Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: An open-label trial

Background: Dissociative phenomena, including flashbacks, are common in pat ients with borderline personality disorder and posttraumatic stress disorde r (PTSD). Although dissociative symptoms can be severe and may interfere wi th psychotherapy, there is no established pharmacotherapy for these symptom s. Evidence suggests that alterations of the endogenous opiate system contr ibute to dissociative symptoms in patients with borderline personality diso rder and PTSD. Method: We treated 2 groups of female borderline personality disorder patie nts (N = 13, with an overlap of 5 patients between the 2 groups; all met th e diagnostic criteria of DSM-IV and the revised Diagnostic Interview for Bo rderline Patients) who experienced prominent dissociative phenomena includi ng flashbacks with the nonselective opiate receptor antagonist naltrexone, 25 to 100 mg q.i.d., for at least 2 weeks. A self-rated questionnaire measu ring dissociation, analgesia, tonic immobility, and tension (DAISS) was app lied to 9 patients, who completed it for 7 consecutive days before and duri ng treatment with naltrexone. In addition, 9 patients (with an overlap of 5 patients from the other group) completed a flashback protocol. Results: DAISS scores reflected a:highly significant reduction of the durat ion and the intensity of dissociative phenomena and tonic immobility as wel l as a marked reduction in analgesia during treatment with naltrexone. Six of 9 patients reported a decrease in the mean number of flashbacks per day. Conclusion: These observations support the hypothesis that an increased act ivity of the opioid system contributes to dissociative symptoms, including flashbacks, in borderline personality disorder and suggest that these sympt oms may respond to treatment with opiate antagonists. In view of these resu lts, a placebo-controlled, double-blind study to assess the potential benef it of naltrexone in a more rigorous way appears justified.