Abstract
Objectives
Non-suicidal self-injury (NSSI) is characterized by the occurrence of physical injury to one’s own body. NSSI is connected with several disorders, namely borderline personality disorder (BPD) and neurodevelopmental disabilities. The underlying pathophysiology is controversial and there aren’t universally accepted treatments. Interestingly, the opioid system has been proposed to be involved in the pathogenesis of BPD, specifically in pain perception and emotion regulation. In this article, we aim to review the literature available about the use of opioid antagonists in the treatment of BPD.
Methods
We conducted a search for the relevant articles in Pubmed, using the keywords “NSSI”, “opioid antagonists“, “BPD”, “self-harm”.
Results
Overall, literature suggests that individuals exhibiting NSSI have a disturbance of the opiate-mediated pain and pleasure system; moreover, for some individuals, elevated endogenous opioids are responsible for maintaining NSSI, and it’s thought that by blocking the reward experience, NSSI could be reduced. According to this, Naltrexone should be considered for NSSI treatment. In general, response is seen within days of initiation, but some studies reported symptom reduction after months of treatment. More recently, the use of Nalmefene in patients with comorbid BPD and alcohol use disorder, reduced not only alcohol consumption but meliorated BDP symptoms. Nonetheless, little consensus exists regarding its efficacy and its mechanism of action due to methodological inconsistencies and study design limitations.
Conclusions
Altought opioid antagonists seem to have a good impact on reducing NSSI in BPD, further studies should be conducted to confirm their role in the treatment of BDP.
