The majority of people who struggle with eating disorders such as anorexia, bulimia and binge eating disorder also struggle with another mental illness as well. These can range from depression and anxiety to post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD), among others. Borderline personality disorder is also a mental illness that may occur in some people who suffer from eating disorders, such as bulimia.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a pattern of instability in relationships, self-image and affects (moods). A person must meet at least five of the following criteria for a diagnosis of BPD.
- Efforts to avoid real or imagined abandonment: the sufferers may feel as though people are ignoring them, withholding love, or avoiding them and frantically attempt to change this
- Multiple unstable relationships that alternate between being very good and being very bad
- Unstable self-image or sense of self: may try to change how one acts or appears to fit in or to be liked
- Impulsive and dangerous behaviors such as shopping sprees, unprotected sex or sex with multiple partners/strangers, substance abuse, reckless driving and/or binge eating
- Recurrent suicidal behavior, threats or self-mutilating behavior
- Mood instability marked by episodes of irritability and/or anxiety
- Feelings of emptiness
- Difficulty controlling anger: may have physical fights and/or loud/intense displays of temper
- Stress-related paranoia or dissociative symptoms (feelings of zoning out, not being in the present moment, or amnesia)
Around 75% of all cases of BPD are diagnosed in females. The highest levels of instability and impulsive behaviors are typically seen in adolescence and in young adulthood. Although people may experience chronic symptoms, many sufferers experience more stability in moods and relationships as they reach middle adulthood.
How Does BPD Relate to Eating Disorders?
Several of the symptoms of BPD and eating disorders overlap. For instance, sufferers of both BPD and eating disorders have an unstable sense of self and typically negative self-image. Bulimia is also characterized by binge-eating, which is listed as one of the potentially damaging behaviors of BPD.
How Does it Affect Treatment?
Borderline personality disorder may make treatment for eating disorders more challenging, but there are effective treatments for both conditions.
Dialectical behavior therapy (DBT), a type of Cognitive-behavioral therapy (CBT) developed by Marsha Linehan, is designed specifically to treat borderline personality disorder. This treatment option includes individual therapy, skills training sessions and telephone consultations as needed. The skills taught in DBT are core mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. These skills do a wonderful job of targeting the symptoms of BPD, and some studies are incorporating these techniques in the treatment of eating disorders as well.
It is important to seek treatment from providers who are familiar and experienced at treating both borderline personality disorder and eating disorders. Such providers are able to use aspects of different treatment options to target both symptoms of BPD and the eating disorder.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press.
National Institute for Clinical Excellence (2004).Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline No.9). London: Author. (Available at www.nice.org.uk/guidance/CG9).
Safer, D.L., Telch, C.F., & Agras, W.S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634.
Telch, C.F., Agras, W.S., & Linehan, M.M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065.
Wisniewski, L. & Kelly, E. (2003). The application of dialectical behavior therapy to the treatment of eating disorders. Cognitive and Behavioral Practice, 10, 131-138.