Eating disorder patients choke on food and are sometimes anorexic and bulimic. This is impulsive behavior as defined by the DSM (particularly in the case of BPD and, to a lesser extent, group B disorders in general). Some patients develop these disorders as a way of self-mutilation. It is a convergence of two pathological behaviors: self-mutilation and impulsive behavior (rather compulsive or ritualistic).
The key to improving the mental state of patients with a dual diagnosis (a personality disorder plus an eating disorder) lies in focusing on their eating and sleeping disorders.
By controlling their eating disorders, patients assert control over their lives. This will surely reduce your depression (even eliminate it completely as a constant feature of your mental life). This is likely to improve other facets of your personality disorders. Here’s the chain: control eating disorders control life improve sense of self-worth, self-confidence, self-esteem, a challenge, an interest, an enemy to subdue a feeling of strength, socialize, feel better.
When a patient has a personality disorder and an eating disorder, the therapist must focus on the eating disorder. Personality disorders are intricate and intractable. They are rarely curable (although certain things, like OCD or depression, can be improved with medication). Its treatment requires a huge, persistent and continuous investment of resources of all kinds on the part of all those involved. From the patient’s point of view, treating her personality disorder is not an efficient allocation of scarce mental resources. Also, personality disorders are not the real threat. If a patient with a personality disorder is cured but his eating disorders worsen, he could die (albeit mentally healthy) …
An eating disorder is both a sign of distress (“I want to die, I feel so bad, someone help me”) and a message: “I think I lost control. I am very afraid of losing control. I will control my food intake and discharge In this way I control at least ONE aspect of my life. “
This is where we can and should begin to help the patient. Help him regain control. The family or other support figures should think about what they can do so that the patient feels that they are in control, that they handle things their way, that they are contributing, that they have their own schedules, their own agenda, it matters.
Eating disorders indicate the strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self-control. The patient feels disorderly, paralyzingly helpless, and ineffective. Your eating disorders are an effort to exercise and assert control over your own life. At this stage, you are unable to differentiate your own feelings and needs from those of others. Your cognitive and perceptual distortions (for example, regarding body image, somatoform disorders) only increase your sense of personal ineffectiveness and your need for even more self-control (in your diet, the only thing left).
The patient does not trust himself in the least. He is his worst enemy, a mortal enemy, and he knows it. Therefore, any effort to collaborate with HIM against his disorder is perceived as a collaboration with his worst enemy against his only way of controlling his life to some extent.
The patient sees the world in terms of black and white, of absolutes. Therefore, you cannot let it go even to a very small degree. He’s HORRIFIED – constantly. That is why it is impossible for him to establish relationships: he distrusts (himself and, by extension, others), does not want to become an adult, does not enjoy sex or love (both imply a minimal loss of control). All of this leads to a chronic lack of self-esteem. These patients like their disorder. His eating disorder is his only achievement. Otherwise, they are ashamed of themselves and dislike their flaws (expressed through shame and disgust directed at their bodies).
There is a possibility of curing the patient of his eating disorders (although the dual diagnosis of eating disorder and personality disorder has a poor prognosis). This, and ONLY this, should be done in the first stage. The patient’s family should consider therapy AND support groups (Overeaters Anonymous). The prognosis for recovery is good after 2 years of treatment and support. The family must be very involved in the therapeutic process. Family dynamics often contribute to the development of such disorders.
Medication, cognitive or behavioral therapy, psychodynamic therapy, and family therapy should do it.
The change in the patient IF the treatment of their eating disorders is successful is VERY MARKED. Your major depression goes away along with your sleep disturbances. He becomes socially active again and has a life. Your personality disorder may make things difficult for you, but in isolation, without the exacerbating circumstances of your other disorders, it is much easier for you to cope.
Eating disorder patients can be in mortal danger. Their behavior is ruining their bodies relentlessly and inexorably. They could attempt suicide. They can use drugs. It’s just a matter of time. Our goal is to buy them time. The older you get, the more experience you get, the more your body chemistry changes with age, the better your prognosis.