BPD Related Conditions Eating Disorders and Borderline Personality By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial process Updated on June 25, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Rachel Goldman, PhD, FTOS Medically reviewed by Rachel Goldman, PhD, FTOS Facebook LinkedIn Twitter Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change. Learn about our Medical Review Board Print FollowTheFlow/Getty Images Eating disorders and borderline personality disorder (BPD) frequently occur together, but until recently, very little was known about the relationship between the two. Recent research is revealing how often BPD and eating disorders co-occur, why they may be related and how to treat these two types of disorders when they do co-occur. What Are Eating Disorders? Eating disorders are psychiatric disorders characterized by severe problems with eating behavior and related thoughts and emotions. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the official guidebook to the diagnosis of psychiatric disorders used by mental health providers, recognizes eight types of eating disorders. Eating disorders included in the DSM-5 include: Anorexia nervosa Avoidant/restrictive food intake disorder (ARFID) Binge-eating disorder Bulimia nervosa Rumination disorder Other specified feeding or eating disorder (OSFED) Pica Unspecified feeding or eating disorder (UFED) Anorexia and Bulimia Anorexia is marked by restrictive food consumption, a preoccupation with gaining weight, and significantly low body weight. In contrast, the central feature of bulimia nervosa is the presence of binge eating, followed by behaviors that attempt to compensate for the binge eating, such as self-induced vomiting, overuse of laxatives, excessive exercise, and others. There can be some overlap in symptoms between these two disorders. For example, someone may engage in binge eating and purging, but also be unwilling to maintain normal body weight. Binge-Eating Disorder Binge-eating disorder was officially added to the DSM as a diagnosis in 2013. The condition is characterized by binge-eating episodes where people feel that their eating is out of control. These episodes are also often accompanied by feelings of embarrassment or guilt. Unlike bulimia, there are no accompanying compensatory behaviors. Treatments for Binge Eating Disorder Other Eating Disorders Pica and rumination disorder were moved from the now-eliminated DSM-IV section of disorders usually diagnosed in infancy, childhood, and adolescence into the feeding and eating disorders section of the DSM-5. Pica involves the craving and consumption of non-food substances. Rumination disorder involves regurgitating previously eaten food in order to spit or re-swallow it. Avoidant/restrictive food intake disorder is a new addition to the DSM, known previously as selective eating disorder. This disorder is characterized by restrictive food intake, but it not marked by distress over body size or weight gain. The DSM-5 also contains umbrella diagnosis options of "other specified" and "unspecified" for conditions that do not meet the criteria of other eating disorders such as anorexia nervosa or binge-eating disorder. 9 Essential Facts About Eating Disorders Prevalence People with borderline personality disorder have a greater prevalence of eating disorders than people in the general population. For example, a widely cited study by Dr. Mary Zanarini and her colleagues at McLean Hospital found that 53.8% of patients with BPD also met criteria for an eating disorder (compared to 24.6% of patients with other personality disorders). In this study, 21.7% of patients with BPD met criteria for anorexia nervosa and 24.1% for bulimia nervosa. Of course, this is not to say that people with eating disorders necessarily have borderline personality disorder. In fact, the overwhelming majority of people with eating disorders do not have BPD. It appears that the rate of BPD in people with eating disorders is somewhat elevated when compared to the general population—about 6 to 11%, compared to 2 to 4% in the general population. Some eating disorders, though, are associated with having a higher risk of BPD than others. One study found that people with bulimia nervosa, purging type may be at a greater risk for BPD (with about 11% meeting BPD criteria) than people with anorexia nervosa, binge-eating/purging type (with about 4% meeting BPD criteria). Myths About Borderline Personality Disorder How Are They Related? Why do people with BPD seem to have eating disorders at a greater rate than people in the general population? Experts have noted that one possible explanation is that BPD and eating disorders (particularly bulimia nervosa) share a common risk factor. Both BPD and eating disorders are associated with histories of childhood trauma, such as physical, sexual and emotional abuse. It could be that having a history of childhood trauma puts one at greater risk for both BPD and eating disorders. In addition, some experts have suggested that it may be that the symptoms of BPD put one at risk for developing an eating disorder. For example, chronic impulsivity and urges to self-harm may lead one to engage in problematic eating behavior, which may over time rise to the level of an eating disorder. Conversely, engaging in eating disordered behavior may lead to experiences of stress (e.g., intense shame, hospitalization, family disruption) that may trigger BPD in someone with a genetic vulnerability for the disorder. Treatments What can be done about BPD and co-occurring eating disorders? The good news is that there are effective treatments available for both types of conditions. While some studies have indicated that people with BPD do not respond as well to eating disorder treatment, other studies have found no differences in treatment response between people with eating disorders with or without BPD. Which problem should be treated first? It may be that both the eating disorder and the BPD symptoms can be treated at the same time, but this may be decided on a case-by-case basis. For example, some people have eating disorder symptoms that are so severe they are immediately life-threatening. In this case, hospitalization for the eating disorder symptoms may be necessary before treatment for the BPD symptoms can begin. Alternatively, in someone with very severe BPD symptoms that are either life-threatening or threaten to reduce their ability to engage in the treatment, the BPD symptoms may be treated first. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Finding Help If you think you (or a loved one) may have BPD and/or an eating disorder, the first step is to find a mental health provider who can make the right diagnosis and give you the right treatment. 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sansone RA, Sansone LA. Personality pathology and its influence on eating disorders. Innov Clin Neurosci. 2011;8(3):14-8. Call C, Walsh BT, Attia E. From DSM-IV to DSM-5: changes to eating disorder diagnoses. Curr Opin Psychiatry. 2013;26(6):532-6. doi:10.1097/YCO.0b013e328365a321 Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord. 2010;43(3):226-32. doi:10.1002/eat.20689 Sansone RA, Sansone LA. Childhood trauma, borderline personality, and eating disorders: a developmental cascade. Eat Disord. 2007;15(4):333-46. doi:10.1080/10640260701454345 Additional Reading Godt K. Personality disorders in 545 patients with eating disorders. Eur Eat Disord Rev. 2008;16(2):94-9. doi:10.1002/erv.844 Pope HG Jr, Hudson JI. Are eating disorders associated with borderline personality disorder? a critical review. Int. J. Eat. Disord. 1989;8:1-9. doi:10.1002/1098-108X(198901)8:1<1::AID-EAT2260080102>3.0.CO;2-# Sansone RA, Sansone LA. Childhood trauma, borderline personality, and eating disorders: a developmental cascade. Eat Disord. 2007;15(4):333-46. doi:10.1080/10640260701454345 Zeeck A, Birindelli E, Sandholz A, Joos A, Herzog T, Hartmann A. Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder. Eur Eat Disord Rev. 2007;15(6):430-8. doi:10.1002/erv.824 By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for BPD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.