Personality Disorders and Eating Disorders

Simone Hoermann, Ph.D. Updated: Aug 19th 2009

a tower of slices of apple, orange and lemon arranged in the shape of an apple The Diagnostic and Statistical Manual of Mental Disorders defines eating disorders as severe disturbances in eating behaviors. The eating disorders recognized in DSM IV are Anorexia Nervosa, Bulimia Nervosa and Eating Disorder Not Otherwise Specified.

Bulimia Nervosa involves episodes eating unusually large amounts of food during a short time period in a way that feels out of control, and then counter-acting these eating binges with what we call compensatory behaviors such vomiting, taking laxatives or diet pills, fasting and exercising in an attempt to prevent weight gain.

Anorexia Nervosa is characterized by a person’s refusal maintain a minimally normal body weight, which generally means that the person weighs less than 85% of what is considered ideal body weight given a person’s height and age. The person also has intense fear of gain and has a distorted perception of what their body looks like or how heavy (or rather, how underweight) they actually are. Another characteristic is that the person has lost their menses for at least three consecutive cycles. There are two kinds of Anorexia: 1) the restricting type, in which the person restricts food intake and does not have episodes of either binge eating or purging (i.e. self-induced vomiting, misuse of laxatives, diuretics or diet pills). 2) the Binge-eating/Purging type, in which the person regularly engages in binge-eating and purging behavior even though they are underweight. Often, people with Anorexia Nervosa will deny the seriousness of their illness and physical dangerousness of their low weight.

Frequently, parents ask: “How can I tell whether my child has an eating disorder?” According to Chiara Battistello, clinical social worker and coordinator of the Eating Disorders Program at the Columbia east 60^th Street Day Treatment Program, one of the key signs of someone having an eating disorder are changes in body weight, especially weight loss. “Often, one can observe a change in eating behaviors,” says Chiara Battistello. “For instance, a person will avoid certain food groups, or they start to regularly avoid meal times with family and tell people that they have already eaten elsewhere.” Additional signs are changes in mood and behavior, particularly a mood that appears depressed, blue, or irritable, or if they start isolating, together with an increased need to control food options and eating schedules. Some clues that suggest Bulimia or Binge-Eating Disorder are if food is missing, people find hidden remnants and leftovers such as wrappers and empty containers. A common sign of purging is if person is often going to the bathroom right after meals.

There is a significant overlap in the diagnosis of certain personality disorders and the eating disorders. According to Ms. Battistello, the latest data show that close to a quarter of people who suffer from the restricting type of Anorexia Nervosa can be diagnosed with Obsessive Compulsive Personality Disorder, a personality disorder that is quite rigid and preoccupied with order, rules, and regulations. This is followed by Avoidant Personality Disorder, which is characterized by severe social anxiety and chronic feelings of inadequacy found in 19% of restricting Anorexia patients.

By far the most frequent personality disorder that people with eating disorders struggle with is Borderline Personality Disorder. Ms Battistello referenced that as many as 26% of people with the bingeing/purging type of Anorexia Nervosa and 28% of people who have Bulimia Nervosa can be diagnosed with Borderline Personality Disorder. These high numbers of co-occurrence make sense, given that eating disorder behaviors, such as bingeing or restricting, despite their devastating long-term consequences, can often function as way short-term ways of coping with intense emotions.

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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