Bipolar Disorder & Eating Disorders
Mood disorders encompass a broad spectrum of diagnoses characterized by a difficulty regulating one’s mood. Similar to eating disorders, mood disorders have many causes including chemical imbalances in the brain, trauma, and genetics. Bipolar disorder is a type of mood disorder that commonly co-occurs with eating disorders. Bipolar disorder can lead to complications in various areas of life including work, academics, and relationships.
by: Sadie Grant
Eating disorders are often distressing and difficult to treat on their own, let alone when they are accompanied by a coexisting mental condition. Unfortunately, many individuals with eating disorders also experience comorbid (co-occurring) conditions such as substance abuse disorder, depression, and post-traumatic stress disorder. Recent research has also shown a connection between eating disorders and bipolar disorder. The link between bipolar disorder and eating disorders is complex and not entirely understood. Treating these disorders concurrently can be especially difficult.
Bipolar disorder is a mental illness that is characterized by intense shifts in mood. Individuals with bipolar disorder can experience periods of extreme joy and energy followed by stretches of deep sadness and fatigue. In order to be diagnosed with bipolar disorder, the individual must experience either mania (a state of extreme euphoria or elevated mood that usually impairs functioning) or hypomania (a less extreme version of mania), and may or may not experience depressive episodes. However, on average, people with bipolar disorder tend to spend more time in depressive states than in manic states. Medications such as mood stabilizers and antipsychotics can greatly reduce the severity of mood swings. Up to 4% of Americans experience bipolar disorder during their lifetime (Ekern, 2019).
People with bipolar disorder are more likely to develop an eating disorder than the average population. Depending on the study, 5% to 14% of individuals diagnosed with bipolar disorder also have an eating disorder. In fact, a study conducted by Wildes et al. found that as many as 1 in 5 individuals with bipolar disorder may meet the diagnostic criteria for an eating disorder during their lifetime (Wildes & Fagiolini, 2008). Sure enough, the two disorders often share some common symptoms, such as changes in eating and weight, compulsive behavior, and the tendency to “cycle”— whether between different disordered eating behaviors or between different affective states.
The most common eating disorders associated with bipolar disorder are bulimia nervosa and binge eating disorder. Individuals with bulimia nervosa tend to experience frequent episodes of binging (or subjective binging) followed by purging (i.e., vomiting, laxatives, or diuretics). Current research suggests a close association between bipolar disorder and bulimia nervosa. Binge eating disorder, like bulimia nervosa, involves repeated episodes of overeating. However, individuals with binge eating disorder do not purge after binge episodes. Many people with bipolar disorder report experiencing binge eating episodes, and certain bipolar medications can increase the urge to binge eat. While the link between anorexia nervosa (characterized by an extremely restrictive/avoidant relationship with food) and bipolar disorder has not yet been established, some studies have also found an association between the two.
The connection between bipolar disorder and eating disorders is not completely clear. However, medications commonly used to treat bipolar disorder seem to sometimes exacerbate eating disorder symptoms. For example, the most effective medications used to treat symptoms of bipolar disorder, such as lithium and valproic acid (Depakote), can sometimes lead to weight gain. Individuals who also have eating disorders such as bulimia or anorexia are typically afraid to gain weight, and may, therefore, engage in disordered eating behavior or struggle to comply with medication plans. Mood stabilizers and antipsychotic medications used to treat bipolar disorder have also been shown to sometimes trigger binge episodes.
On the flipside, certain features that are often associated with having an eating disorder can exacerbate bipolar disorder symptoms. For example, even if an individual consistently takes medication for bipolar symptoms, purging can affect medication levels, reducing the effectiveness of treatment. Furthermore, antidepressants, often used to treat eating disorders, can trigger manic episodes.
Clearly, managing treatment for bipolar disorder and a coexisting eating disorder is difficult. But treatment for both disorders is possible, especially when they are addressed simultaneously. Mood stabilizing medication is a critical part of treatment for symptoms of bipolar disorder. In order to manage medication compliance along with eating disorder symptoms, it is best to work with a psychiatrist who is trained in treating both, or enter into an integrated treatment program (which is designed to address the complexities and symptomologies that can occur with a dual diagnosis). Therapy can also be a great way for individuals to cope with living with both bipolar disorder and a co-occurring eating disorder. Through modalities such as psychotherapy, family therapy, and behavioral therapy, clients can develop better cognitive, behavioral, and emotional skills to navigate the unique challenges of the comorbid conditions.
BALANCE eating disorder treatment center is dedicated to treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. We believe in treating the whole person through customized treatment programs, as we understand that every client is unique and responds to treatment differently.
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This post was written by BALANCE Blog Intern, Sadie Grant.
Sadie is a recent graduate of Oberlin College with a B.A. in psychology. After recovering from disordered eating, Sadie became passionate about eating disorder awareness, body neutrality, and destabilizing beauty standards that are established by social and cultural norms. While earning her Bachelor’s degree, Sadie conducted quantitative research, worked with populations experiencing barriers to essential services, and studied Spanish. Sadie hopes to use her developing research and interpersonal skills to work in the field of eating disorders and address the way in which expectations around eating and beauty vary across different populations.
References
Ekern, B. (2019, July 30). Bipolar Illness and Eating Disorders: What is the Connection? Retrieved July 08, 2020, from https://www.eatingdisorderhope.com/blog/bipolar-illness-and-eating-disorders
Jr, B., Chang, L., Dunleavy, B., & Marrero, C. (n.d.). Eating Disorders and Bipolar Disorder - Bipolar Disorder Center - Everyday Health. Retrieved July 08, 2020, from https://www.everydayhealth.com/bipolar-disorder/eating-disorders-and-bipolar.aspx
Recovery from Co-Occurring Disorders for Teens and Adults. (2019, October 03). Retrieved July 08, 2020, from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/anxiety/concurrent-treatment-of-co-occurring-disorders-for-teens-and-adult
Wildes, J. E., Marcus, M. D., & Fagiolini, A. (2008). Prevalence and correlates of eating disorder co-morbidity in patients with bipolar disorder. Psychiatry research, 161(1), 51–58. https://doi.org/10.1016/j.psychres.2007.09.003