Integrating Personality Disorders in the Treatment of Eating Disorders: A Commentary Based on Clinical Cases With Transdiagnostic Approaches

Eating disorders (ED) do not fully respond to current empirically supported treatments and treatment attrition is significant. One reason is that the comorbidity between ED and personality disorders (PD) has not been sufficiently considered, although it is frequent and poses treatment challenges. The clinical case papers included in this virtual issue of the Journal of Clinical Psychology: In Session dealt with this problem from different theoretical perspectives. All of them tried to address the comorbidity between ED and personality pathology through integrative interventions with positive outcomes on both domains. Patients suffered from different ED and PD diagnoses and each paper showed how the clinician adopted an individually tailored case formulation leading to personalized treatments as early as during the initial assessment. A common thread among the different approaches was a constant attention to ruptures in the therapeutic relationship and efforts at repairing it when necessary. Reasoning on the cases described alongside the introductory literature overview, we suggest that addressing PD is necessary, as focusing only on ED symptoms may partially fail, leave the patient vulnerable to relapse or increase dropout risk. The contribution of individualized case descriptions, as shown in this issue, may lead to adapt ED-focused treatment to deal with comorbid PD traits or full-blown PD when present. This together with addressing common underlying dynamics and skills training could contribute to the much needed improved in treatment attendance and efficacy among ED sufferers.