The Connection Between Borderline Personality Disorder and Eating Disorders

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

• At least 30 million people of all ages and genders suffer from an eating disorder in the United States.
• Every 62 minutes at least one person dies as a direct result of an eating disorder.
• Eating disorders have the highest mortality rate of any mental illness.

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:

• Regular intake of large amounts of food (>2,000 calories) in a very short period (2-3 hours), accompanied by a sense of loss of control over one’s eating, followed by feelings of guilt, shame and/or regret
• Repeated episodes of bingeing and purging at a frequency of >2-3 times per week
• Compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting and/or obsessive or compulsive exercise
• Extreme concern with body weight and shape

Binge Eating Disorder (BED)

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

• Recurrent episodes of eating large amounts of food (>2,000 calories in one sitting) within a discrete period of time (any two-hour period).
• Binge eating episodes that include +3 of the following behaviors:
  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of embarrassment or shame about food consumption
  • Feeling disgusted with oneself, depressed or very guilty after overeating
  • Marked distress with binge eating behaviors
• Binge eating at least once a week for three months.
• Binge eating behavior that is not associated with the regular use of compensatory behaviors (use of diet pills, laxatives and/or diuretics) like in individuals with bulimia nervosa.

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:

• Resistance to maintaining body weight at or above a minimally normal weight for height, body type, age, and activity level
• Intense fear or feeling of weight gain or being “fat” even though underweight
• Disturbance in the experience of body weight or shape, severe and continuous body dissatisfaction, or denial of the seriousness of low body weight
• Loss of menstrual periods in girls and women of childbearing age

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:

• Atypical anorexia nervosa (weight is not below normal)
• Binge-eating disorder (with less frequent occurrences)
• Purging disorder—behaviors meant to compensate for eating such as vomiting, or use of laxatives, diet pills, or excessive exercise without binge eating.
• Night eating syndrome— recurring episodes of night eating that may include eating more after dinner than during dinner or awakening from sleep and feeling the need to eat to feel comforted to fall back asleep. A constant awareness, bordering on obsession with food, calorie counting, exercise and weight
• Repetitive cycles of restricting food à bingeing à feelings of shame and guilt à purging
• Strict, restrictive rules about food, such as foods that can never be eaten, times of day to avoid eating, “good” foods versus “bad” foods, etc.
• Using food to cope with unpleasant emotions

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