Opioid use disorder and borderline personality disorder : evidence for dysregulation of the endogenous opioid system
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[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Borderline Personality Disorder (BPD) may involve a dysregulation of the Endogenous Opioid System (EOS) characterized by a tonic deficit of endogenous opioids interrupted by phasic periods of greatly increased EOS activity. We hypothesized that BPD individuals may use opioids to artificially induce these phasic periods. Data from 34,481 participants of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was used. BPD was separately associated with all substances assessed in NESARC. When all categories of lifetime drug use were entered into a model, opioid, alcohol, and cannabis use uniquely predicted BPD. In a second model, when presence of use (without abuse or dependence), abuse (without dependence), and dependence for each drug category were entered, opioid dependence, alcohol abuse, alcohol dependence, cocaine dependence, cannabis abuse, and sedative abuse were significant drug-related predictors of BPD. BPD individuals who used moderate amounts of opioid painkillers, relative to BPD individuals who did not or who used heavily, reported better functioning on an assessment of bodily pain, a domain mediated by the EOS. Additionally, individuals with diagnoses of opioid painkiller use disorder and BPD reported better functioning on the bodily pain scale than individuals with only BPD or a use disorder. The pattern of results indicated that opioid use was uniquely associated with BPD, suggesting BPD involves a dysregulated EOS. The finding that the combination of opioids and BPD was associated with increased pain-related functioning suggests that BPD individuals may use opioids to regulate a dysregulated EOS.|Borderline Personality Disorder (BPD) may involve a dysregulation of the Endogenous Opioid System (EOS) characterized by a tonic deficit of endogenous opioids interrupted by phasic periods of greatly increased EOS activity. We hypothesized that BPD individuals may use opioids to artificially induce these phasic periods. Data from 34,481 participants of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was used. BPD was separately associated with all substances assessed in NESARC. When all categories of lifetime drug use were entered into a model, opioid, alcohol, and cannabis use uniquely predicted BPD. In a second model, when presence of use (without abuse or dependence), abuse (without dependence), and dependence for each drug category were entered, opioid dependence, alcohol abuse, alcohol dependence, cocaine dependence, cannabis abuse, and sedative abuse were significant drug-related predictors of BPD. BPD individuals who used moderate amounts of opioid painkillers, relative to BPD individuals who did not or who used heavily, reported better functioning on an assessment of bodily pain, a domain mediated by the EOS. Additionally, individuals with diagnoses of opioid painkiller use disorder and BPD reported better functioning on the bodily pain scale than individuals with only BPD or a use disorder. The pattern of results indicated that opioid use was uniquely associated with BPD, suggesting BPD involves a dysregulated EOS. The finding that the combination of opioids and BPD was associated with increased pain-related functioning suggests that BPD individuals may use opioids to regulate a dysregulated EOS.
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