I Hate You, Don't Leave Me; I'm Hungry, Don't Feed Me

Individuals suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) often share characteristics of Borderline Personality Disorder (BPD). These may include concerns about identity and appearance, impulsive eating binges and purging, mood instability, and feelings of emptiness. Eating disorders are often effectively treated in a controlled environment. Improvement, however, may not adequately address the associated BPD pathology. Indeed, clinicians often focus exclusively on the eating disorder, and may totally overlook the BPD symptoms, thereby losing the opportunity for a thorough treatment.

A new study published in Eating Disorders: The Journal of Treatment and Prevention ¹ assessed 208 adolescent psychiatric inpatients, examining the relationships between specific BPD symptoms and symptoms of AN and BN. Generally, symptoms of both eating disorders were more common among patients who described mood instability, disturbed relationships, identity disturbance, inappropriate anger, feelings of emptiness, suicidal behavior, and dissociative or paranoid feelings. Neither AN nor BN groups expressed significant abandonment concerns. Impulsivity, mood instability, and anger were more commonly described in BN patients vs AN individuals. Identity disturbance was more strongly connected to AN than to BN. These observations suggest that patients with BN are more likely to be agitated and more animated. Anorexia Nervosa patients may be more passive and less open and forthcoming about symptoms.

Clinicians, patients, and family should be more aware of the potential of these underlying issues when addressing eating disorders. It is important to look at the whole person, who suffers from specific problems, rather than seeing only a diagnosis.