The majority of other sufferers of personality disorders that I have met with, as an inpatient and in the community service I go to now, have difficult experiences surrounding food, for example, having diagnoses of anorexia or bulimia, struggling with fluctuating weight, punishing themselves with food-related actions (starving or making themselves sick or bingeing, or deliberately eating foods they are allergic to in order to provoke a painful physical symptom) and so on. This is just an observation from what I have encountered and there could be many factors involved – for example, issues around weight do seem to be on the up in the UK (or at least more prominent in media coverage?) and the majority of people I know with personality disorders are women, amongst whom eating disorders are also more common. However, it did get me thinking and resonate strongly with my own experiences of food and disordered eating and of working in an eating disorder service.
I think food is tightly bound to feelings of anger at self or at one’s own uncontrollable emotions, and makes an effective – though it hurts to use that word – form of self-harm. When you have thoughts like: I’m so disgusting I don’t deserve to eat / don’t deserve good food only rubbish, I do not deserve to care for myself so I only eat junk, I hate my body for making these demands [to eat], go on you disgusting bitch [I say to myself] look what you’ve done you greedy pig, now get rid of it, throw up til your throat bleeds….you’re foul, you’re disgusting, look how much you’ve hurt everyone, starve and make sure it hurts……. Those kind of thoughts; or even just being too low in the darkness to respond to the basic need for nourishment.
When my eating was the most disordered, I didn’t get specialist help or even much acknowledge the problem in the worst times, despite the efficacy of the function it was serving for me. I was also blind to it. My mother (in part because of how her thoughts were twisted by her own sickness) also prevented me from accessing the help that my GP desperately wanted me to get. Now I know that I was underweight enough to fall into the severe anorexic weight range where dire physical consequences were a risk. My periods stopped and I suffered damage to discs in my back during this time. (More on my own disordered eating in another post.) This was long before I was diagnosed with personality disorder (my eating disorder first started when I was about 14) and it is only now, nearly 15 years later, that I am acknowledging it and can articulate what its functions were.
The other day I spied a leaflet for carers in the community service I’m part of, which discussed some of the signs of personality disorders. “Eating disorders” was actually specifically listed as a “symptom”. This struck me in particular because personality disorder often occurs jointly with other psychiatric diagnoses but these would not be classed as a “symptom” of personality disorder. (For example, many people with forms of personality disorder also have bipolar disorder, but bipolar would not, at least to my knowledge, be classed as a symptom of personality disorder – it is a different diagnosis which someone may have at the same time.)
I would agree that struggling to feed myself well and at times, actions that would be classed as eating disordered behaviour, are tightly related to my emotional instability, lack of control over strong emotions or thoughts that are repulsive to me, and the need to punish and hurt myself. So yes, I would say these are “symptoms” of my personality disorder.
I talked to two friends about the leaflet I had seen – both are highly experienced in the treatment of eating disorders. One point they made was how much eating disorders are a sign of something else painful. It’s often thought that once someone’s problems with food and weight are treated, they are “all better”. However, that is very much not so. The eating disorder is often masking, indeed a mechanism for coping with, something else.
It could be numbing, or controlling. Overeating could comfort, suppress, bury, emotions. Starvation, I think, ironically consumes; the hunger that gnaws painfully eats away other feelings and leaves a blessed numbness. Thinking back to my own times of starvation, I have to admit that it was, at the very least in a significant part…. fantastic.* I was wrapped in a protective, protecting numbness, for long periods. (The times this cracked were utterly terrible, but the times it lasted froze me in a lighter, safer state, so it seemed.) I will explore more of this in another post.
One struggle in personality disorders is that our emotions may, with less stimulus than it ordinarily takes, reach an unbearable high where we cannot cope or think, where there’s only fear, upset, panic, darkness, anger, sadness… or much more occasionally, extremes of joy (I am not sure why the extremes of positive emotions are so much more occasional. Perhaps do they just trouble us less as these emotions seem more acceptable, and therefore we remember these extremes less?) In these extreme states we can’t think, we don’t act rationally, our memory may be affected, and we may take extreme actions like overdoses, self-harm, suicide attempts, and so on. Then it takes longer to come back down from that extreme state to “normal” – the level of emotion where it is possible to cope and function and think – than it ordinarily would take.
So I think one interaction of eating disorders with personality disorders could be this. First, the eating disorder may serve the function of numbing emotions in the first place, so that those dangerous high extremes are not reached in the first place. Second, it may serve the purpose of bringing us down from the extreme, with their numbing, consuming, controlling effect. It’s similar to other forms of self harm. When I am in extreme distress and I cut, for a brief time, it deals with the emotion or makes things feel safe again because I can be sure I’m hurting myself, not someone else.
These are just my thoughts and I would love to know more about research into this. I wonder how much there is. I have read quite widely in my work and studies about eating disorders but have not come across very much on this topic, beyond the fact that the two diagnoses can occur together. It strikes me that the interaction between eating disorder support services and other support services like personality disorder teams or wider community mental health teams, is something that warrants much exploration if we are to support someone not only to recover physically from an eating disorder, but emotionally as well.
*When I was in the midst of the eating disorder it frequently did feel fantastic. I am NOT advocating eating disorders and I know rationally now – thankfully – that it was anything but fantastic when I was anorexic. I am thankful to be recovered and for the work of specialist eating disorder counsellors and services, GPs and CPNs who so dedicatedly help sufferers. I urge anyone struggling with food and eating to get help.
At the same time, I am acknowledging that disordered eating does serve a purpose and function. It is a way of coping. It is harmful, as overdosing, cutting, other forms of self-harm are harmful and risky, but it is a way of coping, just as I believe other forms of self-harm are. I think eating disorders are a way of coping with so much more than the thought processes I have outlined here. It is different for everyone.
I believe – and I think the clinic the two friends I mentioned work in takes this seriously – that for it to be possible to survive recovery from an eating disorder and take the next steps, treatment has to respect that eating disorders are a coping mechanism, and then enable the sufferer to find alternative coping mechanisms, for example in this case, other ways to deal with the terrifying emotions and extreme lows and highs.
Though I never was specifically in treatment for my eating disorders, I am now very very fortunate that the service treating me now is helping me find these other ways of coping, and I think that as this is the start of dealing with so many aspects of my personality disorder, it will also restore my relationship with my physical body and its need for nourishment.