We call borderline personality disorder a personality disorder because it’s a syndrome in which people are markedly deregulated. They are highly impulsive, their mood is up and down, and they can be very chaotic; they can love someone one minute, and be really enraged with them the next; they can have really dramatic changes in terms of their own self-image so that they feel really good one moment and suicidal the next. They are highly unstable people. And one of the things that goes into that instability, of course, is their self-image problem. Serotonin plays a role as well. So there can be some connections in some people. If you have this problem, you are highly susceptible to binge eating. So you see a large number of people who developed bulimia who may also have that problem. But it doesn’t mean that you have to have it, not everybody who has bulimia has borderline personality disorder.
-Howard Steiger, Ph. D., Mini-Psych School 2009

There are a number of them. The obvious one is that, in anorexia, people get very thin, so thin that you start to say that it isn’t normal and you realize that there is something going on. Along with that, the person might avoid meal times or show anxiety around anything that involves eating; they may be unable to sample unfamiliar foods while their range of “safe” foods gradually diminishes.

Perhaps you pick up on signs of clandestine vomiting that is going on behind closed doors, or realize that laxatives are disappearing. We see the tendency for people to need to exercise after eating. Along with that, there may be mood disturbances; people become very unstable in terms of mood, or have sleep or concentration problems. It’s a tricky thing because dieting behaviours are normal. And so, both clinicians and those close to the patient always have to make a difficult judgment about when normal dieting behaviours go past normal.

However, you should not be the “vomiting police” if somebody around you has an eating disorder. Express your concern, offer help, offer information, and contact us if you want. We have documents and articles and things that are useful for people with eating disorders to read just as an opening to considering that they have a problem and maybe wanting to get help for it. But, until you do that, they probably won’t.

-Howard Steiger, Ph. D., Mini-Psych School 2009

The diagnostic criteria are very confusing so this is a good question. According to the criteria, one either has anorexia nervosa or bulimia nervosa. As I said before, bulimia is seen on a normal weight or an overweight person, not an underweight person. It gets more confusing by the fact that there are two kinds of anorexics: those who don’t binge and purge and those who do. What tends to happen is that people start restricting, and many people eventually deregulate their appetite so they were restrictors and then become anorexic binger-purgers, and then sometimes they become normal weight bulimics after a while because of that process.

People do tend to go in a direction from restricting towards binging-purging. In the next round of diagnostic criteria that is coming out in 2011 the criteria will change to include those who restrict but don’t binge and purge, regardless of how thin or not ,and those who binge and purge, regardless of weight; and then there will be binge eating disorder. For a more direct answer, yes, it is possible to have anorexic behaviour and binge eating behaviour at the same time. In fact, it is very common.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Don’t get me wrong, I’m not against the exercise and I’m not against the eating – these are healthy normal behaviours. But, you can’t push things beyond the limits of reality and our society tends to want us to do that. There is some kind of idea that exercise is always the solution to eating. For example, when you exercise, you increase your body’s caloric needs So, unless you are going to be somebody who says “I worked out a lot today, so I better eat a lot today in order to satisfy my nutritional needs,” you set up an increasing disparity between how much you need and how much you ate. Guess what happens if you do that for long enough? You start to binge eat. So, even though all of our mothers and fathers encourage us to exercise, they also told us to do things in moderation.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Every person suffering from an Eating Disorder reacts differently. There is cause for concern, however, when a person has an unusual relationship with food, loses weight and becomes anxious or depressed, introverted or evasive.

Anorexia can be partially determined by heredity. A study of 31,000 Swedish twins showed that 56% of the risk came from genetic inheritance at birth. For example, there seems to be a region on Chromosome 1 that differentiates people with and without Anorexia. The abnormality on this chromosome is linked to personality traits like compulsivity and anxiety (common in Anorexia). The same genetic vulnerability is also associated with increased risk of depression.

Bulimic behavior may be linked to impulsive personality traits via a biological pathway. Impulsivity is linked to alterations in the activity in the brain of serotonin (one of the chemicals that transmits brain signals). Abnormal serotonin activity can make people susceptible to impulsivity, moodiness, anxiety, and problems with satiety—or bulimic episodes. Impulsive people are therefore more susceptible to becoming bulimic.

There is a new term being used called “orthorexia.” It means being completely obsessed with the nutritional content or health content of food, how many vitamins it has, what it is made of, etc. People get totally obsessed with that, which proves the point that people can become obsessed with almost anything. Especially in a society that makes us very conscious of what we eat. I wouldn’t say that people who have that concern have an eating disorder, but, just like the answer to the question about when a diet becomes an eating disorder, I would say that it is when someone’s preoccupation with weight, eating, and body image starts to take so much space in their life, and to affect their behaviours so much, that it really starts to do damage. And, in the same way, you can damage your life by being orthorexic. And sometimes, orthorexics are unable to eat; they will become emaciated because they are so scared to eat anything that isn’t healthy; they don’t have anything left on their list of “safe” foods.
-Howard Steiger, Ph. D., Mini-Psych School 2009

Anorexia is associated with the highest mortality rate of all mental illnesses. Eating disorders have a very high potential to become chronic and have harmful medical and psychological consequences. According to the National Institute of Nutrition, 10% to 15% of people with Anorexia or Bulimia die of their disease. But Anorexia, Bulimia and Eating Disorders can be treated.

It is important to know that being too thin is no healthier than being overweight and that weight fluctuation is more damaging to the health than being overweight.

Anorexia and Bulimia are Eating Disorders. They are complex mental illnesses that can be treated. They can also affect men, and the average age of people affected is 28.

Adolescence involves many changes at many levels. It’s clear that adolescence is accompanied by changes in body weight and shape. You develop female characteristics and develop curves. It’s also a time of emotional instability and hormones take over. It’s a time when you have to develop your own identity, and a time when peer pressure is extremely high. What your friends think matters way more than what your mother thinks. There is pressure to fit in, to look good, to be socially desirable, and to be sexually desirable. Again, if that collides with the thin ideal, which is “This is what I should look like and this is not what I look like,” this actually has a very negative impact and girls will be much more vulnerable to doing something to change and will experience a lot of peer pressure to do so.

- Mimi Israël, MD, FRCPC, Mini-Psych School 2013