Comorbidity of Borderline Personality Disorder and Disordered Eating: A Difficult Challenge for Psychiatry?

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.