Borderline Personality Disorder (BPD) & Eating Disorders: The Complex Connection

Borderline Personality Disorder (BPD) and eating disorders (EDs) often co-occur, creating a complex and emotionally intense cycle of impulsivity, fear of abandonment, self-destructive behaviors, and difficulties with emotional regulation. Individuals with both conditions may struggle with extreme emotions, unstable self-image, and disordered eating as a way to cope with distress.

Why Do BPD and Eating Disorders Often Co-Occur?

·         Key Shared Features of BPD & eating disorders:

o   Emotional Dysregulation

§  Intense mood swings

·         From extreme sadness to anger, often within minutes

§  Food becomes a coping mechanism

·         Restriction, bingeing, or purging helps numb emotions or regain a sense of control

o   Impulsivity and self-destructive behaviors

§  Binge eating, purging, substance use, reckless spending, or self-harm may co-occur

§  Impulsive decisions in relationships, eating, or life choices

o   Fear of abandonment and unstable relationships

§  Extreme sensitivity to rejection → May restrict food, binge, or purge after emotional triggers

§  ED behaviors may be used to gain validation from others or manage body-related insecurities

o   Identity disturbance and body image issues

§  Unstable sense of self

·          Shifting beliefs about self-worth, attractiveness, and identity

§  Dissociation from the body

·         Feeling disconnected from physical sensations and hunger cues

o   Self-harm and suicidal ideation

§  Self-harm (cutting, burning, overdosing) occurs in up to 75% of individuals with BPD

§  Purging or extreme restriction may be used as self-punishment

o   Both conditions involve emotional distress, impulsivity, and identity struggles, reinforcing each other in a dangerous cycle.

Eating Disorders in Individuals with BPD: How They Manifest

Most Common EDs in BPD:

Eating Disorder Type

How It Manifests in BPD

Binge-Eating Disorder (BED)

Emotional eating after abandonment fears, impulsive bingeing for comfort, intense guilt afterward.

Bulimia Nervosa (BN)

Binge-purge cycles triggered by emotional distress, impulsivity, or self-punishment.

Anorexia Nervosa (AN)

Food restriction as a way to control emotions, avoid rejection, or punish oneself.

Atypical or Mixed ED Behaviors

Periods of restriction followed by impulsive bingeing/purging, extreme dieting, and body-checking.

Many individuals with BPD switch between different ED behaviors depending on emotional triggers.

The Emotional Cycle of BPD and Eating Disorders

·         How BPD & eating disorders reinforce each other:

o   Emotional triggers (rejection, stress, self-doubt)

o   Dysregulated response (intense sadness, anger, dissociation) →

o   Disordered eating behavior (bingeing, purging, restricting) to cope →

o   Temporary relief (momentary numbing or distraction) →

o    Guilt and shame (self-hate, feeling “out of control”) →

o   Repeat the cycle (leading to further emotional distress & ED behaviors)

·          Disordered eating behaviors in BPD serve as short-term emotional coping mechanisms but worsen distress over time

How to Treat BPD and Co-Occurring Eating Disorders

·         Best Therapy Approaches for Dual Diagnosis (BPD and eating disorders):

o   Dialectical Behavior Therapy (DBT)

§  Gold-standard treatment for BPD, helps with impulse control, emotional regulation, and distress tolerance

o   Cognitive Behavioral Therapy for Eating Disorders (CBT-E)

§  Restructures food-related beliefs & binge-purge cycles

o   Radically Open DBT (RO-DBT)

§  Helps with rigid thinking and emotional overcontrol (common in restrictive EDs)

o   Trauma-Focused Therapy (EMDR, CPT)

§  Addresses past trauma that may fuel ED & BPD symptoms

o   Family-Based Treatment (FBT) for younger patients

§  Involves parents in meal support and emotional healing

·         Medication Considerations:

o   SSRIs (Prozac, Lexapro)

§  May help with anxiety, depression, and mood swings.

o   Mood stabilizers (Lamotrigine, Lithium)

§  Useful for severe emotional instability

o   Atypical antipsychotics (Abilify, Seroquel)

§  Sometimes prescribed for severe impulsivity and emotional dysregulation

o   A combination of DBT, CBT-E, and possible medication is most effective for managing both BPD and eating disorders

How to Cope with Emotional Triggers Without Turning to ED Behaviors

Healthy Coping Skills for BPD and eating disorders

·         Distress tolerance strategies (DBT Skills)

o   TIPP (Temperature, Intense Exercise, Paced Breathing, Paired Muscle Relaxation)

§  Helps calm emotional overwhelm quickly

o   Ice Diving or Holding Ice

§  Activates the dive reflex, reducing anxiety and urges to purge/binge

o   5-4-3-2-1 Grounding Exercise

§  Stops dissociation and binge/purge urges

·         Emotional Regulation Techniques

o   Journaling thoughts before acting on them

§  Helps identify triggers and patterns

o   Self-soothing techniques

§  Weighted blankets, calming music, deep pressure therapy

o   Opposite Action

§  If you feel the urge to binge/purge/restrict, do something opposite to the emotion (e.g., self-care, connecting with someone)

·         Building a Support System

o   Therapy (DBT or eating disorder-focused) for professional support

o   Support groups for both BPD and eating disorder recovery (e.g., ANAD, NEDA, EDA, DBT skills groups)

o   Trusted friends/family for accountability in meal support and emotional regulation

·         Replacing ED behaviors with distress tolerance techniques helps prevent relapse

Preventing Relapse in Recovery

Long-Term Recovery Strategies:

·         Stick to structured meals

o   Prevents impulsive restriction/bingeing

·         Create a relapse prevention plan

o   Identify warning signs & coping strategies

·         Use mindfulness-based eating techniques

o   Prevents emotional eating

·         Keep a journal tracking emotional triggers and progress

·         Address trauma in therapy 

o   Prevents past wounds from fueling eating disorder/BPD cycles

Final Thought: Recovery is possible with the right combination of therapy, emotional skills, and a strong support system. With time, both ED and BPD symptoms can be managed, leading to a healthier and more fulfilling life.

Disclaimer: This information is intended for educational purposes and should not replace professional medical advice. If you or someone you know is in crisis or needs immediate help, please contact a healthcare professional or crisis intervention service immediately.