09 Personality and Eating Disorders
Learn how personality disorders and eating disorders are recognized, assessed, and addressed through respectful, individualized, and coordinated care.
Understanding personality disorders
Personality disorders involve enduring, inflexible patterns that cause distress or interfere with important areas of life. A diagnosis is not established by one difficult interaction, an isolated trait, or an unusual coping style; it requires assessment by a qualified professional.
The DSM-5-TR clusters provide a descriptive framework:
includes paranoid, schizoid, and schizotypal personality disorders.
includes antisocial, borderline, histrionic, and narcissistic personality disorders.
includes avoidant, dependent, and obsessive-compulsive personality disorders. Obsessive-compulsive is distinct from obsessive-compulsive disorder.
These groupings can help organize descriptions, but they do not replace individualized assessment.
Assessment and supportive personality-disorder care
Assessment should consider the person's goals and preferences, symptoms and history, physical health, cultural and social context, daily functioning, and safety. Ask about suicide risk, self-injury, and risk to others, and consider co-occurring conditions such as depression, trauma-related disorders, substance use, and .
For , distinguish persistent patterns from symptoms that may be associated with mania or another condition. Psychotherapy is the main treatment approach. is one structured, evidence-supported option; it develops mindfulness, emotion-regulation, distress-tolerance, and interpersonal skills. Medication is not a primary treatment for BPD itself, though it may be prescribed for specific symptoms or co-occurring conditions and reviewed as part of the treatment plan.
Therapeutic communication should be respectful, nonjudgmental, and trauma-informed:
Describe observable behavior and needs rather than using labels such as “manipulative” or “difficult.”
Agree on clear, realistic goals and explain limits calmly.
Use clear language, active listening, and open questions; reflect concerns and check understanding.
Validate feelings without endorsing unsafe behavior. For example: “It sounds overwhelming. Let’s work out what would help you stay safe right now.”
Support autonomy by offering appropriate choices, identifying triggers, and reinforcing effective coping and help-seeking.
Assess safety directly and respond promptly according to clinical policy and the care plan.
Document statements, observed behavior, interventions, responses, and follow-up objectively.
Consistent staff responses can reduce misunderstandings and support care; consistency should not be punitive. Plans should reflect the person's preferences and needs rather than assuming one approach suits everyone.
Recognizing
are serious illnesses involving disturbances in eating behavior and related thoughts or distress. They affect people of all body sizes, ages, sexes, and backgrounds. Appearance or weight alone cannot rule out an eating disorder, and recovery is possible with treatment.
Key patterns include:
: severe restriction, intense fear of weight gain, or disturbed body image. Possible complications include malnutrition, low blood pressure, slowed pulse, and cardiac harm.
: recurrent binge eating followed by compensatory behaviors such as vomiting, fasting, laxative misuse, or excessive exercise. Dehydration, electrolyte imbalance, and dental or gastrointestinal problems may occur; a person may be at an average or higher weight.
: recurrent episodes of eating unusually large amounts with loss of control and distress, without regular compensatory behaviors.
: restriction in food amount or variety related to factors such as low interest, sensory aversion, or fear of consequences such as choking or vomiting. It is not defined by weight or shape concerns.
The type of eating disorder and its effects can differ from person to person. Do not use body size or appearance as a substitute for assessment.
Assessment and coordinated eating-disorder care
Ask about eating patterns, restriction, binge episodes, purging, exercise, body-image distress, medications and substance use, mood, self-harm, and suicide risk. Assess physical health and arrange appropriate medical evaluation. Coordinate mental-health, medical, and nutrition care, and do not rely on appearance, body weight, or self-report alone to judge severity.
Treatment may include psychotherapy, medical monitoring, and nutrition counseling. Some people need hospital or residential care. Depending on the disorder and the person's age, circumstances, and preferences, options may include and family-based treatment, particularly for adolescents. Medication may be used for selected symptoms or co-occurring conditions, but it does not replace medical and psychological care.
Nursing care should support recovery without shame or weight-based assumptions:
Use collaborative, neutral language about food and body image.
Follow the agreed meal and observation plan, and monitor physical and emotional status as ordered.
Report concerning changes promptly.
Avoid power struggles and moralizing; set individualized goals and reinforce progress.
Involve family or other supports with the person's agreement and when clinically appropriate.
Takeaway: coordinated, individualized assessment helps identify both psychological needs and possible medical risks.
Individualized behavioral approaches
Behavioral approaches examine what happens before and after a behavior so the care team and patient can support safer, more effective alternatives. They should be collaborative and consistent with the treatment plan, not used to punish or control.
A practical plan can:
Define a specific target in observable terms, such as attending a meal or using a coping skill when distress rises.
Identify triggers and needs with the patient, considering environmental, medical, cultural, and interpersonal factors.
Choose and rehearse a safe replacement behavior that meets a similar need.
Reinforce effort and effective skills, including help-seeking, rather than focusing only on whether symptoms are absent.
Review outcomes and adjust with the patient and care team, considering safety, functioning, and the person's experience of care.
For example, if distress tends to precede self-injury, the team can help the person notice early warning signs, practice a coping skill, and contact support before the urge escalates. For binge eating, a clinician-guided plan may track triggers and feelings and support regular eating rather than restriction-and-binge cycles.
Takeaway: effective behavioral care is specific, safe, supportive, and reviewed collaboratively.