Eating disorders are a spectrum of behaviors that typically involve extreme dieting, binge eating, inappropriate use of laxatives and diuretics, and excessive exercise. Eating disorders (EDs) are generally diagnosed using the criteria from the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5). The DSM-5 includes three main types of eating disorders: eating disorder not otherwise specified (EDNOS), anorexia nervosa (AN), and bulimia nervosa (BN). EDs have the highest mortality rate of any mental illness and have been associated with higher rates of depressive and anxiety disorders, self-harm, and suicide attempts. EDs can be a significant risk factor for BPD, as individuals with BPD have higher rates of EDs than people without BPD. Family environment and internalization of cultural beauty expectations are thought to contribute to development of EDs in vulnerable individuals.
Being diagnosed with borderline personality disorder (BPD) often comes as a shock for patients and their families. However, the research done on the association between BPD and eating disorders is showing us that specific personality disorders may be shaping corresponding styles of eating pathology.
In BPD, people tend to be extremely sensitive to rejection or criticism, which often triggers a cascade of intense and negative thoughts and emotions which require intervention at the top rehabs in India. The person may engage in self-destructive behavior (such as self-cutting or suicidal gestures), or lash out at others. These frequent and intense mood swings, which can be brought on by stressful situations, have led some researchers to propose that people with BPD may have abnormalities in the areas of the brain that regulate emotions.
The criteria for diagnosing one with a personality disorder such as borderline personality disorder (BPD) can parallel eating disorder symptoms. And, the physical or emotional effects of the eating disorder can generate the symptoms of BPD. Therefore, EDs and BPD work together as a positive feedback loop, exponentially moving one away from his/her equilibrium state causing excessive instability.
Eating disorders can become a way for people with BPD to act out self-destructive tendencies by using food as a means to hurt themselves. Bingeing allows people to fill themselves up, temporarily numbing the pain of feelings of emptiness. Purging results in a momentary high that is followed by fatigue, helping to combat the sudden surges of anger often experienced by those with BPD.
Eating disorders can be seen as unhealthy coping mechanisms to deal with perceived chaos in life. These disorders redirect a person's focus and attention inward, often leading them to manipulate their body and weight as a way to exert control. This can manifest in disordered eating behaviors such as starvation, overeating, and purging, which then require help and treatment at the best luxury rehabilitation centers in India.
EDs can also be used to deal with feelings in a negative way (binge eating disorder and/or bulimia nervosa), get rid of feelings (bulimia nervosa and/or exercise bulimia) or numb feelings (anorexia nervosa). These eating behaviors look like they could be helpful skills to deal with life, yet these unhealthy tactics are self-destructive and not sustainable, long-term and thus require professional help from the best depression and anxiety treatment centers in India.
When it comes to eating disorders, more often than not it's emotional hunger that's driving the bus, rather than physical hunger. In other words, we're letting our feelings dictate when and how much we eat, instead of listening to our bodies. Depending on the person, different emotions can have opposite effects on eating habits--making someone either want to eat more or less.
Learning how to self-soothe and eat intuitively are both important components of treating an eating disorder. Intuitive eating, or mindful eating, is a process of re-learning how to trust your own body to eat what you want and when you want by listening to internal cues of hunger and fullness. This can be difficult to do at first, but with practice it can become second nature and are administered at the top rehabs in Delhi.
It can be difficult to effectively treat a co-occurring disorder if the BPD is not also treated appropriately. For example, if there is an eating disorder present along with BPD, both disorders must be treated in order to properly address the BPD. Speed of treatment can improve when the comorbid disorder is also treated properly. Eating disorders and BPD often go hand-in-hand, so it can be difficult to focus on just one without inadvertently affecting the other. If you have both co-occurring disorders, it's important to be aware of this and make a conscious effort to work on both simultaneously from the best rehabs in India.
The four most common eating disorders found in those with BPD are: 1) Bulimia Nervosa, 2) Binge Eating Disorder, 3) Anorexia Nervosa, and 4) OSFED (otherwise specified feeding and eating disorder; atypical eating disorders).
Clinical experience suggests that disordered eating and actual eating disorders are common among patients with borderline personality disorder (BPD). However, only six cross-sectional studies have assessed the prevalence of eating disorders in samples of criteria-defined borderline patients. [1][2][3][4][5][6]
In general, these studies found that both anorexia nervosa (range: 3–21%; median=6%) and bulimia nervosa (range: 0–26%; median=10%) are relatively uncommon. These studies have also found that neither anorexia nor bulimia was significantly more common among patients with BPD than among comparison subjects. In contrast, eating disorder not otherwise specified (EDNOS), which was first included in our nomenclature in DSM-III-R, has been found to be relatively common (range: 14–26%; median=22%) but not discriminating. [4][5][6]
In addition, only two longitudinal studies have determined the course of eating disorders in samples of rigorously diagnosed borderline patients. [7][8]
The prevalence of anorexia, bulimia, and EDNOS were studied over six years of prospective follow-up in the McLean Study of Adult Development (MSAD). It was found that the prevalence of anorexia and bulimia (but not EDNOS) declined significantly over time in both patients with BPD and patients with other axis II disorders.
Bulimia Nervosa (BN)
Bulimia nervosa is a serious and potentially life-threatening eating disorder. People with bulimia nervosa typically eat large amounts of food in a short period of time (bingeing) and then try to compensate for the binge by purging, which can involve self-induced vomiting, abuse of laxatives or diuretics, fasting, or obsessive or compulsive exercise. People with bulimia nervosa often have an extreme concern with their body weight and shape.
Binge Eating Disorder (BED)
Binge eating disorder, as defined by the DSM-5 (2013, American Psychiatric Association), is characterized by recurrent episodes of eating large amounts of food (>2,000 calories in one sitting) within a discrete period of time (any two-hour period).
Binge eating is a serious problem that can have severe consequences on one's health. Some signs that someone may be binge eating include eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, and eating alone because of embarrassment or shame about food consumption. If you or someone you know is experiencing these symptoms, it is important to get help from a professional from the top luxury rehabs in Delhi.
Binge eating disorder is a type of eating disorder where people eat a lot of food in a short amount of time. People with binge eating disorder often eat when they're not hungry and continue eating even after they're full. Binge eating disorder is different from bulimia nervosa because people with bulimia nervosa use compensatory behaviors (like taking diet pills, laxatives, or diuretics) to prevent weight gain.
When a person binge eats, they may consume 2,000-5,000 calories or more in a single sitting. Many people report feeling a "high" after this massive intake of food. This phenomenon can be explained by research which shows that binge eating can impact the release of serotonin, a chemical which stimulates the reward center in the brain and regulates feelings of pleasure. When we look at food as a drug in this way, for some people - especially in the case of Binge Eating Disorder - food is being used as a drug.
However, unlike traditional substance abuse, one suffering from BED cannot simply stop using their drug—food, as one must eat to survive. Therefore, the individual must learn to moderate their eating through seeking treatment for eating disorder recovery.
Anorexia Nervosa (AN)
The Diagnostic and Statistical Manual of Mental Disorders-IV defines anorexia nervosa as a refusal to maintain body weight at or above the normal weight for the patient’s age and height. Other criteria include either a loss of weight or the maintenance of weight that is less than 85 percent of the normal weight.
Anorexia Nervosa symptoms can include severe weight loss, intense fear of gaining weight, body dissatisfaction, or denial of the seriousness of low body weight. Girls and women of childbearing age may also experience amenorrhea, or loss of menstrual periods.
Results of studies suggest that the prognosis for both anorexia and bulimia in borderline patients is complicated, with remissions being stable but migrations to other eating disorders being common. The results also suggest that EDNOS may be the most prevalent and enduring of the eating disorders in these patients. [9]
Eating disorders can often feel overwhelming and like they are in control, but with the right treatment plan and support from the best luxury rehabs in India, you can overcome these challenges. It's important to remember that eating disorders often arise during transitional phases in life, so having the proper resources in place can help you during your recovery process.
No matter how severe the problem, you can recover from an eating disorder and lead a happy and fulfilling life. You will learn how to eat freely while embodying a healthy relationship with food, along with self-acceptance and gratitude for your body.
LIST OF REFERENCES-
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- 2. Zanarini MC, Gunderson JG, Frankenburg FR. Axis I phenomenology of borderline personality disorder. Compr Psychiatry. 1989;30:149–156. https://pubmed.ncbi.nlm.nih.gov/2920550/
- 3. Coid JW. An affective syndrome in psychopaths with borderline personality disorder? Br J Psychiatry. 1993;162:641–650. https://pubmed.ncbi.nlm.nih.gov/8149116/
- 4. Zanarini MC, Frankenburg FR, Dubo E, Sickel A, Trikha A, Levin A, Reynolds V. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–1739. https://pubmed.ncbi.nlm.nih.gov/9842784/
- 5. Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder. Comp Psychiatry. 1999;40:245–252. https://pubmed.ncbi.nlm.nih.gov/10428182/
- 6. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, et al. The collaborative longitudinal personality disorders study: baseline Axis I/II and Axis II/II co-occurrence. Acta Psychiatr Scand. 2000;102:256–264. https://pubmed.ncbi.nlm.nih.gov/11089725/
- 7. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161:2108–2114. https://pubmed.ncbi.nlm.nih.gov/15514413/
- 8. Grilo CM, Pagano ME, Skodol AE, Sansilow CA, McGlashan TH, Gunderson JG, et al. Natural course of bulimia nervosa and eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology. J Clin Psychiatry. 2007;68:738–746 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527481/
- 9. Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord. 2010 Apr;43(3):226-32. doi: 10.1002/eat.20689. PMID: 19343799; PMCID: PMC2839025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839025/
AUTHOR - Dr. Danish Hussain (MBBS, MD Psychiatry, MIPS)
Dr. Danish received his M.D. Psychiatry and M.B.B.S. degrees from Rajiv Gandhi University of Medical Sciences (Bangalore, Karnataka). He has worked at the Manipal Multispecialty Hospitals Bangalore, following which has continued to undergo regular training from prestigious institutes from all over the world. Dr. Danish serves as Assistant Professor and Head of Department of Psychiatry at AFSMS & RC and is a member of Indian Psychiatric Society. Dr. Danish uses a holistic approach with his patients and brings his expertise at practice to treat varied behavioral health problems from Addiction disorders to Depression, Anxiety, Personality disorders and OCD. Dr. Danish’s goal is to educate and inform the public on addiction issues and help those in need of treatment find the best option for them.
REVIEWED BY - Gauri Kapoor (Addiction Recovery Counselor)
Gauri Kapoor embarked on her journey into sobriety 7 years ago, which led her to her current career path as a Certified Professional Addiction Recovery Coach in Delhi, India. She works closely with facilities that provide residential addiction treatment such as 12-Step programs and other nonprofits to help individuals deal with their addiction. Gauri embraces a holistic, client-centered approach to her work. She brings a natural warmth and genuineness into her sessions and is known for her ability to establish therapeutic relationships based on trust, safety and mutual respect.