The neurobiology of borderline personality disorder (BPD) remains unclear. Dysfunctions of several neurobiological systems, including serotoninergic, dopaminergic, and other neurotransmitter systems, have been discussed.
Here we present a theory that alterations in the sensitivity of opioid receptors or the availability of endogenous opioids constitute part of the underlying pathophysiology of BPD.
This is a radical idea, but I’ve read it before: certain psychological states in certain people can be relieved by opioids. However, even if this proves to be true, we certainly won’t be prescribed this particular drug, no matter how effective it is at easing mental disorders since it’s not even being used for physical pain anymore.
The alarming symptoms and self-destructive behaviors of the affected patients may be explained by uncontrollable and unconscious attempts to stimulate their endogenous opioid system (EOS) and the dopaminergic reward system, regardless of the possible harmful consequences.
Neurobiological findings that support this hypothesis are reviewed.
Frantic efforts to avoid abandonment, frequent and risky sexual contacts, and attention-seeking behavior may be explained by attempts to make use of the rewarding effects of human attachment mediated by the EOS.
Anhedonia and feelings of emptiness may be an expression of reduced activity of the EOS.
Patients with BPD tend to abuse substances that target mu-opioid receptors. Self-injury, food restriction, aggressive behavior, and sensation seeking may be interpreted as desperate attempts to artificially set the body to survival mode in order to mobilize the last reserves of the EOS.
BPD-associated symptoms, such as substance abuse, anorexia, self-injury, depersonalization, and sexual overstimulation, can be treated successfully with opioid receptor antagonists.
An understanding of the neurobiology of BPD may help in developing new treatments for patients with this severe disorder.
The free PDF Download has a great deal of information about our Endogenous Opioid System (EOS) and how its dysfunction could be related to the symptoms of Borderline Personality Disorder.
Endogenous Opioid Theory of Borderline Personality Disorder
From the available evidence can be derived an endogenous opioid theory of borderline personality disorder, according to which the neurobiological changes in BPD are based on a dysregulation of the EOS.
This dysregulation may consist of a reduced sensitivity of endorphin receptors or too low a level of endogenous opioids. Excessive -receptor-mediated activity during stressful states may also play a role.
In the following article, we attempt to explain how the characteristic symptoms of BPD may be caused by a deficiency in the EOS.
Most of these mysterious and alarming symptoms seem to have a common denominator: They can be interpreted as a desperate, albeit mostly unconscious, effort to achieve higher opioid receptor occupancy or normal levels of endorphins in the shortest possible time.