Haslam, M., Mountford, V., Meyer, C., & Waller, G. (2008). Invalidating childhood environment in anorexia and bulimia nervosa. Eating Behaviors, 9(3), 313–318. https://doi.org/10.1016/j.eatbeh.2007.10.005

Invalidating childhood environment in anorexia and bulimia nervosa. 

The Invalidating Childhood Environment Scale (ICES) is a “ retrospective self-report measure of parental invalidating behaviors up to age 18 years” (Lee et al. 2023). It is a highly validated and consistent Likert scale where children assess the invalidating parental behaviors from one (never) to five (all of the time). Examples include items like "My [father or mother] would tell me I was overreacting when I was upset" and "My [father or mother] would get angry if I expressed negative feelings" (Lee et al. 2023). These examples demonstrate that an invalidating environment consists of dismissing the emotions of the child, making it even more difficult for said child to regulate their emotions.

The Invalidating Childhood Environment Scale 

The Emotion Reactivity Scale (ERS) measures emotional vulnerability across three subscales: sensitivity, intensity, and persistence (Lee et al., 2023). It is helpful to find a type of measurement for these variables, not only for coding purposes, but to interpret the level of emotional vulnerability each individual has–it looks different for everyone. Some individuals react quickly and feel it more strongly than others. Some examples from the scale include: “when I experience emotions, I feel them very strongly/intensely”, and “when something happens that upsets me, it’s all I can think about for a long time” (Lee et al. 2023). Higher scores indicate higher emotional reactivity, which is often the case for individuals with BPD and who score high on the ICES. 

Th Emotion Reactivity Scale

Linehan's research emphasizes the effects of the invalidating environment and the continuous cycle it creates. This cycle can ultimately begin with specific traits that an individual may be predisposed to from birth. These traits include:

- Impulsivity
- Emotional Vulnerability

This creates the cycle illustrated below:

Low self-control → harsh punishment → increased impulsivity.

An invalidating environment: the interactions and effects of low self-control and harsh punishment.

- 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.

Saint Olaf College

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.

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


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

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

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