People with bulimia can range from only slightly disturbed individuals who recover with little help to people with severe personality disorders. In people with bulimia and a severe personality disorder other symptoms can include self-destructive behaviour, emotional instability, suicidal ideation and profound interpersonal and social problems. Those people with bulimia and borderline personality disorder (BPD) are regarded as the most difficult bulimia subgroup to treat and the one with the worst prognosis. A German study of 240 bulimia patients found that 13.8% of them had a diagnosis of BPD. There were no differences in binging and purging behaviour between those with and without BPD but BPD patients had significantly more feelings of ineffectiveness and less emotional self-awareness. Although the BPD group began treatment with more mental-health problems they improved as much as the other patients over the course of their treatment.
Zeeck, A. ... [et al] - Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder European Eating Disorders Review November-December 2007, 15(6), 430-438