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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

Personality Disorders and Eating Disorders, Treatment: The Sooner The Better

Simone Hoermann, Ph.D. Updated: Aug 27th 2009

half-eaten apple with a clock superimposed on itLast week, I wrote about the co-occurrence between personality disorders and eating disorders last week, describing the major eating disorders, and gave a few numbers on how frequently people with eating disorders can also be diagnosed with personality disorder.  You might have wondered whether the presence of both a personality disorder and an eating disorder would affect the way these difficulties should be treated.

There are some clinicians who feel that the presence of a personality disorder can complicate the treatment of other difficulties, because people with personality disorders often have difficulties in interpersonal relationship.  This can make it hard for someone with a personality disorder to bond with a therapist, to trust a therapist, or to attend treatment regularly and consistently over longer periods of time.  Some people with personality disorders can be pretty self-destructive and might end up sabotaging the therapy process.  Many people with personality disorders can have a tendency to first idealize and then devalue the therapist, which also makes it hard to maintain a relationship.

In turn, other clinicians believe that presence of an eating disorder can also complicate the treatment of a personality disorder.  If someone is severely underweight, they might need medical attention.  Some people who are restricting end up developing severe obsessions or compulsions (intrusive thoughts and behavioral rituals), and sometimes the low caloric intake can affect the way a person perceives reality.  There are some clinicians who feel that the eating problems should be addressed and that a person might need to be in a residential treatment program that focuses on restoring a healthy weight, before the personality issues can be worked on. 

According to Chiara Battistello, clinical social worker and coordinator of the Eating Disorders Program at the Columbia University day Treatment Program, the most effective treatment for Bulimia Nervosa and Binge Eating Disorder is Cognitive Behavioral Therapy (CBT). Treatment for Anorexia Nervosa requires weight restoration which is often provided in an inpatient or intensive outpatient setting. Once weight is restored CBT may help patients to work on body acceptance and challenge eating disorder thoughts and assumptions.

“I think the usual problems that arise in the treatment of Personality Disorders can treatment for people who are dually diagnosed” says Ms. Battistello. “Most commonly, people who have both eating disorders and personality disorders have a hard time with attachment and with tolerating frustration.  There is often a tendency to idealize and then devalue a therapist very quickly. Also,  recovery from an eating disorder, especially Bulimia or Binge-Eating Disorder often requires impulse control and strategies to delay acting on urges to do something harmful.  This can be very difficult for people coping with Borderline Personality Disorder. Other issues arise for people with Obsessive Compulsive Personality disorder, because they can be extremely set in their ways. Recovery from Anorexia always involves allowing more flexibility. In terms of prognosis, we know that treatment in specialized centers probably improves the outcome, and the sooner one gets treatment, the better chance of recovery.”

 

Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

    Reader Comments
    Discuss this issue below or in our forums.

    Trip pn - Kevin Pfaunmiller - Oct 3rd 2009

    I believe in the sign's,sight's ,sound & smell's are as prevalent as they were in the 60's & the 70's. Politic's,sex ,religeon & this time absent from the clouded drug haze of the past.We can be as prolific and proptiate the time even in the mind . If capured can it materialize, w/ desire & intent,can you dig it?

    Borrowing time while on my way!? - Kevin Pfaunmiller - Sep 30th 2009

    Im suffering with documented multiple disabilities and seeking government disability assistance. I have to deal with scoliosis with arthritic problems and anxiety complicated with paranoia, body dysmorphic disorder (BDD) and psychotic traits and tendencies.

    My scoliosis limits my function capacity to two hour's a day and done, very limited. I feel my spine contorted and weak by its limits! I walk with a cane now to support my weight and medicated with Sulindac 150 mg and Motrin 800 mg for the pain and they seldom work effectively.

    Please read my story with an open mind, an open heart and please find my case worthy of assistance with a grant. All is documented and confirms my mental and physical issues as they are by both the Pa. Va. out patient clinic and a private primary care physician. I'm being medicated with Thorazine and Paxil for anxiety, body dysmorphia and paranoia, etc. Paranoia is only a state of awareness, I still think!

    Some of my mental issues are self-induced; others like anxiety are inherited. I'm currently on a doctor's note and not permitted to work because of my symptoms and effects of my medication. Without any medication like Thorazine and Paxil, I get isolated and withdrawn, rage and mood swings, anxiety and panic episodes. I hear sounds like whisper (or) mumbling and some echoes.

    My case is pending for an appeal for social security and I've exhausted my resources down to dirt! I have an eight-year-old boy and humbling myself!!! Here is some of my story. We hope you can help! EVERYTHING IS DOCUMENTED!!! 
    God bless you all for a moment of your time, I've been writing and want this shared with others, none of which is intended to offend (or) insult. I've been down a crazy, colorful and confusing road involved with LSD, sex and religion, all of which confused and excited me, enthralled and partly enslaved me too!!! Exploits and proclivity aside, I was an addict, a slave captive in the mind!

    I was raised in a dogmatic family and self-taught to allow my freak flag to fly! I wrote in an earlier letter that I felt like a freak, and I'm deserving and entitled to that feeling, and proud of that too! My views and opinions made me unique and different, beyond the normal.

    I was created by my maker and even though he did not direct me down that path I chose, I felt like it was my right to discover and I'm not ashamed that I indulged the different senses to amaze and offend the normal. If a person does not deny an experience and learns from it (be very careful of guilt), it can make you learned and wise. If you deny all your experience and curiosity, that makes you only ignorant and not very wise, again no guilt that can't be forgiven allowed.

    Along my way I was caught up in two conspiracies, four treatment centers, army (briefly), mental hospital (briefly) and a mind trip I can't escape. In the Harrisburg state hospital I remember one on such a Thorazine trip and reduced to dribbling on the floor, while staring at the ceiling, awake and yet not all there, one rotating in circles while mumbling to himself.

    I remember another hitting his head on the shower wall till bleeding and the screams in the night were so surreal! Where is there salvation? Will they be held accountable for losing their minds? I remember being stuck in an elevator in a power outage with at least eight inmates of the hospital and one tried to claw his way out thru the door in the ceiling. I will never forget the smell of vomit and feces, very sickening and offensive to the senses!

    Addiction is much like a mental hospital in that you're not in your right frame of mind and you don't have control of the situation. I remember the feeling of desperation and at a loss without my sanity. In addiction there is a voice and you don't have a choice but to listen because it's ever present and in your head and with out mercy! Until you listen to the second voice, which is the voice of reason, you don't have a chance.

    If you want help, the solution is already inside of you. My eight-year-old boy is totally oblivious to my past and most of my story! I know my son gets some of his insight and creativity from his old man. I choose today not to use drugs, mind altering substance's, cigarettes (or) any alcohol because it's all deceitful and undermining to the senses!

    This letter is directed to those individuals that are either different because of mental or physical issues. Your points of view and opinions matter to me! Do not value anyone's criticizing and ridiculing enough to allow it to hurt you! We're all different, not just our views and belief

    Borrowing time while on my way - Kevin Pfaunmiller - Sep 3rd 2009

    I'm currently suffering from scoliosis with arthritic problems and anxiety complicated with paranoia, Body dysmorphic disorder (BDD) and psychotic traits and tendencies.

    I'm being medicated with Thorazine and Paxil for anxiety and moods, paranoia, etc. Some of my mental issues are self-induced; others like anxiety are inherited. I'm currently on a doctor's note and not permitted to work because of my symptoms and effects of my medication.

    My case is pending for an appeal for social security and I've exhausted my resources down to dirt! I have an eight-year-old boy and humbling myself !!! Here is some of my story. We hope you can help! EVERYTHING IS DOCUMENTED!!!

    God bless you all for a moment of your time, I've been writing and want this shared with others, none of which is intended to offend! I've been down a crazy, colorful and confusing road involved with LSD, sex and religion, all of which confused and excited me, enthralled and partly enslaved me too!!! Exploit's & proclivity aside, i was an addict.

    I was raised in a dogmatic family and self-taught to allow my freak flag to fly! I wrote in an earlier letter that I felt like a freak, and I'm deserving and entitled to that feeling, and proud of that too! my view's an opinion made me unique & different,beyond the normal.

    I was created by my maker and even though he did not direct me down that path I chose, I felt  like it was my right to discover and I'm not ashamed that I indulged the different senses to amaze & offend the norml. If a person does not deny an experience and learns from it (be very careful of guilt), it can make you learned and wise. If you deny all your experience and curiosity, that makes you only ignorant and not very wise, again no guilt that can't be forgiven allowed.

    Along my way I was caught up in two conspiracies, four treatment centers, army (briefly), mental hospital (briefly) and a mind trip I can't escape. In the harrisburg state hospital I remember one on such a Thorazine trip and reduced to dribbling on the floor, while staring at the ceiling,awake &yet not all there, one rotating in circles while mumbling to himself ?

    I remember another hitting his head on the shower wall till bleeding and the screams in the night were so sureal! Where is there salvation? Will they be held accountable for losing their minds?I remember being stuck in an elevator in a power outage  w/ atleast 8 inmate's of the hospital & one tried to claw his way out thru the door in the ceiling . i will never forget the smell vomit & feces, very sickning & offensive to the sences! Addiction is much like a mental hospital in that your not in your right frame of mind & you dont have your control of the situation, i remember the feeling of  desperation & @ a loss w/ out my sanity.In addiction there is a voice & you don't have a choice but  to listen cause it's ever present & in your head  & w/ out mercy!until you listen to the second voice , which is the voice of reason ,you dont have a chance. if you want help the solution is already inside of you...  My eight-year-old boy is totally oblivious to my past and most of my story!

    This letter is directed to those individuals that are either different because of mental or physical issues. Your points of view and opinions matter to me! Do not value anyone's criticizing and ridiculing enough to allow it to hurt you! We're all different, not just our views and belief.I praise god i survived !

    Hurry & wait !? - Kevin Pfaunmiller - Aug 31st 2009

    I've been diagnosed w/personality & perseptual -disorder.Anxiety that is @ time's overwhelming.Also body dysmorphia that causes me to avoid all mirror's not knowing if i'm seeing jesus,a freak (or) an amishman in the reflection. Paranoia,i think paranoia is only a state of awareness.I'm now convinced that my sexual proclivity is my only salvation!? Kevin Pfaunmiller

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