Do narcissists also suffer from eating disorders such as bulimia nervosa or anorexia nervosa?
Patients suffering from eating disorders either binge on food or refrain from eating and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined by DSM and is sometimes comorbid with Cluster B personality disorder, particularly with Borderline Personality Disorder.
Some patients develop eating disorders as convergence and confluence of two pathological behaviours: self-mutilation and an impulsive (rather, obsessive-compulsive or ritualistic) behaviour.
The key to improving mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing at first upon their eating and sleeping disorders.
By controlling his eating disorder, patient reasserts control over his life. This newfound power is bound to reduce depression, or even eliminate it altogether as a constant feature of his mental life. It is also likely to ameliorate other facets of his personality disorder.
It is a chain reaction: controlling one's eating disorders leads to a better regulation of one's sense of self-worth, self-confidence, and self-esteem. Successfully coping with one challenge - eating disorder - generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.
When a patient has a personality disorder and an eating disorder, therapist would do well to first tackle eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved.
From patient's point of view, treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disorders real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)…
An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."
This is where we can and should begin to help patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to make patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.
Eating disorders indicate strong combined activity of an underlying sense of lack of personal autonomy and an underlying sense of lack of self-control. The patient feels inordinately, paralyzingly helpless and ineffective. His eating disorders are an effort to exert and reassert mastery over his own life.