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Depression and Personality Disorders

Eating disorders and personality disorders are two conditions that are often co-occurring. That being said, a person can have an eating disorder and not have a personality disorder and vice versa. Though the two conditions often occur at the same time, little was understood about their relationship with one another until recently. In order to grasp an understanding of these two complex and related conditions, it’s necessary to tease out their differences as well as their similarities.

Understanding Eating Disorders

According to the DSM-5, there are two types of eating disorders that are recognized: bulimia nervosa and anorexia nervosa. Though both of these eating disorders are related because they indicate that the person has a severe issue with eating, there are some crucial differences. A person who has bulimia nervosa, for example, demonstrates binge eating, followed by one or more behaviors that are designed to compensate for the overeating. Anorexia nervosa, on the other hand, is centered around the fact that the individual is engaging in behaviors that don’t allow him or her to maintain a medically appropriate body weight.

What Are Personality Disorders?

It’s understood that there are a total of 10 personality disorders. DSM-5 specifies that a personality disorder can be diagnosed if the individual demonstrates significant impairments in both their interpersonal relationships and their relationship with themselves. Additional features include a fairly stable demonstration of these symptoms and their inability to be explained by their socio-cultural environment, developmental stage, medical condition or substance ingestion.

Personality disorders are classified into three clusters depending on their similarities: Cluster A (odd, eccentric, bizarre), Cluster B (erratic, dramatic) and Cluster C (fearful, anxious). While each cluster has its own central feature that differentiates it from other clusters, something that is now well established is the fact that having a personality and an eating disorder often go together.

McLean Hospital’s Dr. Mary Zanarini studied patients with a personality disorder and found that 24.6 of them also met the criteria for an eating disorder. For those patients who had a borderline personality disorder, that percentage jumped to 53.8 percent. While about 8 percent of the general population has an obsessive-compulsive personality disorder, that incidence rises to 22 percent if a person also has anorexia nervosa.

Personality Disorder and Eating Disorder Personality Traits

There are two personality disorders that are most common for co-occurring along with an eating disorder: obsessive-compulsive personality disorder and borderline personality disorder. By taking a look at the common characteristics that an individual often displays if they have either of those personality disorders, a clearer connection between emerges.

An obsessive-compulsive personality disorder is characterized by personality traits such as detail-oriented, perfectionist, well-ordered and organized. These are many of the same personality traits that are found in those individuals with anorexia nervosa. When taking a look at some of the common characteristics of borderline personality disorder, things such as being impulsive, angry and volatile while feeling empty and engaging in self-harming behaviors are the same ones that are often associated with bulimia and anorexia nervosa.

Treatment for Eating Disorders and Personality Disorders

The data showing the link between personality disorders and eating disorders makes it clear that the ideal treatment plan is one that addresses both disorders. The personality traits associated with eating disorders are often the same ones associated with personality disorders. For this reason, it’s only natural to think that both conditions can be treated simultaneously. While many individuals are able to follow a treatment plan that allows for this approach, the decision to do so is made on a case-by-case basis.

In some instances, for example, an individual who has severe borderline personality disorder symptoms that could reduce their ability to engage in treatment. These borderline personality disorder symptoms would likely need to be the focus of any treatment prior to addressing their eating disorder. The same approach could also be warranted if an individual with an eating disorder had symptoms that were so severe that her or his life were in danger, then the treatment plan would focus on addressing the eating disorder first before the personality disorder.