Comorbidity of Borderline Personality Disorder and Disordered Eating: A Difficult Challenge for Psychiatry?
DOI:
https://doi.org/10.12974/2313-1047.2023.10.05Keywords:
disordered eating, borderline personality disorder, food addiction, Impulsivity, attentional impulsivity, personalized treatmentAbstract
Background; Disordered eating is common in individuals with Borderline Personality Disorder (BPD). Both BPD and certain forms of disordered eating are known to be associated with poor impulse control. Our aim is to identify the clinical and psychometric characteristics of patients with BPD and disordered eating, with particular emphasis on impulsivity.
Methods; A convenience sample of patients with DSM-IV BPD was enrolled from five Italian outpatient mental health services. The BPD sample was divided into two groups according to the presence of clinically significant disordered eating and compared with a third group of outpatients with only disordered eating.
Results; In the BPD sample, 52% had disordered eating. Patients with BPD+disordered eating had more lifetime suicide attempts (p=0.046) and hospitalizations (p=0.038) and showed higher impulsivity on the Barratt-Impulsiveness-Scale (p=0.026) specifically in the domain of attentional impulsivity (p<0.001), as well as greater depressive symptoms on the Beck-Depression-Inventory (p=0.006). A correlation was found between attentional impulsivity and all of the Eating-Disorder-Examination-Questionnaire subscales apart from the restriction one.
Conclusions; Disordered eating is common among individuals with BPD and these patients represent a significantly more impulsive subgroup with a higher rate of suicidality, and therefore a challenge for clinicians. Attentional impulsivity could represent a novel treatment target for this group of individuals.
References
Avena, N.M., Bocarsly, M.E., Hoebel, B.G., Gold, M.S., 2011. Overlaps in the nosology of substance abuse and overeating: the translational implications of "food addiction." Curr Drug Abuse Rev 4, 133-139. https://doi.org/10.2174/1874473711104030133
Appelhans, B. M. (2009). Neurobehavioral Inhibition of Reward-driven Feeding: Implications for Dieting and Obesity. Obesity, 17(4), 640-647. https://doi.org/10.1038/oby.2008.638
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. https://doi.org/10.1037/t00742-000
Bi, B., Liu, W., Zhou, D., Fu, X., Qin, X., & Wu, J. (2017). Personality traits and suicide attempts with and without psychiatric disorders: Analysis of impulsivity and neuroticism. BMC Psychiatry, 17(1), 294. https://doi.org/10.1186/s12888-017-1453-5
Calugi, S., Milanese, C., Sartirana, M., El Ghoch, M., Sartori, F., Geccherle, E., Coppini, A., Franchini, C., & Dalle Grave, R. (2017). The Eating Disorder Examination Questionnaire: Reliability and validity of the Italian version. Eating and Weight Disorders: EWD, 22(3), 509-514. https://doi.org/10.1007/s40519-016-0276-6
Chamberlain, S. R., & Sahakian, B. J. (2007). The neuropsychiatry of impulsivity. Current Opinion in Psychiatry, 20(3), 255-261. https://doi.org/10.1097/YCO.0b013e3280ba4989
Cooper, Z., Cooper, P. J., & Fairburn, C. G. (1989). The validity of the eating disorder examination and its subscales. The British Journal of Psychiatry: The Journal of Mental Science, 154, 807-812. https://doi.org/10.1192/bjp.154.6.807
Cox, W. M., Fadardi, J. S., Intriligator, J. M., & Klinger, E. (2014). Attentional bias modification for addictive behaviors: Clinical implications. CNS Spectrums, 19(3), 215-224. https://doi.org/10.1017/S1092852914000091
Fichter, M. M., Quadflieg, N., & Rief, W. (1994). Course of multi-impulsive bulimia. Psychological Medicine, 24(3), 591-604. https://doi.org/10.1017/S0033291700027744
Fineberg, N. A., Potenza, M. N., Chamberlain, S. R., Berlin, H. A., Menzies, L., Bechara, A., Sahakian, B. J., Robbins, T. W., Bullmore, E. T., & Hollander, E. (2010). Probing Compulsive and Impulsive Behaviors, from Animal Models to Endophenotypes: A Narrative Review. Neuropsychopharmacology, 35(3), 591-604. https://doi.org/10.1038/npp.2009.185
First, MB., Gibbon M, Spitzer RL, Williams, JBW, & Benjamin LS. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). Washington, D.C.: American Psychiatric Press, Inc.
Fossati, A., Di Ceglie, A., Acquarini, E., & Barratt, E. S. (2001). Psychometric properties of an Italian version of the Barratt Impulsiveness Scale-11 (BIS-11) in nonclinical subjects. Journal of Clinical Psychology, 57(6), 815-828. https://doi.org/10.1002/jclp.1051
Gearhardt, A. N., White, M. A., Masheb, R. M., & Grilo, C. M. (2013). An examination of food addiction in a racially diverse sample of obese patients with binge eating disorder in primary care settings. Comprehensive Psychiatry, 54(5), 500-505. https://doi.org/10.1016/j.comppsych.2012.12.009
Gearhardt, A. N., White, M. A., Masheb, R. M., Morgan, P. T., Crosby, R. D., & Grilo, C. M. (2012). An examination of the food addiction construct in obese patients with binge eating disorder. International Journal of Eating Disorders, 45(5), 657-663. https://doi.org/10.1002/eat.20957
Heatherton, T. F., & Wagner, D. D. (2011). Cognitive neuroscience of self-regulation failure. Trends in Cognitive Sciences, 15(3), 132-139. https://doi.org/10.1016/j.tics.2010.12.005
Hege, M. A., Stingl, K. T., Kullmann, S., Schag, K., Giel, K. E., Zipfel, S., & Preissl, H. (2015). Attentional impulsivity in binge eating disorder modulates response inhibition performance and frontal brain networks. International Journal of Obesity, 39(2), 353-360. https://doi.org/10.1038/ijo.2014.99
Hou, R., Mogg, K., Bradley, B. P., Moss-Morris, R., Peveler, R., & Roefs, A. (2011). External eating, impulsivity and attentional bias to food cues. Appetite, 56(2), 424-427. https://doi.org/10.1016/j.appet.2011.01.019
Jonge, P. V. H. D., Furth, E. F. V., Lacey, J. H., & Waller, G. (2003). The prevalence of DSM-IV personality pathology among individuals with bulimia nervosa, binge eating disorder and obesity. Psychological Medicine, 33(7), 1311-1317. https://doi.org/10.1017/S0033291703007505
Kennedy, H. G., & Grubin, D. H. (1990). Hot-headed or impulsive? British Journal of Addiction, 85(5), 639-643. https://doi.org/10.1111/j.1360-0443.1990.tb03525.x
Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., & Reinecker, H. (2010). Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up. Journal of Behavior Therapy and Experimental Psychiatry, 41(4), 381-388. https://doi.org/10.1016/j.jbtep.2010.04.001
Lacey, J. H., & Evans, C. D. H. (1986). The Impulsivist: A multi-impulsive personality disorder. British Journal of Addiction, 81(5), 641-649. https://doi.org/10.1111/j.1360-0443.1986.tb00382.x
Lilenfeld, L. R. R., Wonderlich, S., Riso, L. P., Crosby, R., & Mitchell, J. (2006). Eating disorders and personality: A methodological and empirical review. Clinical Psychology Review, 26(3), 299-320. https://doi.org/10.1016/j.cpr.2005.10.003
Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah, D., Namia, C., Novella, L., & Petrachi, M. (1997). Interrater reliability and internal consistency of the structured clinical interview for DSM-IV axis II personality disorders (SCID-II), version 2.0. Journal of Personality Disorders, 11(3), 279-284. https://doi.org/10.1521/pedi.1997.11.3.279
Marino, M. F., & Zanarini, M. C. (2001). Relationship between EDNOS and its subtypes and borderline personality disorder. The International Journal of Eating Disorders, 29(3), 349-353. https://doi.org/10.1002/eat.1029
Martinussen, M., Friborg, O., Schmierer, P., Kaiser, S., Øvergård, K. T., Neunhoeffer, A.-L., Martinsen, E. W., & Rosenvinge, J. H. (2017). The comorbidity of personality disorders in eating disorders: A meta-analysis. Eating and Weight Disorders: EWD, 22(2), 201-209. https://doi.org/10.1007/s40519-016-0345-x
Mason, T. B., Smith, K. E., Lavender, J. M., & Lewis, R. J. (2018). Independent and interactive associations of negative affect, restraint, and impulsivity in relation to binge eating among women. Appetite, 121, 147-153. https://doi.org/10.1016/j.appet.2017.11.099
Matsunaga, H., Kiriike, N., Iwasaki, Y., Miyata, A., Matsui, T., Nagata, T., Yamagami, S., & Kaye, W. H. (2000). Multi-impulsivity among bulimic patients in Japan. International Journal of Eating Disorders, 27(3), 348-352. https://doi.org/10.1002/(SICI)1098-108X(200004)27:3<348::AID-EAT13>3.0.CO;2-F
McElroy, S. L., Hudson, J., Ferreira-Cornwell, M. C., Radewonuk, J., Whitaker, T., & Gasior, M. (2016). Lisdexamfetamine Dimesylate for Adults with Moderate to Severe Binge Eating Disorder: Results of Two Pivotal Phase 3 Randomized Controlled Trials. Neuropsychopharmacology, 41(5), 1251-1260. https://doi.org/10.1038/npp.2015.275
Meule, A. (2013). Impulsivity and overeating: A closer look at the subscales of the Barratt Impulsiveness Scale. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.00177
Meule, A., & Platte, P. (2015). Facets of impulsivity interactively predict body fat and binge eating in young women. Appetite, 87, 352-357. https://doi.org/10.1016/j.appet.2015.01.003
Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2004). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42(5), 551-567. https://doi.org/10.1016/S0005-7967(03)00161-X
Nagata, T., Kawarada, Y., Kiriike, N., & Iketani, T. (2000). Multi-impulsivity of Japanese patients with eating disorders: Primary and secondary impulsivity. Psychiatry Research, 94(3), 239-250. https://doi.org/10.1016/S0165-1781(00)00157-8
Quick, V. M., & Byrd-Bredbenner, C. (2013). Eating Disorders Examination Questionnaire (EDE-Q): Norms for US college students. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 18(1), 29-35. https://doi.org/10.1007/s40519-013-0015-1
Sansone, R. A., Levitt, J. L., & Sansone, L. A. (2004). The Prevalence of Personality Disorders Among Those with Eating Disorders. Eating Disorders, 13(1), 7-21. https://doi.org/10.1080/10640260590893593
Sica, C., & Ghisi, M. (2007). The Italian versions of the Beck Anxiety Inventory and the Beck Depression Inventory-II: Psychometric properties and discriminant power. In Leading-edge psychological tests and testing research (pp. 27-50). Nova Science Publishers.
Tabler, J., & Geist, C. (2016). Young Women with Eating Disorders or Disordered Eating Behaviors: Delinquency, Risky Sexual Behaviors, and Number of Children in Early Adulthood. Socius, 2, 2378023116648706. https://doi.org/10.1177/2378023116648706
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065. https://doi.org/10.1037/0022-006X.69.6.1061
Zanarini, M. C., Reichman, C. A., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). The course of eating disorders in patients with borderline personality disorder: A 10-year follow-up study. International Journal of Eating Disorders, 43(3), 226-232. https://doi.org/10.1002/eat.20689
