It may not just be an eating disorder

As hard as it is to accept that one's child has a life-threatening eating disorder requiring a complete shift of life priorities, sometimes it isn't just an eating disorder. I've known so many families who have successfully faced an eating disorder only to slowly realize that they are facing larger mental health issues.

Borderline Personality Disorder is one of those issues, and like most mental health issues, it's complicated. The greatest difficulty is in discerning whether the mood and behavioral issues are ED-related. Many patients with just an eating disorder show all the symptoms of BPD while they are ill and for a while afterward: irritability, reactivity, inability to manage moods, impulsivity, and a particular way of manipulating others to re-create rejection and anger.

BPD, unlike eating disorders, is generally lifelong. That is a difficult, difficult realization for a family - and one that should be carefully considered. Many mental health experts now say that BPD diagnosis should not be made until ED symptoms are gone for a year.

Confounding the issues, eating disorder recovery can make BPD symptoms even stronger because ED behaviors and physiology can serve as a self-medication for BPD: semi-starvation numbs emotion and binging and purging both offer brief physiological respite as well. Not to mention the function that illness and family drama can play in scratching the itch of internal distress.

The good news is there are now more tools for treating and coping with BPD and they can be good ones for any parents facing an eating disorder, I believe. I recommend the BPD literature to any parent of an ED patient whether the BPD symptoms are transient or lifelong.

One parent blogger with excellent advice and perspective on BPD is Desert Dweller. Must-read stuff.


  1. I really like this post :) I do not have any symptoms of BPD and so have never been given such a diagnosis. Nevertheless, I can (sort of) understand what it could feel like to have BPD - because during weight gain from low weight AN, one's emotions suddenly return with full force and it's really difficult to know how to manage them. I felt hugely emotionally unstable for the first couple of years of my recovery. It was simply that years of low-weight, restricting AN had numbed my emotions so completely that I didn't know how to cope with 'normal' emotions. I had the urge to self-harm and self-destruct. Thankfully, with continued weight gain I have got over that phase, but it was very frightening when I was in the midst of it all.

  2. Hi, Laura. Thank you for referring to my blog. I wanted to highlight a couple of sentences from the new book to which you've linked because the "blame game" continues to be practices as it is for ED, unfortunately.
    The authors write: "Borderline personality disorder develops when a child born with extremes of temperament and a biologically rooted difficulty managing emotions encounters a mismatched childhood environment. This mismatch may be quite subtle or quite pathological but is experienced by the child as inconsistent and unpredictable, leading her to develop a damaged sense of self and the expectation that others will continue to be inconsistent, unpredictable, and ultimately unreliable and abandoning." I think it's very important to note the word "subtle" and the phrase "....extremes of temperament and a biologically rooted difficulty managing emotions...."

  3. Jen, I'm so glad you bring that up! This is the reason I've always been squeamish about the BPD literature. I personally have no doubt that we will eventually discover that BPD happens in the full range of families and that the idea of an "invalidating" mismatch will be reviewed. I've known many families with kids with BPD and I believe the blame game here will fade away as we realize personality disorders happen in all kinds of families and that we know NOTHING about a family by the diagnosis.

    It behooves us to learn how to be the best parents we can to someone with this disorder but that doesn't mean we did something wrong that needs to be fixed - just that we often need specialized skills now.

  4. I too am squeamish about the blame game in BPD, and it's not just the parents who get it in buckets. Words like "manipulative" and "attention seeking" are frequently bounded about and used against the patient. All this, and the lack of any support and treatment for the disorder, has led my loved one to reject the label seeing it as a pejorative one given her in the midst of ED by a hostile clinician. In the sense that the label was given at the wrong time by the wrong person I agree totally with her. In the sense that it is useless in a climate where it is only used to exclude people from the direly limited amount of help that is available I agree with her. In the sense that it may not be the correct label I am not at all sure and am trying to read and learn and gain those specialised skills whatever name is finally given to the distress they aim to alleviate.


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