Background

Eating Disorders and Personality Disorders

Uploaded 12/4/2010, approx. 5 minute read

I am Sam Vaknin, and I am the author of Malignant Self-Love, Narcissism Revisited.

Patients with eating disorders either binge on food or refrain from eating altogether. They are sometimes both anorectic and bullying.

Eating disorders are impulsive behaviors, as defined by the Diagnostic and Statistical Manual, and they are sometimes homomorphic, exist with cluster B personality disorders, particularly with borderline personality disorders.

Some patients develop eating disorders as the convergence and confluence of two pathological behaviors, self-mutilation and impulsive behaviors.

The key to improving the mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing it first upon their eating and sleeping disorders and only then on their personality disorders.

By controlling her eating disorder, the patient reasserts control over her life, and this newfound power is bound to reduce depression or even eliminate it altogether as a constant feature of her mental life. It is also likely to ameliorate other facets of her personality disorder.

You see, it is a chain reaction. Controlling one's eating disorders leads to a better regulation of one's self-worth, self-confidence, self-esteem.

Successfully coping with one's challenge, the eating disorder, generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.

When a patient has a personality disorder and an eating disorder, the therapist would do well to first tackle the eating disorder.

Personality disorders are intricate and intractable. They are rarely curable. Certain aspects like obsessive-compulsive behaviors or depression can be ameliorated with medication or modified, but the underlying disease is very hard to uproot.

The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved, especially the patient.

From the patient's point of view, therefore, the treatment of a personality disorder is not an efficient allocation of very scarce mental resources. Neither are personality disorders the real threat.

If one's personality disorder is cured but one's eating disorder is left untouched, one may die albeit mentally healthy.

An eating disorder is a signal of distress. It says, I wish to die. I feel so bad. Somebody help me.

It is also a message. I think I lost control. I'm very afraid of losing control. I will control my food intake and discharge. This way I can control at least one aspect of my life, my eating.

And this is where we can and should begin to help the patient by letting her regain control of her life.

The family or other supporting figures in the patient's life must think what they can do to make the patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences and choices, do matter.

Eating disorders indicate the strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self-control.

The patient feels inordinately, paralyzingly helpless and ineffective. Her eating disorders are an effort to exert, reassert mastery over her wayward and chaotic life.

At this early stage the patient is unable to differentiate her own feelings and needs from those of others.

Cognitive and perceptual distortions and deficits only increase her feelings of personal ineffectualness and her need to exercise even more self-control by way of her diet.

She develops somatoform disorder. The patient does not trust herself in the slightest. She rightly considers herself to be her worst enemy, a mortal adversary.

Therefore, any effort to collaborate with a patient against her own disorder is perceived by the patient as self-destructive.

The patient is emotionally invested in her disorder. That's her vestigial mode of self-control.

The patient views the world in terms of black and white, of absolutes. This is a primitive defense mechanism called splitting.

Thus she cannot let go, even to a very small degree. She is constantly anxious. This is why she finds it impossible to form relationships. She mistrusts herself and by extension others. She does not want to become an adult. She does not enjoy sex or love, which both entail a modicum of loss of control.

All this leads to a chronic absence of self-esteem.

These patients like their disorder. Their eating disorder is the only achievement in life. Without their disorder, they are ashamed of themselves and disgusted by their shortcomings, expressed through the distaste with which they hold their own body.

Eating disorders are amenable to treatment, though comorbidity with a personality disorder presages a poorer prognosis. The patient should be referred to talk therapy, medication, and enroll in online and offline support groups, such as over eaters and others.

Recovery prognosis is good after two years of treatment and support. The family must be heavily involved in the therapeutic process. Family dynamics usually contribute to the development of such disorders.

In short, medication, cognitive and behavioral therapy, psychodynamic therapy, and family therapy ought to do it.

The change in the patient following a successful course of treatment is very marked. Her major depression disappears together with her sleeping disorders. She becomes socially active again. She gets a life. Her personality disorder might make it difficult for her, but in isolation, without the exacerbating circumstances of her other eating disorders, she finds herself much easier to cope with.

Patients with eating disorders may be in mortal danger. Their behavior is ruining their bodies relentlessly and inexorably. They might attempt suicide. They might do drugs. It is only a question of time before they succumb.

The therapist's goal is to buy them that time. The older they get, the more experience they become. The more their body chemistry changes with age, the better the chances to survive and thrive.

If you enjoyed this article, you might like the following:

Disorders of Eating and Personality (3rd International Conference on Neurology and Brain Disorders)

Eating disorders are complex and often comorbid with personality disorders, particularly borderline personality disorder. The key to improving the mental state of patients with both disorders is to focus on their eating and sleeping disorders first. By controlling their eating disorder, patients can reassert control over their lives, leading to better regulation of their sense of self-worth, enhanced self-confidence, and self-esteem. Treatment options include medication, cognitive or behavioral therapy, psychodynamic therapy, and family therapy. Recovery prognosis is good after two years of treatment and support.


Over-sexed: Histrionic Personality Disorder and Narcissism

Histrionic personality disorder is more commonly diagnosed in women, leading to questions about whether it is a real mental health problem or a reflection of a patriarchal society. Histrionics crave attention and are uncomfortable when not at the center of it, similar to narcissists. They are preoccupied with physical appearance and sexual conquests, and often act flirtatious and seductive. Histrionics are enthusiastic and emotional, but their behavior can be exhausting and off-putting to others.


Borderline's Miracle Healing

Borderline personality disorder (BPD) is less prevalent than commonly believed, affecting about 1-2% of the general population, yet it accounts for a significant portion of mental health treatment cases due to crises. The prognosis for BPD is generally positive, with many individuals experiencing spontaneous remission or significant improvement through therapies like Dialectical Behavior Therapy (DBT), leading to a high percentage of patients no longer meeting diagnostic criteria over time. While symptoms related to impulsivity and behavior tend to remit more quickly, some underlying traits and dysfunctional behaviors may persist even after the disorder itself has resolved. Effective treatment should not only address the core symptoms of BPD but also focus on helping individuals develop functional skills for social and vocational success, particularly in younger populations.


Body Language of the Personality Disordered

Patients with personality disorders have a body language specific to their personality disorder. The body language comprises an unequivocal series of subtle and not-so-subtle presenting signs. A patient's body language usually reflects the underlying mental health problem or pathology. In itself, body language cannot and should not be used as a diagnostic tool.


Narcissists and Negativistic (Passive-Aggressive) Personality Disorder

Negativistic, passive-aggressive personality disorder is characterized by chronic pessimism, resistance to authority, and a tendency to undermine others in social and workplace settings. Individuals with this disorder often exhibit behaviors such as procrastination, neglect, and sabotage, while feeling unappreciated and victimized by their circumstances. They display a range of negative emotions, including irritability and envy, and often react to perceived slights with sulking or the silent treatment. Despite their obstructive behavior, they may seek forgiveness and promise change when confronted, but these promises typically go unfulfilled.


Histrionic Personality Disorder (HPD): Overview and Issues

Histrionic personality disorder is characterized by a compulsive need for attention, often manifesting through exaggerated emotional displays and provocative behavior, primarily observed in women. The disorder raises questions about its clinical validity versus being a reflection of societal norms, particularly regarding gender roles. Histrionics often misinterpret social cues and relationships, leading to shallow emotional connections and a reliance on sexual manipulation to gain approval and control. The interplay of histrionic traits with other personality disorders, such as borderline and narcissistic disorders, complicates their emotional experiences and relationships, resulting in a cycle of impulsivity, self-sabotage, and a distorted sense of self-worth.


Drama Queens/Kings: Narcissists, Borderlines

Dramatic behavior is common in cluster B personality disorders, such as narcissistic, borderline, and antisocial personality disorders. Drama serves various psychological functions, including enhancing functionality, distancing oneself from trauma, regulating self-esteem, and manipulating others. It can also be a diversionary tactic or a form of emotional blackmail. While attention-seeking is often associated with dramatic behavior, it is not the primary motivation for most individuals with cluster B personality disorders.


Normal Personality and Personality Disorders

Personality is a complex pattern of deeply embedded psychological characteristics that are expressed automatically in almost every area of psychological function. Personality traits are enduring patterns of perceiving, relating to and thinking about the environment in oneself that are exhibited in a wide variety of social and personal contexts. Our temperament is the biological genetic template that interacts with our environment. Our character is largely the outcome of the process of socialization, the acts and imprints and edicts of our environment and nurture, and how they work on our psyche during the formative years, 0 to 6 and in other lists. Personality disorders are dysfunctions of our entire identity, tears in the fabric of who we are.


Labile: Borderline Personality Disorder and Narcissism

Borderline personality disorder is a controversial diagnosis that is often found among women. Some scholars believe it is a culture-bound pseudo-syndrome invented by men to serve a patriarchal and misogynistic society. Patients diagnosed with the disorder have chaotic lives and stormy, short-lived, and unstable relationships. Borderlines are impulsive, reckless, and display wildly fluctuating self-worth, self-image, and affect.


Why the Drama in Cluster B Personality Disorders

Drama is a central feature in the lives of individuals with Cluster B personality disorders, serving various psychological functions such as enhancing self-efficacy, regulating emotions, and creating dependency in relationships. Each disorder—psychopathy, borderline, narcissistic, and histrionic—utilizes drama differently, often as a means to manipulate others, avoid intimacy, or project internal conflicts onto external situations. The chaotic and unpredictable nature of drama allows these individuals to engage in risk-taking behaviors, maintain attention from others, and create a sense of importance and uniqueness. Ultimately, drama acts as a coping mechanism, enabling those with these disorders to navigate their internal struggles and external relationships in a way that feels adaptive, despite its destructive consequences.

Transcripts Copyright © Sam Vaknin 2010-2024, under license to William DeGraaf
Website Copyright © William DeGraaf 2022-2024
Get it on Google Play
Privacy policy