The comorbidity of personality disorders in eating disorders: a meta-analysis



The present meta-analysis summarized the proportion of comorbid personality disorders (PDs) in patients with anorexia (AN) and bulimia nervosa (BN), respectively, and examined possible moderating variables.


A search of the databases PsychINFO, Embase, and Medline for the period 1980–2016 identified 87 studies from 18 different countries.


The mean proportion of PDs among patients with any type of eating disorder (ED) was .52 compared to .09 in healthy controls. There were no statistically significant differences between AN (.49) and BN (.54) in proportions of any PD or PD clusters except for obsessive-compulsive PD (.23 vs .12 in AN and BN, respectively).


Both ED diagnoses had a similar comorbidity profile with a high prevalence of borderline and avoidant PDs. Moderator analyses conducted for any ED and any PD yielded significant differences for diagnostic systems with respect to EDs, method for assessing PD as well as patient weight and age.

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  1. 1.

    Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41:509–528. doi:10.1016/S0005-7967(02)00088-8

    Article  PubMed  Google Scholar 

  2. 2.

    Bamford B, Sly R (2010) Exploring quality of life in the eating disorders. Eur Eat Disord Rev 18:147–153. doi:10.1002/erv.975

    Article  PubMed  Google Scholar 

  3. 3.

    Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, Charlson FJ, Norman RE, Flaxman AD, Johns N, Burstein R, Murray CJ, Vos T (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382:1575–1586. doi:10.1016/S0140-6736(13)61611-6

    Article  PubMed  Google Scholar 

  4. 4.

    Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68:724–731. doi:10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  5. 5.

    Franko DL, Keshaviah A, Eddy KT, Krishna M, Davis MC, Keel PK, Herzog DB (2013) A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry 170:917–925. doi:10.1176/appi.ajp.2013.12070868

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Strober M, Freeman R, Morrell W (1997) The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 22:339–360. doi:10.1002/(SICI)1098-108X(199712)22:4<339:AID-EAT1>3.0.CO;2-N

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Zerwas S, Lund BC, Von Holle A et al (2013) Factors associated with recovery from anorexia nervosa. J Psychiatr Res 47:972–979. doi:10.1016/j.jpsychires.2013.02.011

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Gazzillo F, Lingiardi V, Peloso A, Giordani S, Vesco S, Zanna V, Filippucci L, Vicari S (2013) Personality subtypes in adolescents with anorexia nervosa. Compr Psychiatry 54:702–712. doi:10.1016/j.comppsych.2013.03.006

    Article  PubMed  Google Scholar 

  9. 9.

    Campbell M (2009) Drop-out from treatment for the eating disorders: a problem for clinicians and researchers. Eur Eat Disord Rev 17:239–242. doi:10.1002/erv.934

    Article  PubMed  Google Scholar 

  10. 10.

    Bruce KR, Steiger H (2005) Treatment implications of axis-II comorbidity in eating disorders. Eat Disord 13:93–108. doi:10.1080/10640260590893700

    Article  PubMed  Google Scholar 

  11. 11.

    Pham-Schottez A, Huas C, Perez-Diaz F, Nordon C, Divac S, Dardennes R, Speranza M, Rouillon F (2012) Why do people with eating disorders drop out from inpatient treatment? The role of personality factors. J Nerv Ment Dis 200:807–813. doi:10.1097/NMD.0b013e318266bbba

    Article  Google Scholar 

  12. 12.

    Bruce KR, Steiger H (2006) Prognostic implications of personality disorders in eating disorders. In: Sansone RA, Levitt JL (eds) Personality disorders and eating disorders: exploring the frontier. Routledge, New York, pp 247–262

    Google Scholar 

  13. 13.

    Chen EY, McCloskey MS, Michelson S, Gordon KH, Coccaro E (2011) Characterizing eating disorders in a personality disorders sample. Psychiatry Res 185:427–432. doi:10.1016/j.psychres.2010.07.002

    Article  PubMed  Google Scholar 

  14. 14.

    Kendall PC, Clarkin JF (1992) Introduction to special section: comorbidity and treatment implications. J Consult Clin Psychol 60(6):833–834

    CAS  Article  Google Scholar 

  15. 15.

    Grilo CM, Sanislow CA, Skodol AE, Gunderson JG, Stout RL, Shea MT, Zanarini MC, Bender DS, Morey LC, Dyck IR, McGlashan TH (2003) Do eating disorders co-occur with personality disorders? Comparison groups matter. Int J Eat Disord 33:155–164. doi:10.1002/eat.1012312616581

    Article  PubMed  Google Scholar 

  16. 16.

    Grilo CM, Pagano ME, Skodol AE, Sanislow C, McGlashan TH, Gunderson JG, Stout RL (2007) Natural course of bulimia nervosa and of eating disorder not otherwise specified: 5-year prospective study of remissions, relapses, and the effects of personality disorder psychopathology. J Clin Psychiat 68:738–746. doi:10.4088/JCP.v68n051117503983

    Article  Google Scholar 

  17. 17.

    Berkman ND, Lohr KN, Bulik CM (2007) Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord 40:293–309. doi:10.1002/eat.20369

    Article  PubMed  Google Scholar 

  18. 18.

    Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284–1293. doi:10.1176/appi.ajp.159.8.1284

    Article  PubMed  Google Scholar 

  19. 19.

    Rø Ø, Martinsen E, Hoffart A, Rosenvinge JH (2005) The interaction of personality disorders and eating disorders: a two-year prospective study among patients with a long history of eating disorders. Int J Eat Disord 38:106–111. doi:10.1002/eat.20166

    Article  PubMed  Google Scholar 

  20. 20.

    Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G (2010) The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord 43:226–232. doi:10.1002/eat.20689

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Wentz E, Gillberg C, Gillberg IC, Råstam M (2001) Ten-year follow-up of adolescent-onset anorexia nervosa: psychiatric disorders and overall functioning scales. J Child Psychol Psychiatry 42:613–622. doi:10.1111/1469-7610.00757

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Råstam M (2009) Adolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiat 194:168–174. doi:10.1192/bjp.bp.107.048686

    Article  Google Scholar 

  23. 23.

    Cassin SE, von Ranson KM (2005) Personality and eating disorders: a decade in review. Clin Psychol Rev 25:895–916. doi:10.1016/j.cpr.2005.04.012

    Article  PubMed  Google Scholar 

  24. 24.

    Jackson HJ, Jovev M (2006) Personality disorder constructs and conceptualizations. In: Sansone RA, Levitt JL (eds) Personality disorders and eating disorders: exploring the frontier. Routledge, New York, pp 3–20

    Google Scholar 

  25. 25.

    Sansone RA, Levitt JL, Sansone LA (2005) The prevalence of personality disorders among those with eating disorders. Eat Disord 13:7–21. doi:10.1080/10640260590893593

    Article  PubMed  Google Scholar 

  26. 26.

    Sunday SR, Peterson CB, Andreyka K, Crow SJ, Mitchell JE, Halmi KA (2001) Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients. Compr Psychiatry 42:448–455. doi:10.1053/comp.2001.27896

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Echeburúa E, Marañon I (2001) Comorbilidad de las alteraciones de la conducta alimentaria con los trastornos de personalidad [Comorbidity between personality disorders and eating disorders]. Behav Psychol 9:513–525

    Google Scholar 

  28. 28.

    Ramklint M, Jeansson M, Holmgren S, Ghaderi A (2010) Assessing personality disorders in eating disordered patients using the SCID-II: influence of measures and timing on prevalence rate. Personal Individ Differ 48:218–223. doi:10.1016/j.paid.2009.10.014

    Article  Google Scholar 

  29. 29.

    Rosenvinge JH, Martinussen M, Ostensen E (2000) The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998. Eat Weight Disord 5:52–61. doi:10.1007/BF03327480

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Cumella EJ, Kally Z (2008) Profile of 50 women with midlife-onset eating disorders. Eat Disord 16:193–203. doi:10.1080/10640260802016670

    Article  PubMed  Google Scholar 

  31. 31.

    Bornstein RF (2001) A meta-analysis of the dependency eating-disorder relationship: strength, specificity, and temporal stability. J Psychopathol Behav 23:151–162. doi:10.1023/A:1010913203679

    Article  Google Scholar 

  32. 32.

    Gadalla T, Piran N (2007) Co-occurrence of eating disorders and alcohol use disorders in women: a meta-analysis. Arch Womens Ment Health 10:133–140. doi:10.1007/s00737-007-0184-x

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Masjuan MG, Aranda FF, Raich RM (2003) Bulimia nerviosa y trastornos de la personalidad. Una revisión teórica de la literature [Bulimia nervosa and personality disorders. A review of the literature]. Int J Clin Health Psychol 3(2):335–349

    Google Scholar 

  34. 34.

    Friborg O, Martinussen M, Kaiser S, Øvergård KT, Rosenvinge JH (2013) Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. J Affect Disord 145:143–155. doi:10.1016/j.jad.2012.07.004

    Article  PubMed  Google Scholar 

  35. 35.

    Friborg O, Martinsen EW, Martinussen M, Kaiser S, Øvergård KT, Rosenvinge JH (2014) Comorbidity of personality disorders in mood disorders: a meta-analytic review of 122 studies from 1988 to 2010. J Affect Disord 152–154:1–11. doi:10.1016/j.jad.2013.08.023

    Article  PubMed  Google Scholar 

  36. 36.

    Friborg O, Martinussen M, Kaiser S, Øvergård KT, Martinsen EW, Schmierer P, Rosenvinge JH (2014) Personality disorders in eating disorder not otherwise specified and binge eating disorder: a meta-analysis of comorbidity studies. J Nerv Ment Dis 202:119–125. doi:10.1097/NMD.0000000000000080

    Article  PubMed  Google Scholar 

  37. 37.

    Borenstein M, Hedges L, Higgins J, Rothstein H (2007) Comprehensive Meta-analysis, 3rd edn. Biostat, Englewood

    Google Scholar 

  38. 38.

    Hedges LV, Vevea JL (1998) Fixed and random effects models in meta-analysis. Psychol Methods 3(4):486–504

    Article  Google Scholar 

  39. 39.

    Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, New York

    Google Scholar 

  40. 40.

    Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. Academic Press, London

    Google Scholar 

  41. 41.

    Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL (2009) Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. Am J Psychiatry 166:311–319. doi:10.1176/appi.ajp.2008.08040608

    Article  PubMed  Google Scholar 

  42. 42.

    Skodol AE, Oldham JM, Hyler SE, Kellman HD, Doidge N, Davies M (1993) Comorbidity of DSM-III-R eating disorders and personality disorders. Int J Eat Disord 14:403–416. doi:10.1002/1098-108X(199312)14:4<403:AID-EAT2260140403>3.0.CO;2-X

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Eddy KT, Dorer DJ, Franko DL, Tahilani K, Thompson-Brenner H, Herzog DB (2008) Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V. Am J Psychiatry 165:245–250. doi:10.1176/appi.ajp.2007.07060951

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Castellini G, LoSauro C, Manucci E, Ravaldi C, Rotella CM, Favarelli C, Ricca V (2011) Diagnostic cross-over and outcome predictors according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med 73:270–279. doi:10.1097/PSY.0b013e31820a1838

    Article  PubMed  Google Scholar 

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Correspondence to Monica Martinussen.

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This study was funded by the Department of Psychology, UiT The Arctic University of Norway.

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The authors declare no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Since this is a meta-analysis, informed consent statement was not obtained. No primary data were collected from participants.

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Martinussen, M., Friborg, O., Schmierer, P. et al. The comorbidity of personality disorders in eating disorders: a meta-analysis. Eat Weight Disord 22, 201–209 (2017).

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  • Personality disorders
  • Anorexia nervosa
  • Bulimia nervosa
  • Meta-analysis
  • Comorbidity