Reward and Restriction: Borderline Personality and Eating Disorders

Chris Clancy

February 20, 2019

Both Borderline Personality Disorder (BPD) and Eating Disorders (ED) are highly complex mental health conditions. However, when someone with BPD develops an ED, the manipulation of the person’s relationship with food manifests itself in even more complex ways.

EDs can develop throughout a person’s life span and can result from a variety of factors, including trauma, bullying, perfectionism, or dramatic life change. Disorders like anorexia, bulimia, and binge eating disorder are somewhat easy to diagnose professionally, due to their symptoms. For instance, a person living with anorexia will be visibly ill: emaciated, drawn, and sometimes displaying unusual hair growth.

A big part of the reason for these easily discernible symptoms is because the individual has fully committed to the approach. Individuals with anorexia starve themselves, individuals with bulimia purge, and so on.

“Unless someone has engaged in anorexic behaviors themselves, it is difficult to imagine how starvation might have its own ‘rewards,’ but it does,“ said Melissa O’Neill, LCSW, Director of Clinical Operations at Timberline Knolls, a residential treatment center in Lemont, Ill. “Cognitive processes are slowed down and impulsive thoughts are reduced, allowing for a state of emotional disconnect that provides a form of relief.

However, when the person living with ED also lives with BPD, identifying physical symptoms becomes much more challenging.

The Push-Pull of Borderline Personality Disorder (BPD)

Taking root in the child and adolescent years, as a result of some developmental trauma like neglect, ongoing invalidation, or abuse from an authority figure, BPD often does not “show up” until the twenties.

BPD is often defined by two behavioral features. First, those with this illness develop push-pull habits regarding interpersonal relationships. They can move from “I love you” to “I hate you,” seemingly in a heartbeat.

“Those with BPD often exist in an increased state of emotionality,” O’Neill said, “experiencing their feelings with a high level of intensity and changing very quickly.”

Because of the intensity of their emotional experiences and relationship struggles, friends and family often pull away, which leads to feelings of abandonment and isolation. It come as little surprise, then, that those with BPD often develop an ED as a maladaptive strategy to cope with their anguish.

What is curious about this relationship though, is how the manipulation of food manifests. Those with BPD frequently shift from bulimic behaviors to anorexic behaviors, back and forth.

If caught in extreme emotionality, the bingeing and purging of bulimia can provide relief. Or the radical consumption of food characteristic of binge eating disorder can serve as a distraction from this emotionality, while the act of purging by which anorexia is known provides an emotional catharsis, as well as endorphin release from the brain. A person living with BPD will choose from among these maladaptive strategies as their emotions warrant.

“An individual can easily struggle with BPD and an ED,” O’Neill said. “It is important to remember that treatment and recovery from both is absolutely possible.”

About Timberline Knolls

Timberline Knolls is a leading private residential treatment center for women and adolescent girls, ages 12 and over, with eating disorders, addiction, trauma, mood and co-occurring disorders.  Located in suburban Chicago, residents receive excellent clinical care from a highly trained professional staff on a picturesque 43-acre wooded campus. For more information on Timberline Knolls, call 877-257-9611. Timberline Knolls is also on Facebook, LinkedIn, and Twitter (@TimberlineToday).