Karen's Blogs

Blogs are brief, to-the-point, conversational, and packed with information, strategies, and tips to turn troubled eaters into “normal” eaters and to help you enjoy a happier, healthier life. Sign up by clicking "Subscribe" below and they’ll arrive in your inbox. 

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Borderline Personality Disorder

Here’s something you may not know about. There is a strong correlation (an association, not a cause and effect) between the clinical diagnosis of Borderline Personality Disorder (BPD) and eating disorders. For me, diagnosing is a helpful tool in understanding clusters of symptoms and guiding treatment. On the other hand, I understand how a diagnosis can feel like an unwanted label and a stigma if misused.

Criteria outlined in the fourth edition of the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, aka the DSM-IV-TR, for BPD are as follows: 1) frantic efforts to avoid real or imagined abandonment; 2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation; 3) identity disturbance: markedly and persistently unstable self-image or sense of self; 4) impulsivity in at least two areas that are potentially self-damaging (eg, spending, sex, substance abuse, reckless driving, binge eating); 5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; 6) affective instability due to a marked reactivity of mood (eg, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days); 7) chronic feelings of emptiness; 8) inappropriate, intense anger or difficulty controlling anger (eg, frequent displays of temper, constant anger, recurrent physical fights); 9) transient, stress-related paranoid ideation or severe dissociative symptoms.

To be diagnosed with BPD, a person must meet at least five criteria. The ones I see most commonly in association with binge-eating are fear of abandonment; unstable relationships and an unstable sense of self; impulsivity, particularly in spending and eating; mood reactivity, especially inappropriate anger and overwhelming anxiety; and chronic feelings of emptiness. Examples include yo-yoing between dieting and bingeing; filling up inner emptiness with food, diet rules or exercise obsession; recurrent anxiety or depression or mood swings; difficulty maintaining relationships; low self-esteem; a self-image determined by external factors; and a lack of a stable sense of self.

I’m not saying that having eating problems means you have BPD, but it’s worth considering. You may find the diagnosis helpful or not. Some people are relieved that there are deeper roots to and a name for their cluster of symptoms. Others feel even more defective and that a diagnosis means they’re mentally ill (not true). If you think you may have BPD, start reading about it or talk with a therapist. If you have it, by all means, please consider it a challenge you can definitely work with.

Feel, Then Think

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