Borderline Personality Disorder and Anorexia Nervosa: A Theoretical Review of Shared Psychopathology with a Conceptual Framework

Anorexia nervosa and borderline personality disorder are both often characterized by a chronic, long-term course and high premature mortality. Despite their severity and overlapping clinical features such as emotional dysregulation, self-destructiveness, and disturbances in identity, they have rarely been examined together. This theoretical review synthesizes evidence across domains, with a primary focus on psychological research and theoretical integration. Existing findings indicate partial overlap in vulnerability pathways, including relational trauma, attachment insecurity, and maladaptive emotion regulation, while also revealing distinct contextual expressions - embodied through control and restriction in anorexia nervosa, and enacted interpersonally through attachment ruptures and invalidating relational dynamics in borderline personality disorder. Drawing on these convergences, we propose a theoretical model in which shame-driven, self-reinforcing cycles may link emotional dysregulation with disturbances of the self. Within this framework, restrictive control in anorexia nervosa and impulsive self-destructive behavior in borderline personality disorder may represent parallel attempts to regulate unbearable affect and preserve a fragmented sense of identity. This integrative perspective emphasizes the shared psychopathological mechanisms that may contribute to both conditions, framing their overlap as reflecting partially convergent dynamics between affect regulation and identity disturbance. It highlights avenues for future longitudinal and therapeutic research aimed at testing and refining these conceptual links.