The Connection Between Borderline Personality Disorder and Eating Disorders

EDs and BPDAccording to the National Association of Anorexia Nervosa and Associated Eating Disorders:

Much research has been done on personality disorders and how they are likely shaping corresponding styles of eating pathology.

Eating disorders (EDs) are particularly common in individuals with borderline personality disorder (BPD). Up to 53.8% of patients with BPD also meet criteria for an eating disorder (Salters-Pedneault, P. (n.d.).

Borderline personality has been shown to be present in about 25 percent of those with anorexia nervosa and 28 percent of those with bulimia nervosa. The research done on the association between BPD and eating disorders is showing us that specific personality disorders may be shaping corresponding styles of eating pathology. (Randy A. Sansone, Lori A Sansone. Innov Clin Neurosci. 2011 Mar; 8(3): 14-18. Published online 2011 Mar).

The criteria for diagnosing one with a personality disorder such as borderline personality disorder (BPD) can parallel eating disorder symptoms. And, the physical or emotional effects of the eating disorder can generate the symptoms of BPD. Therefore, EDs and BPD work together as a positive feedback loop, exponentially moving one away from his/her equilibrium state causing excessive instability.

Eating disorders can function as behaviors through which individuals with BPD can act out self-injurious, self-harming tendencies using food as a platform. Bingeing functions to ‘fill’ an individual, temporarily suppressing feelings of emptiness. Purging results in a euphoric ‘high’ of temporary relief followed by fatigue, which combats emotional surges of anger often experienced by those with BPD.

Eating disorders act as unhealthy coping skills to distract one’s self from what is perceived as uncontrollable chaos in life. These eating disorders divert one’s focus and attention inward, leading one to manipulate their body and weight—something someone CAN control—via disordered eating behaviors such as starvation, overeating and/or purging. EDs can also be used to blunt or ‘stuff’ down feelings (binge eating disorder and/or bulimia nervosa), purge feelings (bulimia nervosa and/or exercise bulimia) or numb feelings (anorexia nervosa). These eating behaviors are disguised as skills used to cope with life in an effort to self-soothe, yet these unhealthy tactics are self-destructive and not sustainable, long-term.

Eating disorders can develop through a habitual pattern of eating initiated by emotional hunger instead of physical hunger. In other words, instead of using our internal hunger cues (physical hunger) to guide our eating behaviors, often times emotions (emotional hunger) take the steering wheel affecting our desire to eat. Depending on the individual, various emotions—anxious, bored, angry, frustrated, irritable, etc.—can either stimulate one to eat more or suppress appetite resulting in decreased food intake.

When treating an eating disorder, one of the most important components is to learn healthy ways to self-soothe during times of emotional dysregulation and disturbance and to eat when physically hungry, opposed to eating when emotionally hungry. Additionally, intuitive eating, otherwise known as mindful eating, is an imperative part of the recovery process. Using intuitive eating, one re-learns how to trust his/her own body, allowing him/her to eat what they want and when they want by respecting internal hunger and fullness cues.

It is very difficult to effectively treat a co-occurring disorder if the BPD is not treated appropriately. Additionally, to effectively treat the BPD, any co-occurring disorders, such as eating disorders, must be treated, as well. Properly treating the comorbid disorder properly can help speed up the treatment of BPD.

Eating disorders and BPD are usually very intertwined, and it can be a struggle to work on one and not the other. A conscious effort must be made to work on both co-occurring disorders.

Clearview Women’s Center specializes in helping clients regain a sense of self and improve health. With experts trained in adequate nutrition, therapists with expertise in treating eating disorders, experts in treating Borderline Personality Disorder through evidence-based therapies, and an onsite chef, treatment plans are tailored to individual needs for the greatest chance for sustainable wellbeing.

The four most common eating disorders found in those with BPD are: 1) Bulimia Nervosa, 2) Binge Eating Disorder, 3) Anorexia Nervosa, and 4) OSFED (otherwise specified feeding and eating disorder; atypical eating disorders). These eating disorders are described in more detail, below:

Bulimia Nervosa (BN)

Primary symptoms of bulimia nervosa include:

Binge Eating Disorder (BED)

According to the DSM-5 (2013, American Psychiatric Association), binge eating disorder is characterized by:

Compulsive overeaters or those with binge eating disorder think about food constantly and regularly eat past the point of being full, and they will often eat in secret.

In some cases of binge eating disorder, a person may consume 2,000-5,000 calories or more. Many report feeling “high” after this massive intake of food. Research has explained this phenomenon and has shown that binge eating can impact the release of serotonin, a chemical that stimulates the reward center in the brain regulating feelings of pleasure. This is when we begin to look at food as a drug, and for some, especially in the case of BED, food is, in fact, being used as a drug. However, unlike traditional substance abuse (ex. alcoholism), one suffering from BED cannot simply stop using their drug—food, as one must eat to survive. Therefore, the individual must learn to moderate their eating through seeking treatment for eating disorder recovery.

Anorexia Nervosa (AN)

The Diagnostic and Statistical Manual of Mental Disorders-IV defines anorexia nervosa as a refusal to maintain body weight at or above the normal weight for the patient’s age and height. Other criteria include either a loss of weight or the maintenance of weight that is less than 85 percent of the normal weight.

Anorexia Nervosa symptoms include:

Otherwise Specified Feeding and Eating Disorders (OSFED)

The signs and symptoms of OSFED are like those of other previously defined eating disorders but present as atypical:

If you believe you may be suffering from an eating disorder, treatment is available. Eating disorders are most active through life’s many transitional phases; therefore, having the tools, support, and resources you need for your journey can help you on your path to recovery, as well as maintain your recovery.

No matter how severe the problem, you can recover from an eating disorder to gain a happy and fulfilling life, free of the pain and worry related to food where you will discover how to eat freely while embodying a healthy relationship with food along with self-acceptance and gratitude for your body.

By Brooke Aschidamini, MS, RD, CISSN