Updated: May 25
“Don’t come near me and don’t ever call me again!” she yelled as she slammed the phone. Her family and friends had become all too familiar with her pervasive pattern of unstable inter-personal relationships coupled with her fear of rejection. Her history of self-hurting behavior, slashing her wrists with sharp objects, multiple speeding tickets and remarkably, episodes of intense overeating were the hallmark of her diagnosis of borderline personality disorder. She is not alone. Borderline personality disorder has a point prevalence of 1.6% in the United States general population with a 6% lifetime prevalence. That means 1 in every 60 people suffer from it.
It is easy to not understand why a person with borderline personality disorder will drive recklessly, gamble their life savings away or overeat, consistently. These individuals, in a sense, are no different from patients with pneumonia, cancer or a broken bone. They are victims of the illness they have. Much as we cannot expect an athlete with a torn ligament to just get up and walk, we also cannot expect a person suffering from borderline personality disorder to just stop overeating. It will be even worse to shame them for their condition or any outward consequences such as obesity.
Weight loss in an overeating patient with borderline personality disorder requires, first and foremost, an understanding of the biology of the condition. It requires a well-thought-out plan by a clinician using all the tricks in the toolbox. An evidence-based approach over many months, or even years, may be needed. This can include dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, schema-focused therapy and cognitive behavior therapy. Sometimes, families will have to be involved in the weight loss plan. A good mental health program such as this can help. A global approach including a personalized nutrition plan such as this and a fitness program such as this is necessary.
This though is another example of why a one-size-fits-all approach to weight loss is sub-optimal. In much the same way that the five fingers of the hand are never the same, the approach to weight loss in any two individuals will also need to be different. Our loved ones with borderline personality disorder are a clear example of the need for personalized and evidence-based approach to weight loss.
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