Interventions to promote critical health literacy: a scoping review.

Borderline personality disorder (BPD) and eating disorders (EDs), even when considered separately, are psychiatric disorders associated with substantial functional impairment, emotion dysregulation and serious clinical consequences. BPD is characterized by affective instability, impulsive behaviour and marked interpersonal difficulties and is associated with elevated risk of self‐harm and suicide (Leichsenring et al. ; Paris ). EDs include anorexia nervosa (AN), bulimia nervosa (BN), binge‐eating disorder (BED) and other specified feeding or eating disorder (OSFED) and are associated with considerable physical and psychological morbidity as well as elevated mortality risk (van Hoeken and Hoek ). Although the transition from DSM‐IV to DSM‐5 introduced BED as a distinct diagnosis and replaced the broad EDNOS category with OSFED, clinically meaningful heterogeneity in symptom presentation and severity remains across ED diagnoses (Call et al. ). Comorbidity between BPD and EDs is clinically important and relatively common. A recent meta‐analysis reported that approximately 30% of individuals with BPD meet criteria for an ED, with OSFED, BED and BN being particularly prevalent (Paudex et al. ). Individuals with co‐occurring BPD and EDs often present with more severe psychopathology than those without this comorbidity, including greater alexithymia, anxiety and depressive symptoms and more severe disordered eating attitudes (Khosravi ). Shared features, including affective instability, impulsivity, identity disturbance and emotion‐driven eating, may contribute to the overlap between these conditions and complicate the clinical course (Sansone and Sansone ; Loxton and Gleaves ). Thus, BPD–ED comorbidity represents a clinically complex presentation that may require interventions capable of addressing both eating‐related symptoms and broader difficulties in emotion regulation. Dialectical behaviour therapy (DBT) may be particularly relevant for this population because it was originally developed to treat pervasive emotion dysregulation, chronic suicidality, self‐harm and behavioural dyscontrol in individuals with borderline personality disorder (Linehan , ). Accordingly, DBT targets emotion dysregulation, impulsive behaviour, self‐harm and interpersonal difficulties through a balance of acceptance‐ and change‐oriented strategies. Randomized controlled trials and meta‐analytic findings indicate that DBT reduces self‐harm, suicidal behaviours and other forms of self‐directed violence among individuals with BPD (DeCou et al. ). DBT‐based interventions have also been associated with reductions in binge‐eating frequency and overall ED psychopathology, particularly in BED and BN presentations (Safer et al. ; Rozakou‐Soumalia et al. ). DBT integrates acceptance‐ and change‐oriented strategies and includes individual therapy, group skills training, telephone coaching and therapist consultation teams (Linehan , ). Its core skills modules, including mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, may help individuals manage affect‐driven eating behaviours, while its treatment hierarchy prioritizes life‐threatening and therapy‐interfering behaviours before quality‐of‐life targets, including ED symptoms (Leichsenring et al. ).