Eating Disorders And Personality Disorders

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Patients suffering from eating disorders binge on food and sometimes are both Anorectic and Bulimic. This is an impulsive behaviour as defined by the DSM (particularly in the case of BPD and to a lesser extent of Cluster B disorders in general). Some patients adopt these disorders as their way of self mutilating. We may be witnessing a convergence of two criteria: self-mutilation and an impulsive (rather, compulsive or ritualistic) behaviour.

The key to improving the mental state of patients with dual diagnosis (a personality disorder plus an eating disorder) lies in concentrating upon their eating and sleeping disorders. In my view, these disorders are a blessing in disguise.

It is very rarely, even in the lives of normal human beings, that they are faced with a veritable, identifiable enemy. By controlling their eating disorders, patients can assert control over their lives. This is bound to reduce their depression (even eliminate it altogether as a constant feature of their mental life). This is bound to ameliorate other facets of their personality disorders. Here is the chain: controlling eating disorders=controlling my life=I am worthy, I have self-confidence, self esteem and self-worth=I have a challenge, an interest, an enemy to subjugate=I am strong=I can socialize=I feel better (I am a success) etc.

When a patient has a personality disorder and an eating disorder, I see no point in concentrating at first on anything but his eating disorder. Personality Disorders are intricate and intractable. They are rarely cured (though certain aspects, like OCD, can be dealt with using medication). It calls for the enormous, persistent and continuous investment of resources of every kind by every one involved. This is not realistic. Also this is not a realistic threat. If a personality disorder is cured but the eating disorders are aggravated, the patient might die (though mentally healthy) ...

An eating disorder is both a signal of distress (I wish to die, I feel so bad, somebody help me) and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and out-take. This way I control at least ONE aspect of my life".

This is where we can and should begin to help the patient. Help him to regain control. The family or other supporting figures must think what they can do to make the patient feel that he is in control, that he manages things his own way, that he is contributing, has his own schedules, his own agenda, possesses both authority and responsibility.