Understanding the link between BPD and eating disorders

Borderline personality disorder (BPD) and eating disorders (EDs) are different mental health conditions that frequently co-occur. In fact, research shows BPD to be the most prevalent co-occurring personality disorder in people who have eating disorders.

Eating disorders affect about 9% of the general population. Among people with BPD, however, that percentage might be higher. Research shows that people with BPD have a co-occurring eating disorder.

If you’re concerned about your relationship with food, approach to meals and eating, or emotional well-being, it might be helpful to learn more about eating disorders and BPD. Exploring this connection can help you better understand yourself, identify possible symptoms, and feel empowered to ask for help.

How do BPD and EDs interact?

Disordered eating isn’t an officially recognized symptom of BPD. However, certain BPD symptoms may contribute to disordered eating behaviors. When a person has both an eating disorder and BPD, they might be more likely to experience:

Negative self-image

People with co-occurring BPD and an eating disorder are more likely to have a negative view of their bodies. This perception — when combined with feelings of emptiness — may increase restrictive eating, eating concerns, body dissatisfaction, and other ED symptoms.

Perfectionism

People with co-occurring BPD and an eating disorder might be more perfectionistic. Wanting to achieve an idealized or unrealistic body size may lead to the restrictive eating that’s associated with anorexia.This is partly due to feeling that your internal world may be out of control, so having something to “perfect” and focus on fulfills that need for control. People also share that BPD leads to feelings of low self-worth in relation to others and the need to “make up for it” on the outside.

Impulsivity

People with BPD and bulimia or binge eating disorder (BED) may be more prone to impulsivity and difficulties with self-regulation. These challenges can manifest within the binge-purge cycle associated with these conditions.

We don’t know all the reasons a person with BPD might be more likely to have an eating disorder. But it might be due to a few shared risk factors. These factors may be:

• Biological: Research indicates that BPD and eating disorders affect similar parts of the brain. Specifically, the neural networks that control rejection sensitivity and the ability to process angry faces may be compromised in similar ways for people with BPD and eating disorders.

• Psychological: People with BPD and eating disorders are more likely to experience emotional dysregulation, as well as co-occurring conditions, like anxiety or depression. Interventions aimed at improving emotional regulation can be helpful for people living with both conditions.

• Environmental: BPD and eating disorders can both cause an intense fear of criticism in social settings. This is known as rejection sensitivity, and some research suggests that this experience might serve as a bridge between BPD and eating disorders.

Clinican's take

One pattern that often comes up with those who experience BPD and an ED is how emotional regulation and impulsivity intertwine. Disordered eating can become a coping mechanism for regulating one's emotions, and impulsive behaviors make it difficult to stop episodes of risky dietary practices.

Ashley Ayala, LMFT

Clinical reviewer

Which eating disorders are prevalent with borderline personality disorder?

Several different types of eating disorders frequently co-occur with BPD. However, they do so at different rates.

• 10% of people with anorexia (restricting type) have BPD

• 25% of people with binge eating disorder (BED) (purging type) have BPD

• 28% of people with bulimia have BPD

Research consistently shows that, when eating disorders and BPD co-occur, there’s an increased risk of distress, self-harm, and suicidality.* Increasing your awareness of the signs of these conditions can help you keep yourself and others safe.

*A note on safety: If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. Their counselors will provide confidential support and resources to help keep you safe.

Treatment approaches for BPD with disordered eating

Having an eating disorder and co-occurring BPD can make it more difficult to achieve positive outcomes in treatment. However, there are supports available that can help you manage your symptoms and improve your health.

Dialectical behavioral therapy (DBT) was created to help people living with BPD. But it’s been successfully modified to help people living with eating disorders as well. DBT focuses on helping people improve their emotional regulation and reduce harmful behaviors. It encourages participants to accept themselves and their bodies and replace unhealthy behaviors (like disordered eating) with healthy coping strategies. DBT can be conducted individually or in a group setting, either in person or online.

In addition to participating in a therapy like DBT, it may also be helpful to talk to your therapist about an aftercare plan. Relapse is a common part of recovery for people with eating disorders and/or BPD. But it doesn’t need to derail your progress. It’s how you respond to a relapse that counts. So take some time to consider your triggers or warning signs and think about what will help you get back on track if you experience a relapse.

Find care with Rula

BPD and eating disorders often go hand in hand. While we don’t understand all the reasons for this connection, it’s likely due to some shared biological, psychological, and environmental risk factors. Living with these conditions can make it difficult to regulate your emotions, connect with others, choose healthy behaviors, and nourish your body. But know that, with treatment, you can improve your well-being.

No matter the issues you’re facing, with Rula, you can access specialized, affordable mental healthcare via convenient virtual appointments. When you need support, you can use our therapist-matching program to explore our extensive network and choose a provider that’s right for you. In just a few clicks, you can sort through your options, find a therapist or psychiatric provider who takes your insurance, and schedule your first live video session for as soon as tomorrow.