How Common are Personality Disorders Among Patients with Eating Disorders?

This was a question posed by Dr. Astrid Von Lojewski and two colleagues at Royal North Shore Hospital, New South Wales, Australia (Psychopathol 2013. Feb 13 [Epub ahead of print]). Because personality disorders may act as risk factors for the development of some types of eating disorders, there has been interest in the possible relationship between the two. The results of studies over the past 30 years have been mixed (Nutr Clin Pract. 2010; 25:116.).

The Australian team first identified personality disorders among 132 female inpatients, using the International Personality Disorder Examination. The women were divided into four groups, those with restrictive anorexia nervosa (AN-R), binge-purging anorexia nervosa (AN-BP), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS).

What the researchers found

On this measure, a fifth of the patients (21%) had a definite personality disorder diagnosis (DSM-IV), and 37% had at least 1 definite or probable DSM-IV personality disorder diagnosis. Cluster C personality disorders were the most common (avoidant, 25%; obsessive-compulsive, 9%; dependent, 2%). The authors also identified Cluster B personality disorders: 13% of the women had borderline personality disorders and 2% had histrionic disorders.

The only behavior that was significantly associated with any personality disorder dimensional score (borderline and narcissistic) was self-induced vomiting. The authors concluded that assessing personality disorders using a highly structured interview administered by trained interviewers leads to fewer personality disorder diagnoses than by using other methods. In their study, avoidant personality disorder was identified most frequently and patients who self-induced vomiting were more likely to have borderline personality disorders.

Given the significant overlap between eating disorders and personality disorders, researchers are testing effective treatment approaches for clients who present with both BPD and an eating disorder. One promising area includes the use of Dialectical Behavior Therapy, or DBT. DBT has been effective for reducing impulsive and self-destructive behaviors in individuals with a primary diagnosis of borderline personality disorder. Early study results show that DBT reduces and often eliminates suicidal and self-injurious behaviors. It is also a promising intervention for women with a primary eating disorder diagnosis.