Personality disorders are relatively common among those with eating disorders. Put simply, a person with a personality disorder has thought patterns and behaviors that are very different from others around him. Personality disorders are difficult to treat, and they complicate the treatment of eating disorders.
Common Personality Disorders in Those With Eating Disorders
There are a number of personality disorders, but a few have very significant overlap with different eating disorders. Loosely speaking, the most common personality disorders seen among those who have eating disorders are borderline personality disorder, obsessive-compulsive personality disorder, and avoidant personality disorder.
Borderline Personality Disorder
Borderline personality disorder (BPD) is a pattern of impulsive and unstable behavior that affects emotions, relationships, and circumstances. A person with BPD has powerful fears of abandonment. Separation from others, for any reason, often leads this person to believe that she is "bad" in some way.
Not surprisingly, those with BPD have very unstable relationships. Someone with BPD will often idealize potential friends early in relationships, but then devalue friends and push them away out of a sense that they don't care enough and can't be trusted. In addition, behaviors of those with BPD are impulsive and sometimes self-destructive, potentially including self-mutilation, substance abuse, and suicide attempts.
Obsessive-Compulsive Personality Disorder
The first thing to note about obsessive-compulsive personality disorder (OCPD) is that it is different from obsessive-compulsive disorder (OCD). A person with OCD has genuine obsessions (uncontrollable, repetitive thoughts) and/or compulsions (constant hand washing, for example). With OCPD, these are generally not present.
A diagnosis of OCPD indicates a pervasive pattern of valuing control over flexibility, rule-keeping over convenience, and relational control over openness. This person's life is dominated by rules and perfectionism; he often is unable to give a task to others because they "won't do it the right way."
Avoidant Personality Disorder
Finally, avoidant personality disorder (AvPD) manifests as a pattern of avoiding interpersonal contact due to a sense of inadequacy. The main goal for persons with AvPD is to avoid criticism, and they are extremely sensitive to negative feedback.
Linking Personality Disorders to Specific Eating Disorders
People with anorexia nervosa (restricting type) will more often have OCPD than other personality disorders. A person with anorexia values rules, which are necessary to maintain harsh food restriction. This person has no problem with suffering for the sake of perfectionism. It is common to see a person with anorexia have no need for care from others because she believes she does everything well. She therefore restricts her "intake" of people just as she restricts intake of food. Meanwhile, she will be eager to help others deal with their issues, because she can easily see "defects" in others' behaviors.
In contrast, those with bulimia nervosa seem more likely to have BPD. Their eating patterns are unstable, impulsive, and self-destructive. Further, the cycle of binging and purging mimics the BPD pattern of drawing others close in relationships and then pushing them away -- essentially, binging on people and then purging them from one's life. BPD is also more likely to be present in those with binge-eating disorder and anorexia nervosa (binge-eating/purging type), which both involve more impulsive and erratic behavior than anorexia nervosa (restricting type).
AvPD seems to be relatively prevalent among all eating disorder types. It is more difficult to speculate on the reasons for this. For those with anorexia (restricting type), we might imagine that the sense of refusing help from others would line up well with symptoms of AvPD. For bulimia, binge eating, and anorexia (binge-eating/purging type), it may be that shame surrounding binging and purging, which leads to avoidance of others, connects with AvPD symptoms.
What Causes What?
It is unclear whether people with eating disorders are susceptible to personality disorders, vice versa, or both. Or, it could be that these people could simply have common traits that make them susceptible to both eating and personality disorders. Regardless, having both makes treatment difficult.
Things to Remember About Personality Disorders and Eating Disorders
- A person with an eating disorder does not necessarily have a personality disorder.
- Diagnosis of these disorders must be left to trained professionals.
- Having a personality disorder does not mean a person has no hope of recovery.
Sources:
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 4th ed. 1994. Washington, D.C.: American Psychiatric Association.
Sansone, Randy A., Levitt, John L., and Sansone, Lori A. The prevalence of personality disorders among those with eating disorders. Eating Disorders: The Journal of Treatment & Prevention 13 (2005): 7-21.
