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They are unable to differentiate their feelings and needs from those of others, adds the author.
To add confusion, both types of patients - with eating disorders and personality disorders - share an identically dysfunctional family background. Munchin et al. described it thus (1978): "enmeshment, over-protectiveness, rigidity, lack of conflict resolution."
Both types of patients are reluctant to seek help.
The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-5):
"Individuals with Anorexia Nervosa frequently lack insight into or have considerable denial of the problem ... A substantial portion of individuals with Anorexia Nervosa have a personality disturbance that meets criteria for at least one Personality Disorder."
In clinical practice, co-morbidity of an eating disorder and a personality disorder is a common occurrence. About 20% of all Anorexia Nervosa patients are diagnosed with one or more personality disorders (mainly Cluster C - Avoidant, Dependent, Compulsive-Obsessive - but also Cluster A - Schizoid and Paranoid).
A whopping 40% of Anorexia Nervosa/Bulimia Nervosa patients have co-morbid personality disorders (mostly Cluster B - Narcissistic, Histrionic, Antisocial, Borderline). Pure bulimics tend to have Borderline Personality Disorder. Binge eating is included in the impulsive behavior criterion for Borderline Personality Disorder.
Such rampant comorbidity raises the question whether eating disorders are not actually behavioral manifestations of underlying personality disorders.
Additional resources
Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) - Washington DC, The American Psychiatric Association, 2000
Goldman, Howard G. – Review of General Psychiatry, 4th ed. – London, Prentice-Hall International, 1995
Gelder, Michael et al., eds. – Oxford Textbook of Psychiatry, 3rd ed. – London, Oxford University Press, 2000
Vaknin, Sam – Malignant Self Love – Narcissism Revisited, 8th revised impression – Skopje and Prague, Narcissus Publications, 2006
This article appears in my book, "Malignant Self Love - Narcissism Revisited"
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