Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD – the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary – gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.
Keywords: Borderline personality disorder; cannabidiol; corticolimbic system; endocannabinoid system; hypothalamus; pharmacological treatment.
Approximately 1.6 percent of adults in the U.S. suffer from borderline personality disorder (BPD), a condition characterized by difficulty regulating emotions, impulsivity, low self-image and problems creating and maintaining personal relationships.
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Among the endocannabinoid receptors that CBD activates are 5-HT1A serotonin receptors. Serotonin, informally known as the “happy chemical,” a chemical the body produces that’s important for mood regulation. People suffering from depression and anxiety, for instance, seem to exhibit lower levels of serotonin than do people who are not. People with BPD exhibit the same lowered serotonin levels. When CBD activates the 5-HT1A serotonin receptors, they bind to 5-HT serotonin neurotransmitters and increase serotonin production, which, in turn, combats the negative effects of depression and anxiety that come along with BPD.
Everybody’s different, and so the way BPD manifests in different people and the way CBD affects different people is entirely relative to the individual. But CBD looks promising for BPD patients as a possible treatment option to supplement talk therapy and to target specific BPD symptoms that get in the way of everyday life.
Because BPD is a personality disorder, treatment options are limited. Behavioural therapies like cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) are the most effective treatment options for BPD. There are no medications designed specifically for BPD, but antidepressant, anti-anxiety and antipsychotic medications are often prescribed to BPD patients to address certain symptoms like depression, anxiety, dissociation, paranoia and intense anger. The benefit of these medications for people with BPD, however, remain unclear, and talk-therapy is often the first line of treatment for BPD.
In the United States, 75% of those diagnosed with BPD are women. However, recent research suggests that men may be equally affected by BPD but are misdiagnosed with post-traumatic stress disorder (PTSD) or depression ( 1 ) .
Still, CBD looks promising for BPD patients as a possible treatment for symptoms such as anxiety, depression, and inflammation.
Why People Are Turning to CBD for BPD
Through this interaction, these cannabinoids promote healing and balance (9 ) .
There is no guarantee that CBD can help anyone with BPD. Everybody is different. Thus, the way BPD manifests in individuals and the way CBD impacts people is entirely relative to the individual.
A study showed the mechanism by which CBD inhibits inflammatory and neuropathic pain (4 ) .