The Use of Psychotropic Medications in Eating Disorder Patients with Personality Disorders

Abstract

The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.

Chronic Pain and Psychiatric Conditions

“…Patients with a BPD diagnosis are often stigmatized by healthcare professionals as "difficult" (reviewed by [276]; see also [277][278][279][280]). In BPD, in comparison with other psychiatric disorders, symptoms may be seen as the responsibility or failing of the individual instead of part of the disorder: "perceived as purposefully misbehaving rather than experiencing an illness" [281].…”

“…There may be parallels in this stigmatization with chronic pain, particularly when chronic pain is not explained by injury, illness, or other physical or medical findings [282], with patients' symptoms (chronic pain) again reacted to as a personal failing -e.g., in studies of adolescents, pain believed to be more medically based (i.e., associated with clear physical signs or injury) was reacted to more positively by healthcare providers [283,284]. In BPD, this stigmatization can directly negatively impact care, e.g., by affecting patients already heightened rejection sensitivity -clinicians may emotionally withdraw during psychotherapy, which can have devastating effects [277,279]. The framing of BPD diagnosis and the manner of delivering diagnosis can also have significant effects on subsequent engagement by the patient with services and treatment [285].…”