Misdiagnosing Personality Disorders as Eating Disorders

The existing view of common is that the eating disordered patient is attempting to reassert control more than her life by ritually regulating her food intake and her physique weight. In this respect, eating disorders resemble obsessive-compulsive disorders.

The Eating Disordered Patient
eating disorders – notably Anorexia Nervosa and Bulimia Nervosa – are complicated phenomena. The patient with eating disorder maintains a distorted view of her physique as too fat or as somehow defective (she could have a physique dysmorphic disorder). Numerous sufferers with eating disorders are identified in professions exactly where physique kind and image are emphasized (e.g., ballet students, style models, actors).

The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-five):

“(Sufferers with character disorders exhibit) emotions of ineffectiveness, a powerful want to control one’s atmosphere, inflexible thinking, restricted social spontaneity, perfectionism, and overly restrained initiative and emotional expression… (Bulimics show a better tendency to have) impulse-control issues, abuse alcohol or other drugs, exhibit mood lability, (have) a better frequency of suicide attempts.”

eating Disorders and Self-control

The existing view of common is that the eating disordered patient is attempting to reassert control more than her life by ritually regulating her food intake and her physique weight. In this respect, eating disorders resemble obsessive-compulsive disorders.
1 of the very first scholars to have studied eating disorders, Bruch, described the patient’s state of thoughts as “a struggle for control, for a sense of identity and effectiveness.” (1962, 1974).

In Bulimia Nervosa, protracted episodes of fasting and purging (induced vomiting and the abuse of laxatives and diuretics) are precipitated by pressure (normally worry of social scenarios akin to Social Phobia) and the breakdown of self-imposed dietary guidelines. Therefore, eating disorders appear to be life-lengthy attempts to relieve anxiety. Ironically, binging and purging render the patient even much more anxious and provoke in her overwhelming self-loathing and guilt.

eating disorders involve masochism. The patient tortures herself and inflicts on her physique excellent harm by ascetically abstaining from food or by purging. Numerous sufferers cook elaborate meals for other people and then refrain from eating the dishes they had just ready, maybe as a sort of “self-punishment” or “spiritual purging.” The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (p. 584) comments on the inner psychological landscape of sufferers with eating disorders: “Weight loss is viewed as an impressive achievement, a sign of extraordinary self-discipline, whereas weight achieve is perceived as an unacceptable failure of self-control.”

But the “eating disorder as an physical exercise in self-control” hypothesis might be overstated. If it have been correct, we would have expected eating disorders to be prevalent amongst minorities and the lower classes – individuals whose lives are controlled by other people. But, the clinical image is reversed: the vast majority of sufferers with eating disorders (90-95%) are white, young (mainly adolescent) females from the middle and upper classes. eating disorders are uncommon amongst the lower and functioning classes, and amongst minorities, and non-Western societies and cultures.
Refusing to Develop Up Other scholars think that the patient with eating disorder refuses to develop up. By altering her physique and stopping her menstruation (a situation identified as amenorrhea), the patient regresses to childhood and avoids the challenges of adulthood (loneliness, interpersonal relationships, sex, holding a job, and childrearing).

Similarities with Character Disorders

Sufferers with eating disorders preserve fantastic secrecy about their situation, not unlike narcissists or paranoids, for instance. When they do attend psychotherapy it is typically owing to tangential difficulties: having been caught stealing food and other types of antisocial behavior, such as rage attacks. Clinicians who are not trained to diagnose the subtle and deceptive indicators and signs and symptoms of eating disorders typically misdiagnose them as character disorders or as mood or affective or anxiety disorders.

Sufferers with eating disorders are emotionally labile, regularly endure from depression, are socially withdrawn, lack sexual interest, and are irritable. Their self-esteem is low, their sense of self-worth fluctuating, they are perfectionists. The patient with eating disorder derives narcissistic provide from the praise she garners for having gone down in weight and the way she looks post-dieting. Tiny wonder eating disorders are typically misdiagnosed as character disorders: Borderline, Schizoid, Avoidant, Antisocial or Narcissistic. Sufferers with eating disorders also resemble subjects with character disorders in that they have primitive defense mechanisms, most notably splitting.

The Evaluation of Common Psychiatry (p. 356):

“Folks with Anorexia Nervosa have a tendency to view themselves in terms of absolute and polar opposites. Behavior is either all very good or all poor a choice is either entirely appropriate or entirely incorrect 1 is either totally in control or entirely out of control.” They are unable to differentiate their emotions and requirements from these of other people, adds the author. To add confusion, each kinds of sufferers – with eating disorders and character disorders – share an identically dysfunctional household background. Munchin et al. described it therefore (1978): “enmeshment, more than-protectiveness, rigidity, lack of conflict resolution.”
Each varieties of sufferers are reluctant to seek support.

The Diagnostic and Statistical Manual (DSM) IV-TR (2000) (pp. 584-five):

“People with Anorexia Nervosa often lack insight into or have considerable denial of the difficulty… A substantial portion of people with Anorexia Nervosa have a character disturbance that meets criteria for at least a single Character Disorder.” In clinical practice, co-morbidity of an eating disorder and a character disorder is a typical occurrence. About 20% of all Anorexia Nervosa sufferers are diagnosed with a single or a lot more character disorders (mostly Cluster C – Avoidant, Dependent, Compulsive-Obsessive – but also Cluster A – Schizoid and Paranoid).

A whopping 40% of Anorexia Nervosa/Bulimia Nervosa sufferers have co-morbid character disorders (largely Cluster B – Narcissistic, Histrionic, Antisocial, Borderline). Pure bulimics have a tendency to have Borderline Character Disorder. Binge eating is included in the impulsive behavior criterion for Borderline Character Disorder.
Such rampant comorbidity raises the question whether or not eating disorders are not in fact behavioral manifestations of underlying character disorders.

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Author: Health Benefits

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