The Connection Between Cluster B Personality Disorders and Food

I’d like to welcome the newest Shrink4Men contributor who I’m sure many of you already know, kiwihelen (KH). KH has been a much loved and respected member of the S4M community for close to 2 years now and is also a moderator on the S4M Forum. In her offline life, KH is a registered dietitian with 15 years of clinical experience in three countries. So, in the words of another S4M moderator (Mellaril), it’s time to “Release the Kiwi!” – Dr T

Recently on the Shrink4Men forum, there has been considerable discussion about the dietary habits of many of the high-conflict individuals who trouble the lives of those who post there. I took both a personal interest (having had a whole load of trouble with a HCP spouse who blamed me for his overweight), and a professional interest thinking about some of the more alarming characters I come across in my clinical work.

A quick glance at the literature on eating disorders (ED) and the co-morbid mental health issues associated with this group makes it very clear there is a high incidence of diagnosable personality disorders (PD) in the ED population. Authors disagree on the actual incidence, but the argument behind this appears to be which tools are used to identify PD, rather than the existence of PD. The estimates of diagnosable personality disorders in the eating disordered population appears between 9% and 40%. However, this is the diagnosed rate, and we need to think about two things:

  1. Not all people with ED are diagnosed, and
  2. Just because they are not at the diagnostic threshold for a PD, doesn’t mean they aren’t crazy!

So what kind of red flags would be worth noticing (and running from) in the dating world, when it comes to working out if your love interest is exhibiting ED behaviour?

She is thin, but would like to be thinner

Big red flag, one of the diagnostic criteria for Anorexia Nervosa is “irrational fear of weight gain,” and this the outward expression of the fear of gain, or at the very least a distorted body image. Women with distorted body images are pretty damn miserable partners, no one is better in bed than a woman who likes her body.

Irregular or no menstrual cycle while thin

Unless you know she has an implant under her skin, or can feel the threads of a progesterone releasing IUD, then beware the woman under 50-years old who has few or no periods. We need a certain percentage of body fat to menstruate, and low body fat leads to cessation of periods. This is bad for bone health, bad for future fertility and a bloody great big red flag you have someone who has an ED on your hands.

The feeder

She cooks elaborate meals for you and/or family but will only eat a small amount herself. She seems obsessed with planning meals and food related occasions. This obsession was observed in the Keys studies on starvation in the 1940s, and seems to be a feature of starvation. If she gets upset because you don’t want to participate, it is a sign to GTFO.

The exerciser

If she has to do 500 crunches before she gets to bed or she won’t change her exercise routine for any circumstance including a holiday (this will provoke her to find out exactly where the nearest gym facility will be), then be wary. Exercise induced anorexia is common in elite athletes of all sorts.

Orthexic behaviour

She has funny food rules for seemingly no real reason. Some religions and philosophies have dietary rules, some medical conditions require a special diet, but unless she can talk about the reasons for doing what she is doing in a competent and adult manner, then be very suspicious of any faddy eating. If for example the reason for being vegetarian is “because I feel bad about eating cute wee lambs,” dig a bit further and find out what she understands to be a healthy vegetarian lifestyle. If you ever see anything that even has a sniff of ritual in an eating pattern, e.g., certain foods can only be eaten at certain times of the day, then run and don’t look back.

An alternate test for orthexia is asking if she would eat something on her forbidden list if she could not get anything else to eat. Choosing to starve is an abnormal behaviour.

Going AWOL after meals

That can suggest purging after eating. It is not a 100% rule, because about 1 in 10 people will need to have a bowel motion within 30 minutes of eating a meal. If she comes back to the table smelling of mouthwash and/or perfume you should be wondering what she has been up to. Pay for the meal and say “good-night,” run and don’t look back.

Chaotic eating patterns

OK, all of us are busy and miss meals sometimes or have them at odd times. A total lack of planning, loads of missed meals, not having some food in the house are all red flags which have to raise alarms, particularly if the person you are talking to is overweight.

Food going “missing”

If you buy food together, go to sleep and next morning some of the food is not there, but she denies it, then be suspicious she is a binge eater. Binge eaters, whether they purge or not, eat foods that are easy to consume rapidly and without much thinking. Commonly consumed items include ice-cream, crisps and biscuits. Finding recent till receipts with this kind of food on it, when the food isn’t around is a big marker.

Weight loss surgery which appears to have failed

Some people need weight loss surgery because they gain weight for genetic or genuine medical reasons, and once it is done it is a life transforming event. Good surgical teams screen for psychological disorders, but there are loads of people who can lie their way through the tests and/or less than ethical surgeons. I’ve met more crazy folk who have had bariatric surgery than I have done in any other field, up to and including hearing from a forensic psychiatric unit they had “found” a surgical patient who was anorexic and had Korsakov’s syndrome from nutrient deficiencies.

As a non-personality disordered woman, I have had to work through my own body insecurities and I am selective of my media use because I find the way women are portrayed unrealistic and disturbing. Like all women over 40 I have to make efforts to avoid weight gain, but I can put things in proportion, knowing I am comfortable in a UK size 10-12 (US 6-8), and no amount of dieting and exercise is going to change my body shape.

I am comfortable with my body and can make jokes about my “baby knees,” while still wearing shorts to exercise. I do exercise, but it is not a big catastrophe if I miss a session (though I can get grumpy if I miss a whole week of workouts!) Although I have food likes and dislikes and a strong preference to eat a healthy balanced diet, I have been known to eat McDonald’s or KFC when there are no other options rather than going hungry. I understand the importance of planning meals, and have just stocked up on my favorite lunch option for the next week because it was on special at the supermarket.

My house-mate and I have a very fair rule, “if you buy treats, you buy two and we share,” so we had a chocolate croissant for breakfast as he spotted them in the reduced to clear section while getting milk and coffee last night. I love cooking for friends and family, but it is not a 3-ring circus event. Food is something I enjoy but does not dominate my life. Any woman whose waking thoughts seem to be 90% on food should be treated as a PD bomb just ready to go off . . . particularly if she works in a food related area like me.

Thanks again, KH, for adding your wisdom and voice to Shrink4Men. – Dr T

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Dr Tara J. Palmatier provides confidential, fee-for-service, consultation/coaching services to help both men and women work through their relationship issues via telephone and/or Skype chat. Her practice combines practical advice, support, reality testing and goal-oriented outcomes. Please visit the Shrink4Men Services page for professional inquiries.

Comments

  1. knotheadusc says

    What about Cluster B women who are bingers or compulsive eaters? My husband’s PD ex wife gets very angry or upset and stuffs herself with food, but does nothing to burn off the excess calories. When my husband was married to his first wife, it was not uncommon for her to stop at a fast food restaurant and gorge on burgers and fries or eat several candy bars in one sitting. Consequently, she is very overweight. Sometimes people forget that binge eating disorder and compulsive eating disorder are as dysfunctional as anorexia and bulimia are.

    I totally agree that someone with an eating disorder is probably not much fun to hang out with, especially since so many dating activities are conducted around meals. Dating time is a great time to observe a potential mate for dysfunctional eating patterns. It may offer valuable warning signs against Cluster B individuals.

    • kiwihelen says

      Probably the most recent seriously crazy I dealt with was a binge eater. Your DH’s ex is probably like the “failed” bariatric patients I wrote about.

  2. Paul Elam says

    Another great article. As someone who worked with addictions treatment and recovery for a long time, I am surprised to see that low estimate on the incidence of PD in the ED population. I would guess it was higher.

    But you are spot on correct to caution people away from placing faith in the diagnosis alone. I can tell you that with almost complete certainty, IF SHE IS BAD WITH FOODS, SHE IS BAD WITH DUDES.

    I never saw anyone who was intimately involved with someone with an eating disorder that was not miserable. The control issues, the manipulation, the emotional blackmail, all part of the same sick and recurring picture with this group.

    Dr. T is right, folks. Put eating disorders on your list of deal breakers.

    • Dr Tara J. Palmatier says

      Thanks, Paul. However, I’m not the author of this excellent piece. Kiwihelen wrote it. I believe KH is also registered over at AVfM.

    • kiwihelen says

      Thanks Paul,

      I was not that surprised at the low diagnosis rate of PD comorbid with ED…much of the UK based research is in the lower end of things, because P-docs here are reluctant to give people PD diagnoses.

      I find dealing with ED patients damn hard work. I can’t imagine living with them (actually I house shared with two – lasted 6 weeks and then got rescued by a wonderful older friend of mine who saw I was going nucking futs)…but I would agree on the partners being miserable.

  3. Micksbabe says

    Interesting stuff. My own mother was sent to treatment for anorexia and was diagnosed for BPD at that time. She is, incidentally, a “Feeder”. She makes twice as much food as her audience can/should eat, and then flits around throughout dinner, adding extra helpings.

    I think it’s normal to have some food likes and dislikes (I, for one, will not eat a radish). But I always thought that people who were extremely picky about food, are doing it for negative attention.

  4. thom237 says

    My ex wife is a vegetarian and was diagnosed as being clinically Histrionic (MCMI and MMPI tests administered by a psychologist) and our marriage counselor determined that she exhibited narcissistic and borderline characteristics.

    Every meal with her was an adventure.

    She refused to cook any meals for me (she was a stay at home mom) and she demanded that I cook all meals containing meat outside on the BBQ (even during the winter months).

    She bought her own pots and pans and would hide them in the pantry so I wouldn’t use them.

    She did the craziest things when we were at restaurants. She would ask to have people clean the surfaces of grills/ovens (and watch them if the kitchen was visible from our seats) because she didn’t want any meat products touching her food.

    Yet she ate french fries even after I said that chicken strips and other products were cooked in the same oil. She didn’t care because “fresh hot french fries were her favorite food”.

    She was an on again/off agin vegan. She would tell anyone who would listen about her newest food obsession and quote random statistics form the book “Skinny Bitch” and criticize people and the food they chose to eat (usually me – but even strangers sitting next to us at restaurants).

    Usually once a month my ex wife (and her similarly crazy sisters) all do a cleanse/fast – and she makes it a point to let me know how hard it is on her body and how tired it makes her feel.

    She often shows up to pick up our daughter and says something to her along the lines of “I haven’t eaten anything all day – I am so hungry”. I have spoken to her about setting a poor example for our daughter but she continues to say stuff like that.

    I am from Montana so I like to BBQ. My daughter is at the age where she is starting to help me cook meals. She loves BBQ chicken/BBQ sauce and asks to eat it often. Her mother told her that eating chicken was murder and that I am a bad person for killing/eating chickens. My ex also told my daughter that she would get very sick if she ate chicken. Last week my daughter cried when I suggested we make BBQ chicken sandwiches because she said “she didn’t want to get sick and die”.

    Thank you for yet an another insightful article.

    Keep up the good work!

    T

    • Dr Tara J. Palmatier says

      Hi thom,

      Good to see you here. I agree, kiwihelen’s article is very insightful. Has the PAS abated with your daughter or are the ex and her family up to the same old same old? How are you doing?

      • thom237 says

        Hey Dr T:)

        Same old same old. I have now spent around $50,000+ on legal fees…and it seems as if it will never end some days:(

        But my daughter is starting to understand that her mother has issues (I am not saying anything negative – just listening to and supporting her) and because of that my relationship with my daughter is absolutely wonderful.

        I’m/we’re slowly getting better every day:)

        I have been reading your articles, visiting topics in the forums, and listening to your online programs a lot of late to maintain some clarity and control over my thoughts and emotions.

        Thank you for continuing to fight the good fight – I appreciate it very much!

        I hope you are doing well:)

        T

  5. tenquilts says

    This makes a lot of sense from a bird’s eye view. I’m not psych professional, but I understand the root of most eating disorders is essentially a poor or damaged self-image. It would stand to reason that anyone who loathes themselves can neither love others nor accept love from others. Naturally, the ways that this manifests would not always constitute a PD, but definitely a red flag in that the woman needs more help than anyone but a trained professional can provide. I’d even venture to expand the red flag field into areas like multiple cosmetic procedures or even frequent and drastic impermanent changes to appearance, like radical hairstyle changes every few weeks and huge swings in wardrobe style (Ann Taylor one week and Lady Gaga the next). In essence, anyone who lives with an inflated sense of importance on outward appearances AND always tries to stay at the top of the list of things people are noticing or talking about is probably not one ready for an equal and healthy romantic partnership, unless it’s part of a professional image (like actress or fashion designer) and they can take the trappings and masks off in private and be real.

  6. tallwheel says

    My new girl tells me she is bulimic and occasionally purges, but claims she is trying to quit. She says, “I was X pounds at Y age and I can be X pounds again. I was so beautiful then!” I just can’t understand why she thinks she needs to lose more weight. She’s not fat by any means, and I’ve even told her I like a little fat on my girls. I really can’t say yet whether or not I think she has also has a PD, but she is showing some red flags. I am getting myself into trouble here, aren’t I…

    • tenquilts says

      I’d say so. The “I’d be beautiful if only if …” in any circumstance is a red flag. If she needs you to validate how she thinks or feels about herself, you will never be able to do enough to make up for what she can’t do for herself.

      • tallwheel says

        I’m really having a problem with the ‘run and don’t look back when you see the first red flag’ part of the article. My new girl has shown multiple major red flags, but I’m really attracted to her and she hasn’t done anything at all to hurt me yet, so I am definitely going to proceed with caution rather than running before I really know her well enough to make a full assessment. I know I am far from perfect myself, and I have a feeling that reading this site so much may be causing me to see red flags in people everywhere more than I really should. Maybe I am sounding like another foolish white knight who is about to let his lower brain get himself involved with a crazy. “There goes another one,” I can imagine people saying right now as they read this. At least, now armed with the knowledge from this site, I think I am capable of GTFO before I reach the point of no return, and I have Dr T, Kiwihelen, and all the posters here to thank for that. Actually, to be completely accurate, I was already able to do it with the last crazy I was involved with, and that was before I had even found this amazing site, so I am pretty confident I will come out of this all right in the end. Best case scenario, I am overreacting to her red flags and she will turn out to be a wonderful person. I know the odds of that are very low, but it is just so rare that I find myself truly attracted to a person that I don’t want to throw this away before I see what its full potential might be.

    • tallwheel says

      Update on this: She recently checked into a hospital at the recommendation of a doctor. Guess that’s good for her. Hope she can get help. I’m doubtful. Even now she is saying that the main problem is that she keeps getting fat even though she’s not digesting anything. I think the root problem is that she doesn’t accept her body the way it is.

      Anyway, even though we broke up months ago, the reason I know all this is because she texted me and says she wants me to visit her in the hospital. Nah. Definitely not doing that. I’ll consider it after she’s given some indication that she’s made a positive change for herself.

      • fubar says

        The most likely reason why she is gaining weight is, our bodies require a certain amount of daily caloric intake(around 1000 calories minimum). If the body doesn’t get what is required, I goes into a kind of starvation mode where it begins to converse its energy reservoirs. Result, gain. If yours was like mine, she had no reason to ever doubt her appearance, she was quite amazing in every way.
        I’m glad to hear you got out before you really fell for her (excuse my assumption about that it sounded like you were protecting yourself though). Give her credit for getting help though, mine talked about it all of the time. How she needed to go away to get treatment, and that she is slowly killing herself, it was and still is heartbreaking, I hope with all my heart that she make the decision to help herself.

  7. ron7127 says

    My XW was in extremely good shape when we met. We had three daughters in fairly rapid succesion, and, of course she gained some weight, which was fine with me.
    However, after about 7 years, she went on a bit of a rampage, losing a ton of weight and exercisong like mad.
    Her diet consisted of Saltines, Broccoli, and Non-fat Ranch dressing. That was it, seriously.
    She would not join us for meals(which I cooked, for the most part).
    SHe began to look like a skeleton and began dressing like a much younger woman. This coincided with her going on the prowl and beginning at least two affairs that I know of.
    Her family thought she was on drugs, she looked so emaciated> She bought over 50 bikinis in short order, to go along with her myriad shoes, boots, tops and assorted designer jeans. We were going broke due to her clothes spending.
    I guess the whole scenario encompassed a bunch of red flags. The eating deal, the financial irresponsibility, the hoarding of bikinis, and, of course the infidelity.
    This woman had amazing willpower for both dieting and exercising in the extreme. And, she looked ghastly, transforming herself from a relatively nicely proportioned woman to a skeletor.
    I guess whn motivated to hunt new, younger men, no sacrifice was too great.

  8. chrispunch says

    That was a really interesting article. Thanks KH. I would like to add that men should be wary of women who say that they “used to” have an eating disorder. My ex claimed that, but often when feeling miserable about herself (which was almost daily) would eat a packet of cookies in one sitting and then complain how fat she was (she wasn’t fat).

  9. Tom says

    Having met women in the past with obvious PD and anorexic traits — traits which were, to me, baffling and intriguing at the time: their attitudes, perceptions, beliefs and behaviors (especially secretive behaviors) defied any type of explanation until I became educated in anorexia and bulimia. The best books & resources I’ve read on the subject so far:

    http://www.amazon.com/Dying-Please-Anorexia-Treatment-ebook/dp/B002WWTHYE/

    http://www.amazon.com/Control-ebook/dp/B0044XUVCQ/

    http://www.amazon.com/Anorexics-on-Anorexia-ebook/dp/B003VYC2WG/

    http://www.casapalmera.com/articles/7-warning-signs-of-an-eating-disorder/

    http://ezinearticles.com/?Anorexia—a-Game-of-Control!&id=5730

    http://bjp.rcpsych.org/content/186/6/516.full.pdf+html

    http://psycnet.apa.org/psycinfo/1994-30233-001

    http://www.psychosomaticmedicine.org/content/1/3/335.full.pdf

    http://mindmorsels.com/reprints/Pryor13.pdf

    http://works.bepress.com/david_watson/128/

    http://www2.hawaii.edu/~vitousek/ANSELFWS.PDF

    http://www.nedic.ca/knowthefacts/documents/TheControlParadox.pdf

    Eating Disorders and co-morbid personality disorders are things that a man should know about in some detail, especially if it is a female family member. If you’re only interested in or dating one of these creatures, however, my advice: run away! Run far away, Forrest Gump….

  10. Tom says

    A set of links I forgot to include above:

    A well-done BBC documentary by journalist and presenter, Kate Thornton on anorexia:
    Kate Thornton Anorexic My Secret Past P1

    Kate Thornton Anorexic My Secret Past P2

    Kate Thornton Anorexic My Secret Past P3

    Anorexia and bulimia can occur (or recur) in older women, too:
    http://www.webmd.com/mental-health/anorexia-nervosa/features/anorexia-is-hitting-older-women
    http://harvardpartnersinternational.staywellsolutionsonline.com/HealthNewsLetters/69,M0312a

  11. fubar says

    I entered into I relationship with a woman who at the very least has a eating disorder. That is for sure, and I knew about it before dating her, I thought I could help. This thought process shows my ignorance, and naivete about the situation. I hesitate to say if she has a pd, as I am not qualified to make a diagnosis. She did match many of the criteria for bpd that I have researched. That being said I find that I see that I meet some of the criteria as well, which is makes me wonder if I was really the caused the demise of our relationship. I’m just really confused, and hurt, when I read about the script of “how a bpd relationship evolves” on bpdfamily I was in disbelief. I jumped on that hook, without hesitation I should mention that this was my first relationship, I’m sure that complicates matters for me now. I thought I had found the one, things were amazing for a little bit. I thought that her jealously would pass with time, I didn’t, at the beginning she told me when we were out that ‘she felt like she needed to pee around me’ to mark her territory, she believed that girls were always looking at me. If they were I never noticed, and never cared, I was with the person I wanted. Sadly enough even after all the nonsense that has happened between us I still think about her daily, we have been broken up for eight months or so. We didn’t talk for five months after our breakup, (i initiated, I miss her, fool) none again after that other than wishing me happy bday. Things got so messed up, we couldn’t get back together anyway, she tried to make me the bad guy the best she could, I held onto my morals though. I believe she wanted to be the victim, she was ‘talking to me’ in her car outside my house and she asked me “why don’t you hit me”. I couldn’t believe what I was hearing, it was like this person completely forgot who I am, this is a little embarrassing but hearing her say that made me cry. I’m sorry that this is such a disjointed post but there is just so much swirling in my head still, after all this time. There is so much more I’m confused about, I’m really questioning a lot about myself and what happened.

    • kiwihelen says

      Hi fubar, sounds like it would be worth your while spending some time in the Shrink4men forum as we have a fair number of folk who need to work out what happened and why it happened after a PD relationship
      The important thing is to understand why you were vulnerable to this relationship. In your case it might be like I was – innocent and inexperienced, but it is good to explore as it helps you avoid the same mistakes

      • fubar says

        Thank you kiwihelen, I do believe a majority was innocence and enthusiasm, there I was waiting all this time for the right girl to come along. And there she was, on a superficial level she was everything I ever wanted in a partner, absolutley beautiful to my eyes. She was so nice and sweet, I thought she hadn’t met the right guy, I wanted to give myself to her. I honestly thought I was the luckiest guy in the world, when I found out she was in to me as well. Which is why I’m having such a hard time letting go, I’m having trouble snapping out of what surely was a dream. Now I am stuck in a nightmare, I don’t meet women that I see as possible partners everyday, and I feel like she is just happily moving on and will have no problem replacing me.
        I agree, I am hoping to avoid making the same mistakes that I eviscerate myself for on a daily basis. I have reading this site for awhile but am new to posting, is there a specific forum you are referring to?

        • kiwihelen says

          hi there, top of the page under the banner there is a grey strip of options, click on forum & register. Dr T personally vets all members so it can take a wee while to be activated so you can see and post.
          On meeting partners, I found my beloved when I stopped looking, I had the confidence then I was OK on my own and it kinda shone through!

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