]

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.[40]

See also

Notes and References

  1. Book: Shneidman ES . The Suicidal Mind . Oxford University Press . 1996 . 173 . 9780195118018. Appendix A Psychological Pain Survey .
  2. Psychalgia: mental distress. Merriam-Webster's Medical Dictionary. But see also psychalgia in the sense of psychogenic pain.
  3. Weiss E . Bodily pain and mental pain . . 15 . 1–13 . 1934 .
  4. Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P . Mental pain and its relationship to suicidality and life meaning . Suicide & Life-Threatening Behavior . 33 . 3 . 231–41 . 2003 . 14582834. 10.1521/suli.33.3.231.23213 .
  5. Bolger EA . Grounded theory analysis of emotional pain . Psychotherapy Research . 9 . 3 . 342–62 . 1999 . 10.1080/10503309912331332801. 31 January 2024 .
  6. Joffe WG, Sandler J . On the concept of pain, with special reference to depression and psychogenic pain . Journal of Psychosomatic Research . 11 . 1 . 69–75 . 1967 . 6049033. 10.1016/0022-3999(67)90058-X.
  7. Shattell MM . Why does "pain management" exclude psychic pain? . Issues in Mental Health Nursing . 30 . 5 . 344 . May 2009 . 19437255. 10.1080/01612840902844890 . 29799238 .
  8. Macdonald G, Leary MR . Why does social exclusion hurt? The relationship between social and physical pain . Psychological Bulletin . 131 . 2 . 202–23 . March 2005 . 15740417 . 10.1037/0033-2909.131.2.202 . 10540325 . dead . https://web.archive.org/web/20140301180449/http://www.sozialpsychologie.uni-frankfurt.de/wp-content/uploads/2010/09/MacDonald-Leary-20051.pdf . 2014-03-01 .
  9. Spiritual pain: 60,000 Google results. Soul pain: 237,000 Google results.
  10. Morse JM . Toward a praxis theory of suffering . Advances in Nursing Science . 24 . 1 . 47–59 . September 2001 . 11554533. 10.1097/00012272-200109000-00007 .
  11. Rehnsfeldt A, Eriksson K . The progression of suffering implies alleviated suffering . Scandinavian Journal of Caring Sciences . 18 . 3 . 264–72 . September 2004 . 15355520. 10.1111/j.1471-6712.2004.00281.x .
  12. Meerwijk EL, Weiss SJ. Toward a unifying definition of psychological pain. Journal of Loss & Trauma. 16 . 5 . 402–12 . 2011 . 10.1080/15325024.2011.572044 . 144462525.
  13. Wille RS . On the capacity to endure psychic pain. The Scandinavian Psychoanalytic Review. 34 . 23–30 . 2011 . 10.1080/01062301.2011.10592880. 144997538.
  14. Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E . Mental pain: a multidimensional operationalization and definition . Suicide & Life-Threatening Behavior . 33 . 3 . 219–30 . 2003 . 14582833. 10.1521/suli.33.3.219.23219 .
  15. Mee S, Bunney BG, Reist C, Potkin SG, Bunney WE . Psychological pain: a review of evidence . Journal of Psychiatric Research . 40 . 8 . 680–90 . December 2006 . 16725157. 10.1016/j.jpsychires.2006.03.003 .
  16. Covington EC . Psychogenic pain-what it means, why it does not exist, and how to diagnose it . Pain Medicine . 1 . 4 . 287–94 . December 2000 . 15101873. 10.1046/j.1526-4637.2000.00049.x . free .
  17. Book: Murray HA . Explorations in personality . 70 . 2008 . Oxford University Press . New York, NY . 978-0-19-530506-7 .
  18. Wall PD . On the relation of injury to pain. Pain. 6 . 3. 253–64 . 1979 . 460933. 10.1016/0304-3959(79)90047-2 . 6412475.
  19. Unmet need for professional mental health care among adolescents with high psychological distress . 28486819 . 2018 . Sheppard . R. . Deane . F. P. . Ciarrochi . J. . The Australian and New Zealand Journal of Psychiatry . 52 . 1 . 59–67 . 10.1177/0004867417707818 .
  20. Treatment Seeking and Unmet Need for Care Among Persons Reporting Psychosis-Like Experiences. Jordan E.. DeVylder. Hans Y.. Oh. Cheryl M.. Corcoran. Ellen P.. Lukens. June 20, 2014. Psychiatric Services. 65. 6. 774–780. 10.1176/appi.ps.201300254. 24534875. 6483726.
  21. Book: MacDonald G, Philip J . Corr PJ, Matthews G . Cambridge Handbook of Personality Psychology . 2009 . Cambridge University Press . Cambridge UK . 9780521680516 . Social Pain and Hurt Feelings . http://web.psych.utoronto.ca/gmacdonald/macdonald_social_pain_chapter.pdf.
  22. Book: Thornhill R, Thornhill NW . Bell RW, Bell NJ . Sociobiology and the Social Sciences . 1989 . Texas Tech University Press . Lubbock, Texas . 978-0-89672-161-6 . The Evolution of Psychological Pain . https://archive.org/details/sociobiologysoci0000unse .
  23. Eisenberger NI . The neural bases of social pain: evidence for shared representations with physical pain . Psychosomatic Medicine . 74 . 2 . 126–35 . 2012 . 22286852 . 3273616 . 10.1097/PSY.0b013e3182464dd1 .
  24. Eisenberger NI, Lieberman MD . Why rejection hurts: a common neural alarm system for physical and social pain . Trends in Cognitive Sciences . 8 . 7 . 294–300 . July 2004 . 15242688 . 10.1016/j.tics.2004.05.010 . 15893740 .
  25. Meerwijk EL, Ford JM, Weiss SJ . 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 . March 2013 . 22660945. 10.1007/s11682-012-9179-y . 8755398 .
  26. Biro D . Is there such a thing as psychological pain? And why it matters . Culture, Medicine and Psychiatry . 34 . 4 . 658–67 . December 2010 . 20835887. 2952112. 10.1007/s11013-010-9190-y .
  27. Flaskerud JH . Heartbreak and physical pain linked in brain . Issues in Mental Health Nursing . 32 . 12 . 789–91 . 2011 . 22077752. 10.3109/01612840.2011.583714 . 12451262 .
  28. Dewall CN, Macdonald G, Webster GD, Masten CL, Baumeister RF, Powell C, Combs D, Schurtz DR, Stillman TF, Tice DM, Eisenberger NI . Acetaminophen reduces social pain: behavioral and neural evidence . Psychological Science . 21 . 7 . 931–7 . July 2010 . 20548058 . 10.1177/0956797610374741 . 13800603 .
  29. Randles D, Heine SJ, Santos N . The common pain of surrealism and death: acetaminophen reduces compensatory affirmation following meaning threats . Psychological Science . 24 . 6 . 966–73 . June 2013 . 23579320 . 10.1177/0956797612464786 . 2890442 .
  30. Husebo BS, Ballard C, Sandvik R, Nilsen OB, Aarsland D . Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial . BMJ . 343 . d4065 . July 2011 . 21765198 . 3137923 . 10.1136/bmj.d4065 .
  31. Web site: Reducing agitation through pain relief - Living with dementia magazine October 2011 - Alzheimer's Society. alzheimers.org.uk.
  32. Web site: Don't take paracetamol for painful emotions. www.nhs.uk. 2013-04-22.
  33. Fertuck EA, Jekal A, Song I, Wyman B, Morris MC, Wilson ST, Brodsky BS, Stanley B . 6 . Enhanced 'Reading the Mind in the Eyes' in borderline personality disorder compared to healthy controls . Psychological Medicine . 39 . 12 . 1979–88 . December 2009 . 19460187 . 3427787 . 10.1017/S003329170900600X .
  34. Book: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 1994. American Psychiatric Association. Washington, DC. 978-0-89-042061-4. 4th.
  35. Book: Linehan M . Cognitive-behavioral treatment of borderline personality disorder . 1993 . Guilford Press . New York . 978-0-89862-183-9 . 44 .
  36. Stiglmayr CE, Grathwol T, Linehan MM, Ihorst G, Fahrenberg J, Bohus M . Aversive tension in patients with borderline personality disorder: a computer-based controlled field study . Acta Psychiatrica Scandinavica . 111 . 5 . 372–9 . May 2005 . 15819731 . 10.1111/j.1600-0447.2004.00466.x . 30951552 .
  37. Dome . Peter . Rihmer . Zoltan . Gonda . Xenia . Suicide Risk in Bipolar Disorder: A Brief Review . Medicina (Kaunas) . August 2019 . 55 . 8 . 403 . 10.3390/medicina55080403 . free . 31344941 . 6723289 .
  38. Oldham JM . Borderline personality disorder and suicidality . The American Journal of Psychiatry . 163 . 1 . 20–6 . January 2006 . 16390884 . 10.1176/appi.ajp.163.1.20 .
  39. Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG . The pain of being borderline: dysphoric states specific to borderline personality disorder . Harvard Review of Psychiatry . 6 . 4 . 201–7 . 1998 . 10370445 . 10.3109/10673229809000330 . John G. Gunderson . 10093822 .
  40. Singer M . 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 . 1977 . 4 . 4 . 471–479 . 25 February 2021.

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