Medication Monday: Borderline Personality Disorder and Opioids

It is once again Monday, which means it is once again time for Medication Monday. And this Monday I want to do something a little different, which is to look at how opioid medications impact individuals with borderline personality disorder.

Borderline Personality Disorder is a mental illness that impacts the way people think and more specifically impacts the way people manage their emotions. It has high co-occurrence with PTSD, possibly stemming from the fact that both potentially are developed as the result of childhood trauma or abuse. Indeed, it is sometimes misdiagnosed as either PTSD or as bipolar disorder.

According to, about 1.6 percent of Americans have a diagnosis of borderline personality disorder. Nearly 75 percent of those cases are women. Most patients also reported sexual abuse as children. The Mayo Clinic notes that borderline personality disorder could have genetic causes, or could be caused by mis-development of the brain and the brain’s neurochemicals, with possible risk factors being a genetic pre-disposition or a complicated or abusive childhood. Indeed, one theory suggests a neuropeptide model for understanding borderline personality disorder, with a specific focus on the natural opioids our body produces, oxytocin, and arginine vasopressin.

All of these chemicals are important for healthy social function. Opioids, infamous for the epidemic of overdoses the country is currently facing, help manage both physical and mental pain. Oxytocin is crucial for developing trusting relationships. Lastly, vasopressin can help determine monogamous partner selection, nurturance of offspring, and selective aggression toward perceived romantic competitors.

This theory would help explain the high prevalence of self-harm with borderline patients. Essentially, the thought is that physical pain releases the natural opioids better than mental pain, which is why self-harm actual might cause borderline patients to feel better.

But what does all of this have to do with medication? Today is, after all, Medication Monday. Well, as noted earlier, opioids are at the center of the overdose epidemic currently sweeping the nation. And given the possibility that the natural opioid production of borderline personality patients is in a state of disorder, the complications from opioid use and the risk of addiction and overdose may be even higher. This is particularly true if borderline patients present primarily as pain patients because of the misregulation of their own opioid production or because of their tendency to mirror the psycho-emotional pain.

And while the interaction of opioid medications on borderline personality disorder isn’t well studied, one study that did look at this relationship found that borderline personality patients may be at high risk for sustained use of opioids as well as being at risk of discrimination because of that. The study further noted that such patients may specifically be sensitive to physical pain-mirroring their well-known heightened sensitivity to emotional pain.

Does all of this mean that borderline patients shouldn’t ever be prescribed opioid medication. No. Just as every mental illness is different, everyone’s reaction to and need for opioids is different, particularly if the patient’s borderline personality disorder co-occurs with chronic conditions that cause prolonged periods of pain, such as rheumatoid arthritis flare ups. Not treating valid pain is not the right answer.

So if the point of this post wasn’t to suggest that borderline patients should never be prescribed opioids, then what was it? It was to suggest the complexity of this interaction, as well as the need to better understand borderline personality disorder specifically and mental illnesses generally. And while no medication should ever be ruled out for pain management, it is important to fully understand the risks associated with borderline personality disorder and perhaps consider saving opioids as a medication that is for last resort.

And hopefully, more research and more discussions like this one will help encourage such awareness so that we can treat the total health of borderline personality patients.

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