Living With Food: The Science Supporting Eating Disorder Treatment

By, Dr. Anita Federici

A significant number of individuals with an eating disorder also meet diagnostic criteria for other mental illnesses (e.g., anxiety disorders, major depression, etc.). One topic that has received increased attention in recent years is the relationship between Borderline Personality Disorder (BPD) and eating disorders. Studies show that 25% to 54% of individuals with an eating disorder also meet diagnostic criteria for BPD (Sansone & Levitt, 2006). The co-occurrance of the two disorders tends to be higher among those who exhibit more impulsive behaviors, such as binge eating and purging.

BPD is listed under axis II of the DSM IV. In order to receive a diagnosis, individuals must meet a minimum five of nine criteria. These criteria may be re-organized into five core areas of dysregulation:

1. Emotional Dysregulation: Individuals with BPD often experience emotional ups and downs, often in a given day. There may be chronic negative feelings, anxiety, and problems with anger and irritability. Mood changes can happen suddenly and are often triggered by situations in the external environment.
2. Behavioral Dysregulation: Individuals with BPD often engage in recurrent impulsive and self-destructive behaviors. These may include: suicide attempts, suicide threats, self-injury, alcohol and drug abuse, impulsive sexual behavior, gambling, binge eating and/or purging.
3. Cognitive Dysregulation: This category refers to increased suspiciousness/mistrust of others and/or dissociation (e.g., feeling like the world around you is not quite real). Typically these symptoms increase under stressful conditions.
4. Interpersonal Dysregulation: Relationships are often described as intense, unstable, and chaotic. Frantic efforts are made to avoid abandonment and feelings for others can be intense and may change quickly.
5. Dysregulation in Sense of Self: Individuals with BPD often experience an unstable sense of identity and/or chronic feelings of emptiness.

Some researchers believe that the co-occurance of both disorders may be caused by an inability to tolerate and skillfully manage negative or unpleasant emotions. 

Given the significant overlap between these two disorders, researchers are interested in developing effective treatment for clients who present with both BPD and an eating disorder. Recently, there is exciting and promising evidence for the use of Dialectical Behavior Therapy (DBT). DBT is effective for reducing impulsive and self-destructive behaviors in individuals with a primary diagnosis of BPD. Studies show that DBT reduces, and often eliminates, suicidal and self-injurious behaviors. Early studies also show that DBT is a promising intervention for women with a primary eating disorder diagnosis. DBT has been associated with reduced binge eating and purging behaviors. Studies evaluating DBT for individuals with both disorders are underway. Currently, our center is piloting the feasibility and effectiveness of DBT for individuals with both disorders, including those with multi-diagnostic presentations (such as comorbid PTSD, anxiety disorders, or Obsessive Compulsive Disorder).

For more information on Borderline Personality Disorder check out:

• Behavioral Tech
• The Borderline Personality Disorder Survival Guide
• The Treatment and Research Advancements Association for Personality Disorder (TARA)
• National Education Alliance for Borderline Personality Disorder