The Relationship Between Borderline Personality and Obesity

Sansone-001Dr. Randy A. Sansone is a Professor in the Departments of Psychiaty and Internal Medicine at Wright State University School of Medicine and is also Director of Psychiatry Education at Kettering Medical Center.

Dr. Sansone’s research interest in eating disorders began after medical school when he was in residency, where he participated in a family study of anorexia and bulimia nervosa. During his work in this field, he noticed that a number of patients had symptoms beyond the confines of eating pathology, such as promiscuity, drug and alcohol difficulties, and self-harm behavior in the form of self-mutilation (e.g., self-cutting) and suicide attempts. This impulsive subgroup oftentimes suffered from a co-present disorder, borderline personality disorder, which initiated his path as a researcher in borderline personality disorder, which is now his primary focus of research. His work in this field has culminated into 330 professional articles, 36 book chapters, 2 co-edited books (Self-Harm Behavior and Eating Disorders; Personality Disorders and Eating Disorders) and 2 co-authored books (Borderline Personality in the Medical Setting; Transcending the Personality Disordered Parent). This last volume is a self-help guide to those individuals who struggle with problematic parents.

His recent paper, titled “The Relationship Between Borderline Personality and Obesity” was published in the journal Innovations in Clinical Neuroscience.

Background of the study: The Relationship Between Borderline Personality and Obesity

Historically, researchers have been aware that a number of individuals who suffer from obesity have impulsive eating patterns. Impulsive behaviors, including impulsive eating patterns, are oftentimes associated with borderline personality disorder. Therefore, we suspected a potential relationship between obesity and borderline personality in some individuals.

In this paper, we summarized our past four studies along with five additional studies on the prevalence of borderline personality among obese study participants. At the time of the publication (2013), these represented the majority of available studies. We found that in averaging the prevalence rates for each of the measures used to assess borderline personality in these various studies, the prevalence rate was around 27%–a significant minority.

Key findings

From my perspective, this is fairly straightforward. It seems that restrictive personality styles, like obsessive-compulsive personality disorder, are oftentimes associated with restrictive eating styles, like anorexia nervosa, restricting type. In contrast, impulsive personality styles, like borderline personality disorder, are oftentimes associated with impulsive eating styles, like anorexia nervosa, binge-eating purging type; bulimia nervosa; and obesity. Importantly, not all individuals follow these patterns, but these are the general trends.

Implications

We need to continue to strategize from a prevention perspective. Because personality is established from the roots of early temperamental characteristics, I think it’s safe to say that personality styles precede consolidated styles of eating pathology. Therefore, among children with strong or extreme personality tendencies, either restrictive or impulsive, we need to garner balance, particularly with eating behaviors.

Next steps

The findings really confirm the importance of offering additional treatment modalities to individuals who are suffering from obesity and borderline personality disorder. Given this prevalence rate, each obese individual needs to be screened for borderline personality, and when present, directed towards treatment that addresses this disorder as well as treatment for the eating disorder.

Increasing awareness

We really need to have more public education around borderline personality and its many symptom manifestations–so that the public can become more self-aware.

About the department

Our department is headed by Jerald Kay, M.D., our chair, and offers training to medical students, psychiatry residents, and various other residents, particularly primary care. We do research on psychiatric disorders and also provide patient care services to the community.