Princess Diana, Eating Disorders, and Borderline Personality Disorder



After watching the Princess Diana movie yesterday, I’ve been thinking about her behavior and how someone in the psychology field might diagnose her. Diana was known to have a history of bulimia and self-injury (cutting behavior), and in the movie she demonstrated what appeared to be some manipulative behaviors and even described herself as “stalking” a partner at one point. On the flip side, Diana was also known to be one of the most empathic, loving, and generous women in the world. This complex assessment of an individual – someone who would likely be diagnosed with borderline personality disorder, but also having a Mother Teresa type influence...is an interesting dichotomy for sure.

While in graduate school, I really enjoyed the conversations I had with Dr. Cook-Cottone, my mentor. Two conversations I had with her helped me to maybe understand Princess Diana’s story a little better. First of all, I remember that Dr. Cook-Cottone refrained from diagnosing individuals with “borderline personality disorder.” For example, she indicated that she would treat individuals with eating disorders and “A DIAGNOSIS OF borderline personality disorder” rather than simply listing borderline as a specialization.
Borderline is a very pathologizing diagnosis – most treatment professionals would prefer few if any of these individuals on their caseload. In the field of eating disorders, however, you come across this diagnosis quite frequently. Eating disorders are complex issues, oftentimes pretty resistant to treatment…recovery on average takes 5-7 years, so it isn’t surprising that treatment professionals classify an individual as “borderline” when they are difficult to treat. Individuals with eating disorders also often have emotion dysregulation issues – they experience their emotions very intensely – thus self-injury, restrictive eating, binge eating, and purging behaviors become a way to “numb” out from the feelings or reestablish control. Many of these individuals contemplate suicide as well because of the way they experience themselves and others in relationships – fearing abandonment, idealizing and later devaluing others.

The other topic I discussed with Dr. Cook-Cottone – which to my knowledge has not been researched, but this was her speculation, which I tend to agree with that individuals with eating disorders may possess an excessive amount of mirror neurons in the brain. Some scientists have hailed mirror neurons a cornerstone of human empathy – whereas other scientists have indicated the importance of mirror neurons has been exaggerated. Anyway, I am not stating that I know anything about mirror neurons, that any of this is actually true – but it seems to make sense as to why individuals with eating disorders have a difficult time identifying their own emotions, while being very attuned to the feelings in others. This could explain why Princess Diana cared so deeply for others and suffered such emotional turmoil herself.

The way I view individuals with eating disorders who may be classified by treatment professionals as “borderline” is as follows:

1)      They have an amazing potential to do good work in this world if their passion and attunement to the feelings in others can be directed in a positive way.

2)      If taught via therapy or otherwise to connect with their own feelings and regulate their emotions, they are very capable of maintaining stable, mutually beneficial, loving relationships.
 
3)      They may benefit from harnessing the inner voice of negativity in relationships – Jenni Shaefer refers to this voice as ED and recently we selected the term “Trixie” in one of my treatment groups – This “voice” (not an actual auditory hallucination) suggests that others do not care about you, that you are essentially alone in the world, and suggests that extreme behavior is needed to reinforce that individuals will still be there even when your behavior is unacceptable. The problem is that this is not conducive at all to maintaining relationships. It becomes a self-fulfilling prophecy…

      Recently I’ve begun to talk with clients about this constellation of traits and distorted interpersonal beliefs as similar to the hallucinations/delusions of a person with schizophrenia – just to illustrate that these beliefs are just as harmful and false. This helps individuals to develop a metacognitive ability to think about their thinking – about how their brains work – and to challenge their beliefs that may not be serving them in an adaptive way.

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