Negative Affect and Pain Catastrophizing Link Borderline Personality Disorder to Pain: Replicating and Extending the Borderline Personality Disorder-Pain Association

Borderline personality disorder (BPD) is commonly comorbid with chronic pain and associated with pain symptoms and interference. BPD features are associated with negative affect, which is associated with pain catastrophizing and/or pain anxiety, and finally pain severity or interference. We extended models of the BPD-pain associations in a chronic pain sample (N = 202), highlighting the role of negative affect (depression and anxiety) and pain catastrophizing, and exploring the potential benefit of emotional suppression/distraction as a component of these associations. BPD symptoms were positively associated with pain severity, mediated by negative affect and pain catastrophizing, supporting a cognitive-affective pathway linking BPD to pain experiencing. There was only minor evidence for the benefit of incorporating emotional suppression/distraction into research or treatment on the BPD-pain association. We provide clinical implications based on targeting affective symptoms and catastrophizing among individuals with co-occurring chronic pain and BPD.