Abstract
Purpose
Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation.
Method
Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale.
Results
All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated.
Conclusion
A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment.
Level of evidence
III, evidence obtained from well-designed cohort or case–control analytic studies.
Similar content being viewed by others
References
Smink FR, van Hoeken D, Hoek HW (2013) Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry 26(6):543–548
Claudino AM, Pike KM, Hay P, Keeley JW, Evans SC, Rebello TJ, Bryant-Waugh R, Dai Y, Zhao M, Matsumoto C, Herscovici CR, Mellor-Marsá B, Stona AC, Kogan CS, Andrews HF, Monteleone P, Pilon DJ, Thiels C, Sharan P, Al-Adawi S, Reed GM (2019) The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines. BMC Med 17(1):1–7
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, text revision, 4th edn. American Psychiatric Association, Washington (DC), p 943
Kells M, Kelly-Weeder S (2019) Binge eating behavior among a cohort of normal weight college women. J Am Assoc Nurse Pract 31(12):741–746. https://doi.org/10.1097/JXX.0000000000000317 (PMID: 31738272)
Wassenaar E, Friedman J, Mehler PS (2019) Medical complications of binge eating disorder. Psychiatr Clin North Am 42(2):275–286. https://doi.org/10.1016/j.psc.2019.01.010
Hudson JI, Hiripi E, Pope HG, Kessler RC (2007) The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry 61(3):348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
Erskine HE, Whiteford HA (2018) Epidemiology of binge eating disorder. Curr Opin Psychiatry 31(6):462–470. https://doi.org/10.1097/YCO.0000000000000449 (PMID: 30113324)
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Press, Washington, DC
Streit F, Colodro-Conde L, Hall ASM, Witt SH (2020) Genomics of borderline personality disorder. Personal Psychiatry. https://doi.org/10.1016/B978-0-12-813176-3.00019-5
McDonald S (2019) Understanding the genetics and epigenetics of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD): a systematic review. Eat Weight Disord EWD 24(5):799–814. https://doi.org/10.1007/s40519-019-00688-7
Newton JR (2019) Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity. Australas Psychiatry 27(6):556–558. https://doi.org/10.1177/1039856219852297 (Epub 2019 Jun 3 PMID: 31154810)
Al-Salom P, Boylan K (2019) Borderline personality disorder and disordered eating behaviour: the mediating role of rejection sensitivity. J Can Acad Child Adolesc Psychiatry 28(2):72–81
Selby EA, Ward AC, Joiner TE (2010) Dysregulated eating behaviors in borderline personality disorder: are rejection sensitivity and emotion dysregulation linking mechanisms? Int J Eat Disord 43(7):667–670. https://doi.org/10.1002/eat.20761
Biberdzic M, Tang J, Tan J (2021) Beyond difficulties in self-regulation: the role of identity integration and personality functioning in young women with disordered eating behaviours. J Eat Disord 9:93. https://doi.org/10.1186/s40337-021-00398-5
Schag K, Schönleber J, Teufel M, Zipfel S, Giel KE (2013) Food-related impulsivity in obesity and binge eating disorder–a systematic review. Obes Rev 14(6):477–495
Mallorquí-Bagué N, Testa G, Lozano-Madrid M, Vintró-Alcaraz C, Sánchez I, Riesco N et al (2020) Emotional and non-emotional facets of impulsivity in eating disorders: from anorexia nervosa to bulimic spectrum disorders. Eur Eat Disord Rev 28(4):410–422. https://doi.org/10.1002/erv.2734
Sebastian A, Jacob G, Lieb K, Tüscher O (2013) Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Curr Psychiatry Rep 15(2):339. https://doi.org/10.1007/s11920-012-0339-y
Navarro-Haro MV, Botella C, Guillen V, Moliner R, Marco H, Jorquera M, Garcia-Palacios A (2018) Dialectical behavior therapy in the treatment of borderline personality disorder and eating disorders comorbidity: a pilot study in a naturalistic setting. Cogn Ther Res 42:636–649. https://doi.org/10.1007/s10608-018-9906-9
Chen EY, Brown MZ, Harned MS, Linehan MM (2009) A comparison of borderline personality disorder with and without eating disorders. Psychiatry Res 170(1):86–90
Farstad SM, McGeown LM, von Ranson KM (2016) Eating disorders and personality, 2004–2016: a systematic review and meta-analysis. Clin Psychol Rev 46:91–105
Waseem F, Rizwan F, Anwar NS (2019) Disordered eating attitude and body dissatisfaction among adolescents of arab countries: a review. Asian J Biol Sci 12:373–379. https://doi.org/10.1186/s40337-019-0265-
Nery FG, Miranda-Scippa A, Nery-Fernandes F, Kapczinski F, Lafer B (2014) Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: results from the Brazilian bipolar research network. Compr Psychiatry 55(5):1116–1121. https://doi.org/10.1016/j.comppsych.2014.02.006
First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS (1997) SCID-II personality questionnaire. American Psychiatric Press, Washington, DC
Hatata H, Khalil A, Asaad T, et al (2004) Dual diagnosis in substance use disorders. M.D. Degree thesis, Faculty of Medicine, Ain Shams University
Gormally J, Black S, Daston S, Rardin D (1982) The assessment of binge eating severity among obese persons. Addict Behav 7(1):47–55. https://doi.org/10.1016/0306-4603(82)90024-7
Essawy H, Zaki N, Elhawary Y, Morsy M (2019) Prevalence of eating disorders and alexithymia among a sample of Egyptian medical students not attending psychiatric clinics. Faculty of Medicine, Ain Shams University, Cairo
Salovey P, Mayer JD, Goldman SL, Turvey C, Palfai TP (1995) Emotional attention, clarity, and repair: exploring emotional intelligence using the trait meta-mood scale. In: Pennebaker JW (ed) Emotion, disclosure, and health. APA, Washington, DC, pp 125–154
Kafafi H, El Dawash M (2006) Trait meta mood scale for adolescents and adults. Egyptian Anglo library, Cairo
Patton JH, Stanford MS, Barratt ES (1995) Factor structure of the barratt impulsiveness scale. J Clin Psychol 51(6):768–774. https://doi.org/10.1002/1097-4679(199511)51:6%3c768::aid-jclp2270510607%3e3.0.co;2-1 (PMID: 8778124)
Ellouze F, Ghaffari O, Zouari O, Zouari B, M’rad MF (2013) Validation of the dialectal Arabic version of Barratt’s impulsivity scale, the BIS-11. Encéphale 39(1):13–18. https://doi.org/10.1016/j.encep.2012.06.034
Tragesser SL, Solhan M, Schwartz-Mette R, Trull TJ (2007) The role of affective instability and impulsivity in predicting future BPD features. J Pers Disord 21(6):603–614. https://doi.org/10.1521/pedi.2007.21.6.603 (PMID: 18072862)
Ellison WD, Rosenstein L, Chelminskil I, Dalrymple K, Zimmerman M (2016) The clinical significance of single features of borderline personality disorder; anger, affective instability, impulsivity, and chronic emptiness in psychiatric outpatients. J Pers Disord 30(2):261–270. https://doi.org/10.1521/pedi_2015_29_193 (Epub 2015 Apr 20 PMID: 25893552)
Williams GE, Daros AR, Graves B, McMain SF, Links PS, Ruocco AC (2015) Executive functions and social cognition in highly lethal self-injuring patients with borderline personality disorder. Personal Disord 6(2):107–116. https://doi.org/10.1037/per0000105
Wagner G, Krause-Utz A, de la Cruz F, Schumann A, Schmahl C, Bär KJ (2018) Resting-state functional connectivity of neurotransmitter producing sites in female patients with borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 83:118–126. https://doi.org/10.1016/j.pnpbp.2018.01.009
Soler J, Elices M, Pascual JC, Martin-Blanco A, Feliu-Soler A, Carmona C, Portella MJ (2016) Effects of mindfulness training on different components of impulsivity in borderline personality disorder: results from a pilot randomized study. Borderline Personal Disord Emot Dysregul 3:1. https://doi.org/10.1186/s40479-015-0035-8
Coffey SF, Schumacher JA, Baschnagel JS, Hawk LW, Holloman G (2011) Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders. Personal Disord 2(2):128–141. https://doi.org/10.1037/a0020574 (PMID: 22448732)
Leible TL, Snell WE (2004) Borderline personality disorder and multiple aspects of emotional intelligence. Personality Individ Differ 37(2):393–404
Lizeretti NP, Extremera N, Rodríguez A (2012) Perceived emotional intelligence and clinical symptoms in mental disorders. Psychiatr Q 83(4):407–418
Salgó E, Szeghalmi L, Bajzát B, Berán E, Unoka Z (2021) Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects. PLoS ONE 16(3):e0248409. https://doi.org/10.1371/journal.pone.0248409
Badrasawi MM, Zidan SJ (2019) Binge eating symptoms prevalence and relationship with psychosocial factors among female undergraduate students at Palestine Polytechnic University: a cross-sectional study. J Eat Disord. https://doi.org/10.1186/s40337-019-0263-1 (PMID:31592130; PMCID:PMC6774213)
Schulte SJ (2016) Predictors of binge eating in male and female youths in the United Arab Emirates. Appetite 105:312–319
Mousa TY, Al-Domi HA, Mashal RH, Jibril MA-K (2010) Eating disturbances among adolescent schoolgirls in Jordan. Appetite 54:196–201
Rabie MA, Abo-El-Ezz NF, El-din M (2010) Anxiety and social anxiety symptoms among overweight females seeking treatment for obesity. Curr Psychiatr Ther 17:13–20
Marino MF, Zanarini MC (2001) Relationship between EDNOS and its subtypes and borderline personality disorder. Int J Eat Disord 29(3):349–353. https://doi.org/10.1002/eat.1029
Shenoy SK, Praharaj SK (2019) Borderline personality disorder and its association with bipolar spectrum and binge eating disorder in college students from South India. Asian J Psychiatr 44:20–24. https://doi.org/10.1016/j.ajp.2019.07.017
Khosravi M (2020) Eating disorders among patients with borderline personality disorder: understanding the prevalence and psychopathology. J Eat Disord 8(1):38. https://doi.org/10.1186/s40337-020-00314-3 (PMID:32821383; PMCID:PMC7429899)
Zeidan RK, Haddad C, Hallit R, Akel M, Honein K, Akiki M, Kheir N, Hallit S, Obeid S (2019) Validation of the Arabic version of the binge eating scale and correlates of binge eating disorder among a sample of the Lebanese population. J Eat Disord 7:40. https://doi.org/10.1186/s40337-019-0270-2 (PMID:31798879; PMCID:PMC6885321)
Greeno CG, Marcus MD, Wing RR (1995) Diagnosis of binge eating disorder: discrepancies between a questionnaire and clinical interview. Int J Eat Disord 17(2):153–160. https://doi.org/10.1002/1098-108x(199503)17:2%3c153::aid-eat2260170208%3e3.0.co;2-v
Escrivá-Martínez T, Galiana L, Rodríguez-Arias M, Baños RM (2019) The binge eating scale: structural equation competitive models, invariance measurement between sexes, and relationships with food addiction, impulsivity, binge drinking, and body mass index. Front Psychol 10:530. https://doi.org/10.3389/fpsyg.2019.00530
Grupski AE, Hood MM, Hall BJ, Azarbad L, Fitzpatrick SL, Corsica JA (2013) Examining the binge eating scale in screening for binge eating disorder in bariatric surgery candidates. Obes Surg 23(1):1–6. https://doi.org/10.1007/s11695-011-0537-4
Freitas SR, Lopes CS, Appolinario JC, Coutinho W (2006) The assessment of binge eating disorder in obese women: a comparison of the binge eating scale with the structured clinical interview for the DSM-IV. Eat Behav 7(3):282–289. https://doi.org/10.1016/j.eatbeh.2005.09.002
Dahl RE (2004) Adolescent brain development: a period of vulnerabilities and opportunities. Keynote address. Ann NY Acad Sci 1021:1–22
Patton CJ (1992) Fear of abandonment and binge eating. J Nerv Ment Dis 180(8):484–490. https://doi.org/10.1097/00005053-199208000-00002 (PMID: 1500929)
Svaldi J, Griepenstroh J, Tuschen-Caffier B, Ehring T (2012) Emotion regulation deficits in eating disorders: a marker of eating pathology or general psychopathology? Psychiatry Res 197(1–2):103–111. https://doi.org/10.1016/j.psychres.2011.11.009
Racine SE, Horvath SA (2018) Emotion dysregulation across the spectrum of pathological eating: comparisons among women with binge eating, overeating, and loss of control eating. Eat Disord 26(1):13–25. https://doi.org/10.1080/10640266.2018.1418381
Selby EA, Doyle P, Crosby RD, Wonderlich SA, Engel SG, Mitchell JD et al (2012) Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder. J Psychiatr Res 46(11):1492–1500 (PMID:22959165)
Selby EA, Anestis MD, Joiner TE (2008) Understanding the relationship between emotional and behavioral dysregulation: emotional cascades. Behav Res Ther 46:593–611
De Paoli T, Fuller-Tyszkiewicz M, Huang C, Krug I (2020) A network analysis of borderline personality disorder symptoms and disordered eating. J Clin Psychol 76(4):787–800. https://doi.org/10.1002/jclp.22916 (Epub 2020 Jan 17 PMID: 31953849)
Blasco-Fontecilla H, de León-Martínez V, Delgado-Gomez D, Giner L, Guillaume S, Courtet P (2013) Emptiness and suicidal behavior: an exploratory review. Suicidol Online 4(4):21–32
Mason TB, Smith KE, Lavender JM, Lewis RJ (2018) Independent and interactive associations of negative affect, restraint, and impulsivity in relation to binge eating among women. Appetite 121:147–153. https://doi.org/10.1016/j.appet.2017.11.099
Miller KY, Limberg B (2011) Binge eating behaviors and motoric, attentional, and nonplanning impulsivity. Grad Stud J Psychol 13:45–51
Hege MA, Stingl KT, Kullmann S, Schag K, Giel KE, Zipfel S, Preissl H (2015) Attentional impulsivity in binge eating disorder modulates response inhibition performance and frontal brain networks. Int J Obes (Lond) 39(2):353–360. https://doi.org/10.1038/ijo.2014.99
Annagur BB, Orhan O, Ozer A, Yalcin N, Tamam L (2015) The effects of depression and impulsivity on obesity and binge eating disorder. Klinik Psikofarmakoloji Bulteni 25:162–170. https://doi.org/10.5455/bcp.20130408021434
Meule A, Heckel D, Kübler A (2012) Factor structure and item analysis of the Yale food addiction scale in obese candidates for bariatric surgery. Eur Eat Disord Rev 20(5):419–422. https://doi.org/10.1002/erv.2189
Pearson CM, Wonderlich SA, Smith GT (2015) A risk and maintenance model for bulimia nervosa: from impulsive action to compulsive behavior. Psychol Rev 122:516–535. https://doi.org/10.1037/a0039268
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no competing interests to declare.
Ethical approval
The procedure and the design of the study were approved by the ethical committee of Ain Shams University, Cairo, Egypt.
Informed consent
Informed consent was taken from the participant before enrollement in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Shaker, N.M., Azzam, L.A., Zahran, R.M. et al. Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity. Eat Weight Disord 27, 2497–2506 (2022). https://doi.org/10.1007/s40519-022-01358-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-022-01358-x