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Borderline Personality Disorder (BPD) and Anorexia Nervosa

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Borderline Personality Disorder (BPD) and Anorexia Nervosa (AN) are complex and challenging mental health conditions. These two conditions have revealed a striking connection in recent years in many individuals. 

The intersection of these two disorders has interested researchers, clinicians, and those affected by them. Shedding light on their connection can help us better understand their underlying mechanism and work towards devising their treatment.

Understanding Borderline Personality Disorder

Bipolar personality disorder (BPD) is a multifaceted mental health condition.

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), BPD is described as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts.” 

Individuals grappling with BPD often struggle to manage their emotions. They may experience rapid mood swings and difficulties in maintaining stable relationships. Such individuals also often exhibit an intense fear of abandonment.

Unraveling Anorexia Nervosa

On the other hand, Anorexia Nervosa (AN) is an eating disorder primarily associated with an intense fear of weight gain. Patients, usually young women, suffer from distorted body image and severe calorie restriction despite being under or normal weight. 

borderline personality anorexia

According to the DSM-5, Anorexia nervosa has the following diagnostic criteria:

1. Restricting energy intake relative to requirements leads to a significantly low body weight in age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even underweight.

3. Disturbance in how one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the    

current low body weight.

Anorexia Nervosa manifests in the relentless pursuit of thinness. This quest for extreme thinness often results in severe health consequences and, in severe cases, can be life-threatening.

The Overlapping Relationship

Recent studies have pointed towards a significant connection between BPD and eating disorders such as bulimia nervosa and anorexia nervosa. Statistics indicate a disproportionately higher prevalence of eating disorders in individuals diagnosed with BPD. 

A significant percentage of individuals with BPD also meet the diagnostic criteria for Anorexia Nervosa. Which far surpasses the anticipated rate within the general population.

Shared Risk Factors

The relationship between BPD and AN is not coincidental. Both disorders share common risk factors which may play a role in the causative association.

Some common risk factors for both conditions include:

  • Childhood Trauma: Both BPD and AN have been associated with a history of childhood trauma. Traumatic experiences, including emotional, physical, or sexual abuse during childhood, can significantly impact one’s mental health. 

Research suggests that exposure to such traumas can increase the vulnerability to developing mental health conditions like BPD and AN. Trauma can influence emotional regulation, interpersonal relationships, and self-image. All of which are core aspects of both disorders.

  • Genetic Predisposition: Evidence suggests a genetic predisposition to developing BPD and AN. Biological factors and genetic predisposition could cause these disorders to manifest. 

While genetic predispositions do not solely determine the development of these conditions, they may increase the likelihood of their occurrence. The likelihood increases when combined with environmental factors.

  • Emotional Dysregulation: Emotional instability and difficulty regulating emotions are core features of both BPD and AN. While triggers differ, both disorders manifest destructively. Both disorders involve maladaptive coping mechanisms in response to intense emotions. 
  • Low Self-Esteem and Identity Issues: Individuals with BPD often experience an unstable self-identity. This instability in self-perception can contribute to feelings of worthlessness and inadequacy. 

Similarly, in AN, a distorted body image and an overemphasis on weight and shape play a crucial role in shaping the individual’s sense of self. 

Low self-esteem and identity issues are intertwined risk factors that contribute to the development and maintenance of both BPD and AN.

  • Perfectionism and Control Issues: A desire for control and pursuit of perfectionism may be a shared personality trait in both disorders. 

Individuals with AN often strictly control their food intake and body weight. They view thinness as an ideal representation of control and perfection. 

In BPD, the fear of abandonment and unstable relationships might drive a similar pursuit of control to manage their environment and emotions.

Traumatic experiences and unstable relationships during formative years may catalyze the development of both conditions. However, it is important to note that not every individual who experiences a less ideal childhood will necessarily develop these disorders.

Behavioral Parallels

Behavioral overlaps further underscore the intertwined nature of BPD and AN. Some of these include:

  1. Impulsivity: Both BPD and AN can exhibit impulsive behaviors. For example, individuals suffering from BPD exhibit self-harm, sexual misconduct, or substance abuse. Similarly, individuals suffering from AN display acts like self-induced vomiting and excessive laxative use.
  1. Self-Harm and Suicidal Behavior: Self-harming behaviors are prevalent in both conditions. In BPD, these behaviors may be a way to alleviate emotional distress. In AN, the harm is self-inflicted through extreme food restriction or purging.
  1. Emotional Dysregulation: Intense mood swings, emotional lability, and difficulty regulating emotions are shared features in both disorders.
  1. Distorted Self-Image: Both conditions involve distorted perceptions of the self. In BPD, this often relates to unstable self-identity. In AN, individuals may perceive themselves as overweight when they’re not or exhibit body image distortions.

Treatment Strategies

Understanding the linkage between BPD and AN is crucial for effective treatment. While treatments vary for both disorders, considering the possible coexistence can assist in more effective treatments.

Let’s discuss the treatment strategies for them respectively. 

Treatment Of Anorexia Nervosa

Treatment options for Anorexia Nervosa usually have these main components:

  • Medical Stabilization: The priority is to address any life-threatening conditions caused by severe malnutrition. This might involve hospitalization to manage these problems more aggressively. These may include dangerously low body weight, heart problems, electrolyte imbalances, or other acute medical complications.
  • Nutritional Rehabilitation: Re-establishing healthy eating habits is fundamental. Nutritional counseling and meal planning help individuals reintroduce regular and adequate eating patterns into their routines. This needs to be done under expert supervision to avoid conditions like dumping syndrome.
  • Therapeutic Interventions: Psychotherapy is a cornerstone in AN treatment. Various types of therapy are used for AN, such as Cognitive-Behavioral Therapy (CBT), Family-Based Therapy (FBT), and Interpersonal Therapy (IPT). These are used to address distorted thought patterns, body image issues, and problematic behaviors associated with the disorder.
  • Medication: There are no medications specifically approved to treat anorexia symptoms. However, doctors might prescribe medications to address co-existing conditions. These include depression, anxiety, or obsessive-compulsive symptoms.
  • Multidisciplinary Approach: The right treatment approach involves a team of healthcare providers. An effective team should include mental health professionals, dietitians, and physicians. Coordinated care ensures that all aspects of the disorder, both physical and psychological, are addressed.
  • Support Groups and Aftercare: Support groups and aftercare programs are valuable in recovery maintenance. These groups offer a sense of community, understanding, and encouragement. These groups can help individuals share their struggles and motivate each other to remain on their path to recovery. Aftercare programs allow for close monitoring of the individual’s progress.
  • Holistic Therapies: Integrating complementary therapies such as art therapy, yoga, or mindfulness techniques can complement traditional treatments. These therapies can help manage stress and improve emotional well-being. They offer an alternate, healthier coping mechanism for such individuals.
  • Educational Support for Families: In many cases, family involvement is essential for a successful recovery. Providing education and support for family members helps create an environment conducive to the individual’s recovery.

Treatment Of Borderline Personality Disorder

While the treatment of Borderline Personality disorder usually varies with severity, these are the main components of the treatment plan:

  • Psychotherapy: Different therapeutic modalities have been found effective in treating BPD. Dialectical Behavior Therapy (DBT) is one of the most commonly used approaches. It focuses on teaching skills for emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Cognitive Behaviour Therapy, Schema-Focused Therapy, Mentalization-Based Therapy, and Transference-Focused Psychotherapy are other approaches that have shown effectiveness in treating BPD.
  • Medication: There are no specific medications for treating BPD itself. However, medications can help manage certain symptoms that often co-occur with BPD. These include depression, anxiety, or impulsivity. Antidepressants, mood stabilizers, and antipsychotics might be prescribed to address these BPD symptoms.
  • Supportive and Structured Environments: Creating a supportive and structured environment can be beneficial for individuals with BPD, especially when experiencing severe symptoms. Inpatient or residential treatment settings can offer an intensive, structured therapeutic environment.
  • Self-help and Support Groups: Peer support is invaluable for individuals with BPD. Support groups provide a sense of community and understanding, helping individuals feel less isolated and stigmatized.
  • Family Therapy: It is crucial to educate family members about BPD and how they can support their loved ones. This can improve communication, reduce conflict, and create a more supportive environment.
  • Distraction Therapies: Incorporating holistic approaches such as mindfulness, yoga, art therapy, or meditation can aid in managing stress, improving emotional regulation, and enhancing overall well-being.
  • Skill Building and Coping Strategies: BPD treatment often involves teaching practical skills for coping with distressing emotions, managing impulsive behaviors, and improving interpersonal relationships. These skills help individuals develop healthier and more adaptive ways of managing feelings and interactions.
  • Long-Term Psychotherapeutic Relationships: BPD treatment is often long-term. Building a stable, consistent therapeutic relationship can be essential for progress. Establishing trust with a therapist is important for individuals with BPD, as trust issues are common.
  • Rehabilitation and Recovery Programs: For those with BPD who struggle with substance use disorder or have co-occurring disorders, rehabilitation and recovery programs might be necessary. These programs address addiction issues alongside mental health treatment.

Treating Both Conditions Simultaneously

The coexistence or overlapping of BPD and AN often required a combined treatment approach.

Therapeutic interventions like Dialectical Behavioral Therapy (DBT) have emerged as a promising approach for addressing both disorders simultaneously. DBT focuses on emotional regulation, mindfulness, and interpersonal effectiveness. It deals with distress tolerance, addressing both conditions’ intricate emotional and behavioral aspects. 

It also helps to have a multidisciplinary team of experts as mentioned above. This helps address all components of treatment at once. 

The correlation between BPD and AN sheds light on the complexities of mental health. Recognizing the interwoven nature of these disorders is a pivotal step toward developing comprehensive and integrated treatment approaches. 

By comprehensively addressing the emotional, psychological, and behavioral aspects, there’s hope for better outcomes. We have a better chance to improve the quality of life for individuals grappling with both BPD and AN.

About the author
Shannon M
Shannon M's extensive experience in addiction recovery spans several decades. Her journey started at a young age when she attended treatment aftercare sessions for a family member and joined Alateen meetings, a support group for young people affected by a loved one's addiction. In 1994, Shannon personally experienced the challenges of addiction and took the courageous step of joining Alcoholics Anonymous. This experience gave her a unique perspective on the addiction recovery process, which would prove invaluable in her future work. Shannon's passion for helping others navigate the complexities of addiction led her to pursue a degree in English with a minor in Substance Abuse Studies from Texas Tech University. She completed her degree in 1996, equipping her with the knowledge and skills necessary to provide compassionate and effective support to those struggling with addiction.