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.

Borderline's Miracle Healing

Borderline personality disorder (BPD) is a mental health issue that affects 1-2% of the general population. Contrary to popular belief, BPD is not untreatable and has a positive prognosis over time. Studies have shown that most patients with BPD improve with time, and by age 45, a significant portion of patients will have healed spontaneously. However, while the disorder may remit, some dysfunctional behaviors persist, and there is a need for a two-step treatment approach: first, tackle the core disorder, and then focus on teaching the recovered patient functional skills.

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.

Attention Whores, Impulse Control, and Munchausen by Narcissist

Attention-bores, mostly women with histrionic and borderline personality disorders, use male attention to regulate their sense of self-worth. They become flirtatious, seductive, and trade sex for even the most inconsequential signs of attention from a man. Male attention serves a few important psychodynamic functions with these women, including reassuring them of their irresistibility and attractiveness, reasserting control and power of a man via her sex, and adrenaline junkies. Impulsive behaviors are addictive, and recurrences and recidivism are very common. As these women grow older, most of the signs and symptoms of borderline and histrionic personality disorder recede, unfortunately only to be replaced with dysthymia, background depression.

Borderline Woman as Dissociative Secondary Psychopath

Borderline Personality Disorder and Psychopathy may not be as different as previously thought. Recent studies suggest that Borderline and Histrionic Personality Disorders may be manifestations of secondary type psychopathy in women. Survivors of Complex Post-Traumatic Stress Disorder (CPTSD) also exhibit psychopathic and narcissistic behaviors. Borderline Personality Disorder can be described as a subspecies of Dissociative Identity Disorder, with mood lability and emotional dysregulation being outward manifestations of changes in self-states.

Psychosexuality of the Personality Disordered

Sexual behavior can reveal a lot about a person's personality, including their psychosexual makeup, emotions, cognitions, socialization, traits, heredity, and learned and acquired behaviors. Patients with personality disorders often have thwarted and stunted sexuality. For example, paranoid personality disorder patients depersonalize their sexual partners, while schizoid personality disorder patients are asexual. Histrionic personality disorder patients use their sexuality to gain attention and narcissistic supply, while somatic narcissists and psychopaths use their partners' bodies to masturbate with. Borderline personality disorder patients use their sexuality to reward or punish their partners, while dependent personality disorder patients use it to enslave and condition their partners.

The Three Voices: Histrionic, Psychopathic, Borderline

Borderline personality disorder is often comorbid with other personality disorders, such as histrionic, narcissistic, and antisocial. Women are predominantly diagnosed with these comorbidities, and borderline personality disorder is a post-traumatic state that is triggered by neglect, abandonment, and abuse. When comorbid with histrionic personality disorder, women seek comfort, acceptance, validation, sex, and intimacy from other men, but conflicting inner voices arise. The histrionic voice says men will make them feel better, the psychopathic voice says don't feel guilty about cheating, and the borderline voice says their sexuality is bad, mad, and dangerous. When faced with the prospect of sex, borderline patients panic because of negative thoughts, and if they cross the line and have full-fledged sex

GREAT NEWS New Treatments, BPD Redefined ( Borderline Personality Disorder Literature Review)

Recent studies have challenged common perceptions of borderline personality disorder. One study found that individuals can qualify for a diagnosis without engaging in self-harm or self-mutilation. Another study showed that combining individual and group schema therapy can lead to a reduction in symptoms for patients with borderline personality disorder. Additionally, a study suggested that early interventions focusing on clinical case management and psychiatric care may be more effective for young patients with borderline personality disorder than individual psychotherapy. Other studies explored the effectiveness of various psychotherapies and interventions for borderline personality disorder, with mixed results.

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.

Shyness or Narcissism? Avoidant Personality Disorder

Avoidant personality disorder is characterized by feelings of inadequacy, inferiority, and a lack of self-confidence. People with this disorder are shy and socially inhibited, and even constructive criticism is perceived as rejection. They avoid situations that require interpersonal contact and find it difficult to establish intimate relationships. The disorder affects 0.5 to 1% of the general population and is often co-diagnosed with mood and anxiety disorders, dependent and borderline personality disorders, and cluster A personality disorders.

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