Key Points Concerning Neurobiology and Psychotherapy for BPD

There are common therapeutic elements in all of the psychotherapies for BPD, most notably activation of the prefrontal cortex to bring "thinking" to bear on unbearable affects produced by amygdala hypersensitivity.

An opioid deficit appears to be prominent in BPD. Patients with BPD

• ○ have difficulty deriving satisfaction from intimate relationships,

• ○ often say they experience emotional pain as physical pain,

• ○ often resort to cutting themselves for release of endogenous opioids,

• ○ show a high rate of opioid abuse.

Neurobiological research can help clinicians tailor psychotherapies to the needs of individual patients. Some evidence has emerged indicating that BPD patients with dissociative symptoms may not respond as well to dialectical behavior therapy as other patients, suggesting that other treatments may be needed for this subgroup.