BETSHY

Tag: Neuroscience

  • Trigeminal Neuralgia in the Long-Term: Bidirectional Impact on Psychological Health

    Trigeminal Neuralgia in the Long-Term: Bidirectional Impact on Psychological Health

    Trigeminal Neuralgia (TN) is a rare but devastating neuropathic condition characterised by sudden, electric shock-like episodes of excruciating facial pain distributed along the branches of the trigeminal nerve — the fifth cranial nerve, responsible for sensation across the face. The attacks are frequently triggered by the most mundane of stimuli: brushing teeth, speaking, eating, or even the touch of a gentle breeze. The severity of pain has long been described as among the most intense that human physiology is capable of producing, earning TN its well-known and historically significant designation as the “suicide disease” (Neto et al., 2025 ).

    While this label has been challenged in recent years as medical and surgical treatments have advanced, its existence is not without clinical basis. The psychological burden imposed by long-term TN is substantial, multidimensional, and — critically — profoundly underestimated within mainstream healthcare. This article examines how trigeminal neuralgia influences psychological changes over time, exploring the bidirectional relationship between chronic pain and mental health, the specific psychiatric conditions associated with TN, the risk of suicidality, the disruption to social and occupational functioning, and what the evidence recommends for integrated clinical management.

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    A Bidirectional Relationship: Pain and Mental Health

    The relationship between trigeminal neuralgia and psychological disorders is not unidirectional. Traditionally, the assumption has been that the pain of TN causes secondary mood changes such as depression and anxiety — a logical and intuitive proposition. However, emerging research using Mendelian randomisation analysis — a methodology that applies genetic markers to establish causal direction — has demonstrated that the relationship is in fact bidirectional: not only does TN precipitate psychiatric illness, but pre-existing mental health conditions including depression, anxiety, and insomnia also significantly increase the risk of developing TN in the first instance (Wang et al., 2025).

    A landmark 2025 study published in The Journal of Headache and Pain found that people with depression were more than twice as likely to develop TN, while insomnia and anxiety also significantly elevated TN onset risk. Conversely, carrying a diagnosis of TN increased the risk of developing anxiety by 43%, depression by 30%, and insomnia by nearly 40% (TNA, 2025). Furthermore, the study confirmed that longer disease duration and broader trigeminal nerve involvement were independently associated with increased severity of depressive, anxiety, and insomnia symptoms — underscoring a dose-response relationship between the chronicity of TN and the depth of its psychological toll (Wang et al., 2025).

    Depression: The Most Prevalent Psychological Consequence

    Depression is the most consistently documented psychological comorbidity in TN populations and one of the most clinically consequential. The mechanism is well-evidenced: chronic, unrelenting pain of the intensity characteristic of TN depletes neurochemical resources, disrupts sleep architecture, undermines the capacity for daily functioning, and progressively narrows the individual’s world — all known aetiological contributors to major depressive disorder (Wu et al., 2019). The unpredictability of TN attacks — which can occur without warning at any moment during waking hours — generates a state of sustained psychological vigilance that, over time, mirrors the cognitive and physiological features of a depressive episode.

    A systematic review published in Neurosurgery Reviews in 2025 — the first of its kind to comprehensively examine the psychological burden of TN — confirmed that TN patients carry significantly elevated rates of depressive disorders across multiple validated assessment tools, including the PHQ-9, Hamilton Depression Rating Scale, and Hospital Anxiety and Depression Scale. Critically, the review also found that surgical treatments, particularly microvascular decompression (MVD), effectively alleviated both pain and depressive symptoms, while multidisciplinary approaches combining psychological support with neurorehabilitation yielded the best overall outcomes — a finding with direct implications for how NHS services structure TN care pathways (Martinelli et al., 2025).

    Anxiety, Anticipatory Fear, and Catastrophising

    Anxiety in TN takes a form that is, in many respects, distinct from generalised anxiety disorder as it presents in the broader population. The central driver is anticipatory fear — the perpetual, hypervigilant dread of the next attack. Because TN pain is triggered by ordinary activities that cannot be permanently avoided — talking, eating, drinking, facial exposure to air — affected individuals frequently develop avoidance behaviours that progressively restrict their lives. They stop eating in public. They cease speaking unnecessarily. They avoid wind, cold, and touch with an intensity that begins to resemble phobic avoidance (Wu et al., 2019).

    Research comparing patients with TN against those with persistent idiopathic facial pain found that anxiety symptoms were significantly more elevated in the TN group, and that for individuals reporting prior trauma exposure, PTSD symptoms were also significantly greater among TN patients than comparison groups (ScienceDirect, 2025). The phenomenon of pain catastrophising — a cognitive pattern in which individuals magnify the threat value of pain, ruminate on its impact, and feel helpless in the face of it — is documented at elevated rates in TN and has been shown to independently worsen both pain perception and psychological outcomes over time (Frontiers in Neurology, 2025).

    PTSD, Trauma, and the Neurological Siege

    The conceptualisation of TN-related suffering within a trauma framework is gaining increasing traction in the clinical literature, and it is not difficult to understand why. The lived experience of TN — sudden, violent, entirely unpredictable episodes of pain that resist personal control and occur in the context of innocuous daily activities — shares structural features with the traumatic experiences that give rise to post-traumatic stress disorder. The nervous system learns to associate ordinary environmental stimuli with overwhelming threat, generating the hyperarousal, intrusive re-experiencing, and avoidance behaviours that characterise PTSD (Neto et al., 2025 ).

    Emerging evidence confirms that PTSD symptoms are measurably elevated in TN populations, particularly in those with longer disease duration, greater pain intensity, and inadequate treatment response. The systematic review by Martinelli et al. noted that sleep disorders — which are independently associated with the development and maintenance of PTSD — were among the most prevalent and underaddressed comorbidities in TN patients, creating a reinforcing cycle of neurological and psychological distress that becomes progressively more difficult to interrupt without targeted intervention (Martinelli et al., 2025).

    Suicidality: An Urgent and Under-Addressed Clinical Concern

    The designation of TN as the “suicide disease” demands honest and careful clinical scrutiny. A 2025 study conducted by researchers from Harvard Medical School and Massachusetts General Hospital — the largest study to date examining suicidality in TN — recruited 229 adults with TN and related conditions between December 2023 and January 2024. Their findings were sobering: suicidal ideation was found at clinically significant rates within the sample, and was strongly associated with high pain intensity, elevated anxiety, and severe depression (Fishbein, Bakhshaie and Greenberg, 2025). The authors concluded that suicidality is an urgent yet substantially under-addressed concern among adults with TN, and that its association with pain intensity places comprehensive psychological screening at the centre of responsible clinical management.

    Research examining psychological status in TN patients before and after surgical intervention has further identified that the risk of suicidal ideation is significantly higher in patients with atypical TN (TN2) than in those with classical TN (TN1), requiring more intensive psychological monitoring in this subgroup — and supporting the argument that indications for surgical treatment should be established with urgency in patients at elevated psychological risk (ScienceDirect, 2021). While the “suicide disease” label may now be contextually outdated given advances in surgical and pharmacological treatment, it retains clinical utility as a reminder of the severity of psychological risk that chronic, inadequately managed TN produces (Neto et al., 2025 ).

    Social Isolation, Identity, and Occupational Disruption

    Beyond the domain of discrete psychiatric diagnoses, TN exerts a pervasive and devastating influence on social functioning, personal identity, and occupational engagement. The avoidance behaviours generated by anticipatory fear — the withdrawal from eating, speaking, and social interaction — progressively erode the structures around which personal identity is built. Work becomes impossible, or severely constrained, for many individuals during active disease phases. Social relationships deteriorate under the weight of unexplained withdrawal and communicative limitation. For those who depend on speech professionally — teachers, therapists, lawyers, performers — the occupational consequences can be total and permanent (TNA, 2025).

    The psychological literature consistently identifies social isolation as both a consequence and an amplifier of chronic pain, generating a self-reinforcing cycle in which pain produces withdrawal, withdrawal reduces protective social buffering, and the absence of social support intensifies the subjective experience and psychological weight of pain. In TN, where the very act of social communication — speaking — can trigger an attack, this cycle is particularly vicious and particularly difficult to interrupt without targeted psychosocial intervention alongside physical pain management (Frontiers in Neurology, 2025).

    Treatment Implications: The Case for Multidisciplinary Care

    The weight of evidence reviewed here makes a compelling and unambiguous case for the integration of psychological support into the standard clinical management of trigeminal neuralgia. Pharmacological and surgical interventions — carbamazepine and oxcarbazepine as first-line medications, microvascular decompression as the preferred surgical option for suitable candidates — address the neurological substrate of TN pain with variable success, but do not in themselves address the psychological sequelae that accumulate across the duration of the illness (Martinelli et al., 2025).

    The systematic review by Martinelli et al. explicitly concluded that standardising psychological assessment and treatment methodologies is crucial for optimising TN management outcomes — and that multidisciplinary approaches combining psychological support with neurorehabilitation consistently yield superior results to purely biomedical approaches alone. The Trigeminal Neuralgia Association UK has similarly called for psychological therapy, pain counselling, and sleep support to be embedded as standard within TN care pathways — not optional additions, but structural components of responsible clinical provision (TNA, 2025).

    Conclusion

    Trigeminal neuralgia is not merely a condition of the face. It is a condition of the whole person — neurological in origin, but psychological in consequence, social in impact, and existential in the challenges it poses to identity, connection, and the basic quality of human experience. The long-term psychological changes it produces — depression, anxiety, anticipatory fear, PTSD-like trauma responses, suicidal ideation, social withdrawal, and occupational collapse — are not incidental features of living with chronic pain. They are clinical realities that demand clinical responses: structured, evidence-based, and delivered alongside rather than after physical pain management. Recognising TN as the biopsychosocial emergency it truly is remains one of the most important steps the clinical and research communities can take toward meaningfully improving outcomes for those who live with this condition.

    If you or someone you know is living with chronic pain and experiencing thoughts of suicide or self-harm, please contact the Samaritans on 116 123 (free, 24/7 in the UK) or speak to your GP or local NHS mental health service as soon as possible. If you are seeking help from outside the UK, call your local support service.

    References

    Fishbein, N.S., Bakhshaie, J. and Greenberg, J. (2025) ‘Suicidal Ideation and Self-Injury in Trigeminal Neuralgia’, Journal of Pain Research, 18, pp. 2003–2010. Available at: https://www.dovepress.com/suicidal-ideation-and-self-injury-in-trigeminal-neuralgia-peer-reviewed-fulltext-article-JPR (Accessed: 10 June 2026).

    Frontiers in Neurology (2025) ‘Effects of risk factor-based targeted nursing intervention on psychological status, sleep quality, and pain in patients with trigeminal neuralgia’, Frontiers in Neurology. Available at: https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1681364/full (Accessed: 10 June 2026).

    Martinelli, R., Vannuccini, S., Burattini, B., D’Alessandris, Q.G., D’Ercole, M., Izzo, A., Chieffo, D.P.R., Doglietto, F. and Montano, N. (2025) ‘Psychological assessment in patients affected by trigeminal neuralgia: a systematic review’, Neurosurgery Reviews, 48(1), 414. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069416/ (Accessed: 10 June 2026).

    Neto, R., Fonseca Silva, B., Remelhe, M. and Araujo, R. (2025) ‘Trigeminal Neuralgia — rethinking the “suicide disease” label’, European Psychiatry. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438733/ (Accessed: 10 June 2026).

    ScienceDirect (2021) ‘Psychological status before and after surgery in patients with trigeminal neuralgia’, Journal of Clinical Neuroscience. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0303846721001050 (Accessed: 10 June 2026).

    ScienceDirect (2025) ‘Psychological profiles and sleep quality differences between patients with persistent idiopathic facial pain and trigeminal neuralgia: a 7-year retrospective study’, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. Available at: https://www.sciencedirect.com/science/article/abs/pii/S2212440325007746 (Accessed: 10 June 2026).

    Trigeminal Neuralgia Association UK (2025) Trigeminal Neuralgia and Mental Health. Available at: https://www.tna.org.uk/ceo/trigeminal-neuralgia-and-mental-health/ (Accessed: 10 June 2026).

    Wang, J., Li, M., Zhang, Z., Duan, Y., Zhang, Z., Liu, H. et al. (2025) ‘Association between mental disorders and trigeminal neuralgia: a cohort study and Mendelian randomization analysis’, The Journal of Headache and Pain, 26, 74. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11992777/ (Accessed: 10 June 2026).

    Wu, T.H., Hu, L.Y., Lu, T. et al. (2019) ‘Effects of Depression and Anxiety on Microvascular Decompression Outcome for Trigeminal Neuralgia Patients’, World Neurosurgery. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1878875019311891 (Accessed: 10 June 2026).

  • Anterior Cingulate Cortex: The Neural Basis of Empathy

    Anterior Cingulate Cortex: The Neural Basis of Empathy

    Empathy is the ability to understand and share the feelings of another person . It plays a crucial role in human relationships, allowing us to connect with others on an emotional level and respond to their needs and feelings. But have you ever wondered about the neural basis of empathy and how our brain enables us to feel empathy towards others?

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    One key brain region that has been implicated in the experience of empathy is the anterior cingulate cortex (ACC). The ACC is a part of the brain’s limbic system, which is involved in emotional processing and regulation. It is located in the frontal part of the brain, just above the corpus callosum.

    Research has shown that the ACC is involved in a variety of social and emotional functions, including empathy. Studies have found that individuals with damage to the ACC have difficulty in recognising and responding to others’ emotions. On the other hand, individuals with highly active ACC tend to be more empathetic and sensitive to others’ feelings.

    One way in which the ACC is thought to contribute to empathy is through its role in emotional regulation. The ACC helps us to monitor our own emotional responses and to adjust them in accordance with social cues and norms. This ability is crucial for maintaining appropriate social interactions and responding empathetically to others’ emotions.

    Moreover, the ACC is also involved in mentalising, or the ability to understand the thoughts, beliefs, and feelings of others. This process is essential for empathy, as it allows us to put ourselves in another person’s shoes and imagine what they might be experiencing. Research has shown that the ACC is activated when we engage in mentalising tasks, indicating its role in empathetic processing.

    In addition to its role in empathy, the ACC has also been implicated in other social functions, such as conflict monitoring, decision-making, and social cognition. It is a versatile brain region that integrates information from various sensory and emotional sources to guide our behaviour in social situations.

    Overall, the anterior cingulate cortex plays a crucial role in empathy, allowing us to understand and respond to others’ emotions. By studying the neural mechanisms of empathy, researchers hope to gain a better understanding of how we connect with others and how we can promote empathy in society.

  • Impairment of the Ventromedial Prefrontal Cortex (vmPFC)

    Impairment of the Ventromedial Prefrontal Cortex (vmPFC)

    The ventromedial prefrontal cortex (vmPFC) is a crucial region of the brain involved in decision-making, emotional regulation, and social behaviour. Damage to this area can have serious implications for an individual’s ability to navigate the complexities of everyday life.

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    Impairment of the vmPFC can result from various factors, including traumatic brain injury, stroke, or neurodegenerative diseases such as frontotemporal dementia. When this region is damaged, individuals may experience difficulties in evaluating risks and rewards, regulating emotions, and understanding social cues.

    One of the most notable effects of vmPFC impairment is a phenomenon known as “acquired sociopathy.” Individuals with damage to this region may display a lack of empathy, moral reasoning, and remorse for their actions. This can lead to antisocial behaviour, impulsivity, and a disregard for social norms.

    In addition to changes in social behaviour, impairment of the vmPFC can also impact decision-making abilities. Individuals may struggle to weigh the potential outcomes of their choices, leading to poor judgement and impulsive decision-making. This can have far-reaching consequences in various aspects of their lives, from personal relationships to financial management.

    Furthermore, damage to the vmPFC can hinder emotional regulation, leading to heightened emotional reactivity and difficulty in controlling one’s emotions. This can manifest as mood swings, irritability, and difficulty in managing stress. This can have a significant impact on an individual’s overall well-being and quality of life.

    Treatment for impairment of the vmPFC is challenging, as this region of the brain is highly interconnected with other areas involved in cognition and emotion. However, cognitive-behavioral therapy, medication, and social support can help individuals cope with the behavioral and emotional changes associated with vmPFC damage.

    In conclusion, impairment of the ventromedial prefrontal cortex can have profound effects on an individual’s social behaviour, decision-making abilities, and emotional regulation. Understanding the impact of vmPFC damage is crucial in providing support and intervention for those affected by this condition. Further research into the functioning of this region of the brain is essential for developing effective treatments and interventions for individuals with vmPFC impairments.

  • The Brain’s Bodyguard: Exploring the Role of the Cerebellum

    The Brain’s Bodyguard: Exploring the Role of the Cerebellum

    The cerebellum is a fascinating and important part of the brain that often goes unnoticed. Located at the back of the brain, just below the cerebral hemispheres, the cerebellum plays a crucial role in coordinating movement, balance, and motor skills. Without the cerebellum, our ability to walk, talk, and perform daily tasks would be severely impaired.

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    One of the primary functions of the cerebellum is to integrate sensory information from the body with signals from the cerebral cortex to produce smooth and coordinated movements. For example, when we reach out to grab a cup of coffee, the cerebellum helps to ensure that our hand moves smoothly and accurately towards the cup without any jerky or irregular movements. It also helps to maintain posture and balance, allowing us to stand upright and walk without falling over.

    In addition to its role in motor control, the cerebellum is also involved in cognitive functions such as attention, language, and emotional regulation. Studies have shown that damage to the cerebellum can result in problems with executive function, memory, and impulse control. This highlights the complex and interconnected nature of brain function, with different regions working together to ensure that we can navigate the world around us effectively.

    Interestingly, the cerebellum has also been linked to conditions such as autism, ADHD, and dyslexia. Researchers have found that individuals with these disorders often have abnormalities in the structure and function of the cerebellum, suggesting that it may play a role in the development of these conditions. Understanding the role of the cerebellum in these disorders could potentially lead to new treatments and interventions to help improve outcomes for affected individuals.

    In conclusion, the cerebellum plays a vital role in our daily lives, helping us to move, balance, and coordinate our actions. Its involvement in cognitive functions further highlights its importance in ensuring that we can navigate the world effectively. While often overshadowed by the cerebral cortex, the cerebellum is a key player in the complex orchestra of brain function, and its role should not be overlooked.

  • The Role of the Insula in Mental Health

    The Role of the Insula in Mental Health

    The insula is a small, sea-urchin shaped region in the brain that is often overlooked in discussions about mental health. However, recent research has shown that the insula plays a crucial role in regulating emotions, self-awareness, and social cognition – all of which are key components of mental health.

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    One of the main functions of the insula is to integrate bodily sensations with emotional experiences. This means that when we feel a physical sensation in our bodies, such as a rapid heartbeat or a tightness in our chest, the insula processes that information and connects it to the corresponding emotion – whether it be fear, anxiety, or excitement. This process is essential for our ability to understand and regulate our emotions, which in turn has a significant impact on our mental well-being.

    The insula is also involved in self-awareness, or our ability to recognise and understand our own thoughts and feelings. Studies have shown that individuals with damage to the insula often have difficulty accurately identifying their own emotions and may struggle with introspection and self-reflection. This lack of self-awareness can contribute to various mental health conditions, such as depression, anxiety, and substance abuse disorders.

    Furthermore, the insula plays a role in empathy and social cognition – our ability to understand and interact with others. Research has found that the insula is activated when we observe someone else experiencing an emotion, allowing us to empathize with that person and understand their perspective. Dysfunction in the insula has been linked to difficulties in social interactions, as well as conditions like autism spectrum disorders and psychopathy.

    Overall, the insula is a complex and multifaceted brain region that is integral to our mental health. By better understanding the role of the insula in regulating emotions, self-awareness, and social cognition, researchers and clinicians can develop more targeted therapies and interventions for individuals struggling with mental health issues. It is important to continue studying the insula and its functions in order to improve our understanding of the brain and develop more effective treatments for mental health disorders.

  • The Ventromedial Prefrontal Cortex in Borderline Personality Disorder

    The Ventromedial Prefrontal Cortex in Borderline Personality Disorder

    Borderline Personality Disorder (BPD) is a complex mental health condition characterised by a pervasive pattern of instability in mood, behaviour, and interpersonal relationships. People with BPD often struggle with intense emotions, impulsivity, and a distorted self-image. While the exact cause of BPD remains unclear, researchers have identified a potential role for the ventromedial prefrontal cortex (vmPFC) in the development and manifestation of this disorder.

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    The vmPFC is a region of the brain located in the prefrontal cortex, responsible for emotional regulation, decision-making, and self-control. It plays a critical role in integrating emotions, thoughts, and behaviours to produce appropriate responses in social situations. In individuals with BPD, abnormalities in the vmPFC have been observed, and these may contribute to the dysregulation of emotions and difficulties with interpersonal relationships.

    One key aspect of BPD is an exaggerated response to emotional stimuli. People with BPD often experience intense emotional reactions, such as anger, sadness, or anxiety, which are difficult to regulate. Studies using brain imaging techniques have demonstrated that individuals with BPD display abnormal activity in the vmPFC when processing emotional information. This suggests that the vmPFC may have a reduced ability to regulate emotional responses in people with BPD, leading to heightened emotional reactivity.

    Furthermore, the vmPFC plays an essential role in decision-making processes, particularly in contexts that involve risk and reward assessment. People with BPD frequently engage in impulsive and risky behaviours, such as self-harm, substance abuse, or reckless driving. These behaviours may result from an impaired vmPFC, leading to difficulties in adequately considering long-term consequences and making sound decisions.

    Additionally, the vmPFC is involved in social cognition, which refers to the ability to understand and navigate social situations. Individuals with BPD often experience challenges in interpersonal relationships, struggling with feelings of abandonment, frequent conflicts, or idealisation and devaluation of others. Dysfunction in the vmPFC may impact the ability to accurately interpret social cues, leading to misperceptions, mistrust, or emotional volatility in relationships.

    While the role of the vmPFC in BPD is becoming increasingly recognised, it is important to note that this is just one aspect of a complex biopsychosocial disorder. BPD likely arises from a combination of genetic, neurobiological, and environmental factors. Therefore, understanding the vmPFC’s involvement is a step towards a holistic understanding of BPD but does not fully explain the disorder’s complexities.

    Nevertheless, identifying the role of the vmPFC in BPD offers potential avenues for therapeutic interventions. Targeting this region of the brain through techniques such as cognitive-behavioural therapy or neurofeedback could potentially help individuals with BPD regulate their emotions more effectively, make better decisions, and improve their social interactions.

    In conclusion, the ventromedial prefrontal cortex appears to play a crucial role in Borderline Personality Disorder. Dysregulation in this brain region may contribute to the emotional instability, impulsivity, and difficulties in social interactions experienced by individuals with BPD. Further research on the vmPFC and its connections to other brain regions will provide valuable insights into BPD’s underlying mechanisms, ultimately leading to improved diagnostic tools and more effective treatment options.

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