Bulimia Nervosa, Borderline Personality Disorder, and Executive Functions: Treatment and Follow-up in a Case Study

Abstract

This study describes the clinical case of a 20-year-old woman diagnosed with bulimia nervosa (BN), borderline personality disorder (BPD), and impaired executive functioning. The objectives were to: 1) Determine the efficacy of cognitive-behavioral therapy (CBT) and dialectic behavioral therapy (DBT) in a case of BN and BPD comorbidity, evaluating the improvement of specific parameters related to eating disorders (BN) and aspects of BPD after treatment (posttreatment) and at 1-year follow-up; and 2) Determine whether the psychological intervention of choice for BN and BPD is also of benefit for alteration of executive functions. She was assessed at three time points: pretreatment, posttreatment, and at 12-month follow-up. The instruments used were EDI-3, SCL-90-R, MCMI-III, ring test, and WCST. CBT and DBT were applied for 11 months. The results at 1-year follow-up showed a decrease in the characteristic symptomatology of BN and BPD, whereas executive functioning impairments did not show any improvement. It was concluded that a specific unit on neuropsychological rehabilitation must be included in the treatment protocol for patients with these characteristics. However, more research is still necessary to provide an answer to the open debate on whether alterations of executive functions are previous to or consequences of ED.