From the Guidelines
The most effective treatment approach for individuals with eating disorders and borderline personality disorder is an integrated, multidisciplinary strategy that combines psychotherapy, nutritional rehabilitation, and medication management, with Dialectical Behavior Therapy (DBT) being a first-line psychotherapeutic intervention. This approach is supported by the American Psychiatric Association's practice guideline for the treatment of patients with eating disorders 1, which emphasizes the importance of a comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise.
Key components of this approach include:
- Psychotherapy: DBT is considered a first-line intervention, typically delivered in weekly individual sessions and group skills training over 6-12 months, as it addresses both the emotional dysregulation of borderline personality disorder and disordered eating behaviors.
- Nutritional rehabilitation: Supervised by a registered dietitian who works closely with the treatment team, with individualized goals set for weekly weight gain and target weight for patients with anorexia nervosa 1.
- Medication management: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (20-60mg daily) or sertraline (50-200mg daily) may be used to address comorbid depression and anxiety, while low-dose atypical antipsychotics like olanzapine (2.5-10mg daily) may help with thought distortions and weight restoration in anorexia cases.
The American Psychiatric Association recommends that patients with an eating disorder have a documented, comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team 1. This approach is crucial in addressing the unique challenges created by the combination of eating disorders and borderline personality disorder, where emotional dysregulation often triggers disordered eating behaviors, requiring simultaneous attention to both conditions for effective recovery. Regular monitoring of vital signs, electrolytes, and weight is essential, as is coordination between all treatment providers.
From the Research
Treatment Approaches for Eating Disorders and Borderline Personality Disorder
- The recommended treatment approach for individuals with eating disorders and borderline personality disorder involves a combination of psychotherapies, such as dialectical behavior therapy (DBT) and mentalization-based treatment, which have been adapted to accommodate the shared vulnerabilities and features of the two disorders 2.
- DBT has been shown to be effective in reducing eating disorder symptomatology and improving emotional regulation and impulsiveness in individuals with borderline personality disorder and eating disorders 3, 4.
- A 12-month study of DBT for borderline patients suffering from eating disorders found significant improvement in patients' outcome measurements, including a reduction in eating disorder-related behaviors and an improvement in coping skills 3.
- General psychiatric management (GPM) is another approach that can be used to treat adolescents with borderline personality disorder and eating disorders, which relies on interventions such as diagnostic disclosure, psychoeducation, and managing patients' self-destructive behaviors 2.
- Transdiagnostic treatment approaches, such as DBT, can be effective in addressing emotion dysregulation and reducing eating disorder symptomatology in individuals with borderline personality disorder and eating disorders 4.
Effectiveness of Dialectical Behavior Therapy
- DBT has been shown to be effective in reducing eating disorder symptomatology and improving emotional regulation and impulsiveness in individuals with borderline personality disorder and eating disorders 3, 4.
- A case study of a 31-year-old woman with borderline personality disorder and eating disorder not otherwise specified found that DBT was effective in reducing eating disorder symptomatology and improving emotional regulation and impulsiveness 4.
- Another study found that DBT was effective in reducing binge-eating episodes and improving global psychosocial functioning in women with borderline personality disorder and bulimia nervosa 5.
Limitations and Future Directions
- While DBT has been shown to be effective in reducing eating disorder symptomatology and improving emotional regulation and impulsiveness, further research is needed to establish its efficacy in randomized controlled trials 3.
- The treatment of borderline personality disorder and eating disorders is complex and requires a comprehensive approach that addresses the shared vulnerabilities and features of the two disorders 2, 6.
- Further research is needed to develop more effective treatments for individuals with borderline personality disorder and eating disorders, including the development of transdiagnostic treatment approaches that can address the complex needs of these individuals 6, 4.