Hurting Inside and Out? Emotional and Physical Pain in Self-Harm Ideation and Enactment

Those who self-harm have been shown to be less sensitive to physical pain, but more sensitive to emotional pain, appearing to contradict social neuroscience research that suggests that individuals who are more sensitive to physical pain are also more sensitive to emotional pain. The current study investigated the relationship between self-reported emotional pain sensitivity and physical pain distress in those who think (ideate) about and engage in (enact) self-harm. A total of 351 healthy adults completed a battery of anonymous online questionnaires assessing emotional sensitivity, physical pain distress and sensitivity, and lifetime history of self-harm, as well as depressive symptoms, self-critical style, perfectionistic cognitions, and perfectionistic self-presentation. Emotional sensitivity and physical pain distress were higher in both the self-harm ideation and enactment groups than in controls and there was a significant ordered effect, such that the enactment group was more sensitive to emotional and physical pain than the ideation group. A similar significant ordered effect in physical pain sensitivity was observed only when controlling for previous suicide attempt. Within the ideation group, physical pain distress and self-critical style were the only factors significantly associated with emotional pain sensitivity, but only the presence of perfectionistic cognitions was significantly associated with emotional pain sensitivity in the enactment group. Taken together, the findings suggest an association between self-perceived emotional sensitivity and physical pain distress in self-harm ideation, but possibly a disconnection between self-perceived and behavioral sensitivity to physical pain in self-harm enactment. Furthermore, self-criticism and perfectionism may be differentially associated with emotional sensitivity in self-harm ideation and enactment.