One of my favorite people recently asked if I had ever written anything on the correlation between borderline personality disorder (BPD) and eating disorders. I told her I have not, but was also curious myself and quickly began doing a little research. Before I began reading up on it, I wasn't exactly sure what BPD was, but the more I read, the more I started to wonder whether or not I should have been diagnosed with BPD.
Borderline personality disorder, according to the U.S. National Library of Medicine, can be defined as, "a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others." Those suffering from BPD might feel uncertain about their identity; therefore, interests and values can sporadically change. They also view things as black or white; always in extremes. The views and opinions of BPD patients typically change quickly.
Other symptoms of BPD include:
-Intense fear of being abandoned
-Cannot tolerate being alone
-Frequent feelings of emptiness and boredom
-Frequent displays of inappropriate anger
-Impulsiveness, such as with substance abuse or sexual relationships
-Repeated crises and acts of self-injury, such as wrist cutting or overdosing
Eating disorders often become extremely difficult to treat due to the co-occurring disorders potentially involved. Treatment facilities specialize in the food and emotional related symptoms, but often lack the knowledge to also deal with other symptoms listed above. Eating disorders and BPD frequently do occur together, making it crucial to understand the relationship between the two.
According to a study done by Mary Zanarini at McLean Hospital located in Belmont, Massachusetts, approximately, "53% of patients with BPD also met criteria for an eating disorder (compared to 24% of patients with other personality disorders). In this study, 21% of patients with BPD met criteria for anorexia nervosa and 24% for bulimia nervosa." Patients diagnosed with bulimic tendencies are also at a higher risk of showing symptoms of BPD than patients diagnosed with anorexia nervosa. It is important to note, however, that not all eating disorder patients suffer from BPD.
Eating disorders are not the only comorbid disorder associated with BPD and there is also a major difference between genders when it comes to which impulsive behavior they "specialize" in. More specifically, "substance use disorders were found to be significantly more common in the histories of male than female borderline patients. In contrast, eating disorders, particularly eating disorder not otherwise specified (EDNOS), were found to be significantly more common in the histories of female than male borderline patients (Zanarini, 1998)." This is not to say that this is true for each patient though; studies have also found that about 50% of females diagnosed with BPD abuse substances at some point in their lives and about 20% of males with BPD are diagnosed with a serious eating disorder.
So what exactly is the relationship between BPD and eating disorders?
Studies show two major factors relating the two: (1) history of childhood trauma and (2) a main symptom of BPD, chronic impulsiveness, may lead to disordered eating habits. If a patient grew up in a broken home or was abused (physically, emotionally, or sexually) there is a much greater risk of developing BPD. These patients have difficulty expressing emotions and trusting others, which can cause fear of abandonment and feelings of emptiness, often leading to anorexia. For those patients who show highly impulsive tendencies, self harm and displays of inappropriate anger, bulimia is typically (but not always) developed as a result. The symptoms are all intertwined in their own complex way.
As far as treatment for both eating disorders and BPD, it is important to take the individual patient's needs into consideration. Some patients do well in eating disorder treatment facilities and show improvement in their BPD symptoms, while others do not. There is also the question of which disorder should be treated first - eating disorder or BPD? Again, this should be answered on a case-by-case basis. Some eating disordered patients might be so severely underweight that they require immediate treatment for those ED symptoms. Some patients, on the other hand, find that if they work on the BPD symptoms, the eating disordered symptoms decrease.
The truth is, mental health and eating disorders often go hand-in-hand. There are very few eating disorder patients who only show ED related symptoms. Knowing your own individual symptoms and needs is the best way to receive the treatment needed. Also, it is perfectly acceptable to try multiple treatment methods before finding the one that works best for you. Treatment facilities need to be more aware of the individual component of eating disorders before prescribing a treatment plan.
After reading up on BPD, thankfully, I do not think I would self-diagnose myself with this disorder at this point in my recovery. That is not to say I did not show BPD symptoms during different stages of my eating disorder. By taking control of my eating disordered symptoms, I have been able to unconsciously improve my overall mental health - funny how that works.