- BPD Development and Environment: Linehan's model proposes that BPD does not develop solely due to genetics, but is significantly influenced by an individual's environment (Lee et al., 2023). This environment can alter an individual's actions and coping mechanisms, particularly those with BPD.

- Definition of an Invalidating Environment: An invalidating environment encompasses not only overt forms of harm, such as neglect or physical abuse, but also subtler forms of harm, such as permissive parenting or being excessively involved in a child’s life (Lee et al., 2023).

- The Importance of Balance in Parenting: A crucial aspect of avoiding an invalidating environment lies in finding a balance between being hands-on in a child's life and allowing for their interdependence. This equilibrium between hands-on involvement and fostering interdependence will manifest uniquely across different developmental stages of a child's life.

The "Invalidating Environment": Linehan's Biosocial Model

- Emotional dysregulation refers to an individual’s inability to cope with feelings of discomfort. As a result, they are often highly sensitive, or what Linehan calls super-feelers, are unable to express their feelings, and turn to unhealthy coping mechanisms to gain a sense of comfort (Federici, 2009). 

- In borderline personality disorder (BPD), Marsha Linehan makes it clear that emotion dysregulation is “the core difficulty in BPD” (Lee et al., 2023). However, according to Lee et al. (2023), emotional dysregulation is not a primary symptom in BPD; rather, it begins to slowly manifest in certain conditions of the child’s temperament and home/environment. It is for these reasons that Linehan developed Dialectical Behavioral Therapy (DBT), a type of therapy that focuses on both criteria.

- Eating disorders (ED) symptoms often become a way for individuals to cope with emotional dysregulation. Individuals with eating disorders report that they find it difficult to understand or even report their emotions, and in that way, they act as a threat (Federici, 2009). It appears that self-harming behaviors provide temporary relief. Similar to BPD, emotion dysregulation is a result of both the individual's temperament and their environment. A child who is already confused about the world around them and how they perceive themselves will not react well to a parent who, intentionally or unintentionally, creates doubt within their child about reality (Federici, 2009). Not only do parents create the invalidating environment, but schools, friends, or social media can as well. This is the case, especially for eating disorders, where the world profits off of diet culture.

What is emotional dysregulation, and how does it apply to Borderline Personality and Eating Disorders?

Emotional vulnerability refers to the inherent predisposition that an individual experiences, characterized by heightened emotional affect and the speed at which they can return to baseline (Lee et al., 2023). For instance, some individuals might be more hurt/bothered by certain comments or actions that are conventionally acceptable to some. The Combination of emotional vulnerability and an invalidating environment, according to Linehan, is the key ingredient to the development of BPD symptoms, specifically emotional dysregulation. 

Emotional Vulnerability in Both Eating and Borderline Personality Disorder

Lee, S. S. M., Keng, S.-L., & Hong, R. Y. (2024). Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study. Development and Psychopathology, 36(4), 1752–1762. doi:10.1017/S0954579423001116

Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study. 

Key Considerations of Marsha Linehan’s Biosocial Model for Eating Disorders and Borderline Personality Disorder (Lee et al. 2023):

- Invalidating Environment
- Emotional Vulnerability
- Inability to return to baseline quickly.
- Highly reactive.

Although this model was initially developed for BPD, it has become a useful model in interpreting eating disorders since eating disorders often are a means to cope with uncomfortable emotions or thoughts.

Saint Olaf College

The two approaches in treating comorbid BPD and ED:

- Cognitive Behavioral Therapy
- Dialectical Behavioral Therapy

Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are both widely used to treat comorbid Borderline Personality Disorder (BPD) and Eating Disorders (EDs), but they approach symptom management differently.

Transdiagnostic Treatment Approaches for Comorbid BPD and ED.

Costa, J., Marôco, J., Pinto-Gouveia, J., Ferreira, C., & Castilho, P. (2016). Validation of the Psychometric Properties of the Self-Compassion Scale. Testing the Factorial Validity and Factorial Invariance of the Measure among Borderline Personality Disorder, Anxiety Disorder, Eating Disorder and General Populations. Clinical Psychology and Psychotherapy, 23(5), 460–468. https://doi.org/10.1002/cpp.1974

Bozzatello, P., Garbarini, C., Rocca, P., & Bellino, S. (2021). Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel, Switzerland), 11(11), 2142. https://doi.org/10.3390/diagnostics11112142
Khosravi, M. Eating disorders among patients with borderline personality disorder: understanding the prevalence and psychopathology. J Eat Disord 8, 38 (2020). https://doi.org/10.1186/s40337-020-00314-3

Dyson Tori, Thomas Susan J., Townsend Michelle L., Finch Adam, South Alexandra, Barkus Emma, Walter Emma, Mendonca Carley, Grenyer Brin F. S., Pickard Judy A. (2023). Salivary testosterone and cortisol levels in borderline personality disorder before and after a 12-week group dialectical behavior therapy intervention. Frontiers in Psychology, 14(14). https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1195187

Federici, A. (2009). Dialectical Behaviour Therapy for the Treatment of Eating Disorders. NEDIC, NEDIC Eating Disorders Bulletin.

Lee, K. S., & Vaillancourt, T. (2024). Trajectories, comorbidity, and risk factors for adolescent disordered eating and borderline personality disorder features. Development and Psychopathology, 36(4), 1546–1557. doi:10.1017/S0954579423000792

Lee, S. S. M., Keng, S.-L., & Hong, R. Y. (2024). Validating the biosocial model of borderline personality disorder: Findings from a longitudinal study. Development and Psychopathology, 36(4), 1752–1762. doi:10.1017/S0954579423001116

Lester, R. J. (2009). Brokering Authenticity: Borderline Personality Disorder and the Ethics of Care in an American Eating Disorder Clinic. Current Anthropology, 50(3), 281–302. https://doi.org/10.1086/598782

Miller, A. E., Hotte-Meunier, A., Bain, T., Macdonald, E. P., Steiger, H., & Racine, S. E. (2025). A Qualitative Study of the Lived Treatment Experiences of Women With an Eating Disorder and Comorbid Borderline Personality Disorder. The International journal of eating disorders, 58(5), 860–867. https://doi.org/10.1002/eat.24390

Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., Baños, R., & Garcia-Palacios, A. (2018). Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting. Cognitive Therapy and Research, 42(5), 636–649. https://doi.org/10.1007/s10608-018-9906-9

Newton, J. R. (2019). Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity. Australasian Psychiatry : Bulletin of the Royal Australian and New Zealand College of Psychiatrists, 27(6), 556–558. https://doi.org/10.1177/1039856219852297

Ni, X., Chan, D., Chan, K., McMain, S., & Kennedy, J. L. (2009). Serotonin genes and gene–gene interactions in borderline personality disorder in a matched case-control study. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 33(1), 128–133. https://doi.org/10.1016/j.pnpbp.2008.10.022.

Ntshingila, N., Poggenpoel, M., Myburgh, C. P. H., & Temane, A. (2016). Experiences of women living with borderline personality disorder. Health SA = SA Gesondheid, 21(1), 110–119. https://doi.org/10.1016/j.hsag.2016.01.001

Sansone, R. A., & Sansone, L. A. (2007). Childhood Trauma, Borderline Personality, and Eating Disorders: A Developmental Cascade. Eating Disorders, 15(4), 333–346. https://doi.org/10.1080/10640260701454345

Sansone, R. A., & Sansone, L. A. (2010). Personality Disorders as Risk Factors for Eating Disorders: Clinical Implications. Nutrition in Clinical Practice, 25(2), 116–121. https://doi.org/10.1177/0884533609357563.

Steiger, H. (2004). Eating disorders and the serotonin connection: state, trait, and developmental effects. Journal of psychiatry & neuroscience: JPN, 29(1), 20–29.

Power, R. A., & Pluess, M. (2015). Heritability estimates of the Big Five personality traits based on common genetic variants. Translational psychiatry, 5(7), e604. https://doi.org/10.1038/tp.2015.96

Reference List: Comorbidity of Borderline Personality Disorder and Eating Disorders

Is Linehan’s Biosocial Model Accurate Among Co-Occurring Disorders with BPD?


Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., Baños, R., & Garcia-Palacios, A. (2018). Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting. Cognitive Therapy and Research, 42(5), 636–649. https://doi.org/10.1007/s10608-018-9906-9

Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting.

DBT, in contrast, prioritizes crisis de-escalation and emotional regulation. Its four stages begin with reducing self-harm/suicidal behaviors, then fostering open communication and therapy engagement, followed by developing healthier coping mechanisms and refining impulse-control skills (Navarro-Haro et al., 2018).

The Role of DBT in Comorbid BPD and ED

In comorbid cases, CBT often begins by targeting impulsive behaviors (e.g., binge eating, purging) through increased awareness of maladaptive actions and restructuring distorted thinking patterns. Clinicians may use reward-based procedures to promote internal attribution and prevent relapse (Navarro-Haro et al., 2018).

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