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Cited by 135Personality Disorders and PsychopathologyPersonality Traits and PsychologyPsychopathy, Forensic Psychiatry, Sexual Offending

Borderline personality disorder: a dysregulation of the endogenous opioid system?

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Bandelow, Borwin, Schmahl, Christian, Falkai, Peter, Wedekind, Dirk·2010·Psychological Review
DOI 10.1037/a0018095
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Abstract

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. 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.

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  • Evidence points to a deficiency of serotonin in BPD, while the partial efficacy of antipsychotic agents suggest hyperactivity of dopamine.

    “Evidence points to a deficiency of serotonin, while the partial efficacy of antipsychotic agents suggest hyperactivity of dopamine (Bandelow et al., 2010Ripoll, 2011).”

    From A motivation model of sex addiction – Relevance to the controversy over the concept (2022) · cites this paper as Bandelow et al., 2010

  • BPD is often associated with difficulties with emotional regulation, a search for instant gratification, increased frequency of drug addiction, sensation-seeking and behavioral addictions.

    “BPD is often associated with difficulties with emotional regulation, a search for instant gratification, increased frequency of drug addiction (the preference being crack or a combination of cocaine and heroin), sensation-seeking and behavioral addictions (Bandelow et al., 2010).”

    From A motivation model of sex addiction – Relevance to the controversy over the concept (2022) · cites this paper as Bandelow et al., 2010

  • Bandelow et al. (2010) marshal evidence that at base in BPD is dysregulation of an endogenous opioid system, e.g. insensitivity of receptors or low levels of secretion.

    “Bandelow et al. (2010) marshal evidence that at base in BPD is dysregulation of an endogenous opioid system, e.g.insensitivity of receptors or low levels of secretion.”

    From A motivation model of sex addiction – Relevance to the controversy over the concept (2022) · cites this paper as Bandelow et al., 2010

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Authors
Bandelow, B., Schmahl, C., Falkai, P., & Wedekind, D.
Affiliations
  • University of Göttingen (DE)
  • Central Institute of Mental Health (DE)
ORCID
Venue
Psychological Review
Publisher
American Psychological Association (APA)
Published
2010
Volume
117
Issue
2
Pages
623-636
ISSN
  • 0033-295X (ISSN-L)
  • 1939-1471
DOI
10.1037/a0018095
OpenAlex
W2043716512
Cited by
135
References
166
Citations by year
2026: 4 · 2025: 9 · 2024: 11 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 11 · 2019: 6 · 2018: 8 · 2017: 11 · 2016: 7 · 2015: 9 · 2014: 11 · 2013: 11 · 2012: 10
FWCI
9.11
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Psychological Review (publishedVersion)
  • PubMed (publishedVersion)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
  • GRO (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
borderline personality disorder, endogenous opioid system, opioid receptors, mu-opioid receptor, dopaminergic reward system, self-harm, substance abuse, anorexia, anhedonia, emptiness, attachment, attention seeking, opioid antagonists
MeSH terms
Affect, Benzodiazepines, Borderline Personality Disorder, Brain, Dopamine, Humans, Interpersonal Relations, Object Attachment, Risk-Taking, Serotonin, Sexual Behavior, Social Behavior, Substance-Related Disorders

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