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 ...Read More
Last week, I wrote about the co-occurrence between personality disorders and eating disorders last week, describing the major eating disorders, and gave a few numbers on how frequently people with eating disorders can also be diagnosed with personality disorder. You might have wondered whether the presence of both a personality disorder and an eating disorder would affect the way these difficulties should be treated.
There are some clinicians who feel that the presence of a personality disorder can complicate the treatment of other difficulties, because people with personality disorders often have difficulties in interpersonal relationship. This can make it hard for someone with a personality disorder to bond with a therapist, to trust a therapist, or to attend treatment regularly and consistently over longer periods of time. Some people with personality disorders can be pretty self-destructive and might end up sabotaging the therapy process. Many people with personality disorders can have a tendency to first idealize and then devalue the therapist, which also makes it hard to maintain a relationship.
In turn, other clinicians believe that presence of an eating disorder can also complicate the treatment of a personality disorder. If someone is severely underweight, they might need medical attention. Some people who are restricting end up developing severe obsessions or compulsions (intrusive thoughts and behavioral rituals), and sometimes the low caloric intake can affect the way a person perceives reality. There are some clinicians who feel that the eating problems should be addressed and that a person might need to be in a residential treatment program that focuses on restoring a healthy weight, before the personality issues can be worked on.
According to Chiara Battistello, clinical social worker and coordinator of the Eating Disorders Program at the Columbia University day Treatment Program, the most effective treatment for Bulimia Nervosa and Binge Eating Disorder is Cognitive Behavioral Therapy (CBT). Treatment for Anorexia Nervosa requires weight restoration which is often provided in an inpatient or intensive outpatient setting. Once weight is restored CBT may help patients to work on body acceptance and challenge eating disorder thoughts and assumptions.
“I think the usual problems that arise in the treatment of Personality Disorders can treatment for people who are dually diagnosed” says Ms. Battistello. “Most commonly, people who have both eating disorders and personality disorders have a hard time with attachment and with tolerating frustration. There is often a tendency to idealize and then devalue a therapist very quickly. Also, recovery from an eating disorder, especially Bulimia or Binge-Eating Disorder often requires impulse control and strategies to delay acting on urges to do something harmful. This can be very difficult for people coping with Borderline Personality Disorder. Other issues arise for people with Obsessive Compulsive Personality disorder, because they can be extremely set in their ways. Recovery from Anorexia always involves allowing more flexibility. In terms of prognosis, we know that treatment in specialized centers probably improves the outcome, and the sooner one gets treatment, the better chance of recovery.”