eating Disorders , Anorexia nervosa, Bulemia nervosa , personality disorders, borderline personality disorders , treatment , comorbidity

1. BORDERLINE PERSONALITY
DISORDERS AND EATING
DISORDERS
By Heba Essawy MD., CEDS.,
Prof of Psychiatry
International Chapter chair –Egypt Iaedps
Head of Egyptian Association of Eating
Disorders
Head of Eating Disorders Clinics
Okasha Institute -Medical school
Ain Shams University.Cairo- Egypt

2. INTRODUCTION
• BPD and eating disorders can first appear in adolescence and
young adulthood and can occur together.
• It is estimated that about 54% of patients with BPD also have a
history of an eating disorder.
• BPD has shown to be present in about 25% of people with
anorexia nervosa and 28% of those with bulimia nervosa.
• These rates of eating disorders in the BPD population is much
higher than the general population which is 5-10%.
• This represents a large number of people with comorbid
disorders who may have impaired long-term functioning

3. ROADMAP
• 1- Onset
• 2- Biological correlates between BPD and Eds
• 3- Enviromental link between BPD and Eds
• 4- Emotional link between BPD and Eds

4. BPD AND EATING DISORDERS : ONSET
Both BPD and eating disorders are associated with
histories of:
• Childhood trauma : physical, sexual and emotional abuse.
• BPD develops before eating disorders and therefore
understanding and recognizing the relationship between
the two disorders is important to determine best course of
treatment.

5. BPD AND EATING DISORDERS : ONSET
• The criteria for diagnosing borderline personality
disorder (BPD) can parallel eating disorder
symptoms.
• 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, causing excessive instability.

6. CORRELATION BETWEEN BPD AND
EATING DISORDERS
• Eating disorders can function as behaviors through
which individuals with BPD can act out self-injurious,
self-harming tendencies using food as a platform.
• Bingeing functions to ‘fill’ an individual, temporarily
suppressing feelings of emptiness.
• Purging results in a euphoric ‘high’ of temporary
relief followed by fatigue, which combats emotional
increase of anger often experienced in BPD

7. 1-ENVIOROMENTAL AETIOLOGY :
TRAUMA IN CHILDHOOD
• Childhood Emotional Neglect (CEN) and Childhood
Emotional Abuse (CEA) are important in AN and BN
developments .
• CEN is a lack of emotional affection
appreciation for the child.
• CEA is a permanent hostile rejection or devaluation

8. 1-ENVIOROMENTAL AETIOLOGY :
TRAUMA IN CHILDHOOD
In Childhood Emotional Abuse
Prevalence rates IS
24% in AN-R
48% in AN-BP
81% in BN

9. 1-ENVIOROMENTAL AETIOLOGY :
CONSEQUENCES OF CHILDHOOD
TRAUMA
Invalidation
• Invalidatating the child s emotional responses either by
ignoring , dismissing or punishing them or oversimplifying the
problem
• The invalidating enviroment transacts with the childs
disposition towatd emotional vulnerability , thus incresing the
risk of developing BPD
• The child is afraid of his emotions ( Emotion phobic) and will
resort to self destructive ways to cope with negative emotions
with symptoms of disordered eating ( emotional eating)

10. 1-ENVIOROMENTAL AETIOLOGY :
CONSEQUENCES OF CHILDHOOD
TRAUMA
Methylation
• Childhood abuse, is considered as an enviromental
pressure that is associated with epigenetic effects
correlated with BPD and Eds
• Childhood abuse have been associated with increase
methylation of various glucocordicoid receptors gene
• Glucocorticoids receptor is central to modulating
individuals stress reactivity and anomalies in this system
are seen in BN and BPD
• Methylation of BN- BPD may be correlated

11. 2-NEUROBILOGICAL AETIOLGY : BRAIN –
DERIVED NEUROTROPHIC FACTOR
• Is implicated in the rgulation of food intake and
energy homeostasis
• BDNF is reduced in AN and BN
• Methylation of the BDNF gene is higher in BPD
than in general population
• Early stress and abuse have implication in
hypermethylation of the BDNF gene
Again creating a potential connection between
childhood abuse and BN and BPD

12. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS
• 1- Impulsivity :
- Exposure to an invalidating and traumatic
environment
- Difficulties in regulating emotions may account
for the association between childhood abuse
experiences and the development of borderline PDs
Thus, impulsive behaviors may serve as emotion
regulation strategies in abused patients with EDs.

13. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS : NEUROIMIGAING
• EDs have aberant frontostriatal neural circuity which
represent altered reward pathways . This will impare
regulation of appetide , emotion and self-control
• Altered funtion of limbic regions together with reduced or
exaggerated cognitive control ( via the PFC) are
contributing factors to either impulsive or exaggerated
self-control related symptoms or behavior
• The paralles between bulimia and BPD reveal that both
cases have higher levels of serotonin than PD
(Kessler 2016)

14. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS
2- Rejection Sensitivity
• Mediate the relationship between BPD and EDs
• Both displayed heightened sensitivity to rejection and
social criticism
• They hyperfocus on critical cues and feeling distress
from peer teasing and bulling
• Both have a maladaptive relationships
• They have a bias towards processing angry faces
• So a similar neural networks underlie RS in either
BPD and EDs

15. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS
• 3-Emotinal regulation and coping with stress
• Borderline personality disorder is characterized by
distinct impairments in emotion regulation
• Resulting in affective instability especially in the
social context.
• Impaired social cognitive functioning such as
impaired facial emotion recognition contributes to the
social disturbances in BPD

16. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS
3- Emotinal regulation and coping with stress
• BPD and BN have been proved that they have poor
emotinal regulation to cope with emotional distress
• In BN , patients impulsivively use binge eating to
reduce their distress or avoid their emotional state
• Affective instability , inappropriate anger and
impulsivity are commen in BPD and BN

17. 3-EMOTIONAL LINK BETWEEN BPD
AND EDS
• In one Egyptian study , revealed that BPD and BED ,
both have
-Emotional dysregulation
- Fear of abandonment
- Clarity of feelings
- Difficulty in understanding their emotions
( Randa Zahran et.,al., 2021)

18. TIPS TO GO
• 1- Good and appropriate handling for early childhood
trauma and abuse
• 2- Assess for eating behaviors in Personality disordrs
especially BPD
• 3- Ask for evidence of Borderline personality trait in
cases of disordered Eating and Eating disorders
• 4- In comorbid Eds and BPD treatment plan , start

19. • Thank you