What’s the connection between bipolar disorder and eating disorders?

If you live with both bipolar disorder and a co-occurring eating disorder,  the intricacies of your unique experience can feel disheartening. While it’s true that every person’s experiences are unique, you’re not alone. Research shows that approximately 33% of people with an eating disorder also have bipolar disorder. 

These two distinct conditions overlap in complex ways, and, unfortunately, the symptoms of each can make the other worse.

Getting the right diagnosis for both conditions is key to effective treatment that will help you manage your symptoms and improve your mental health.

How does one condition influence the other?

Research has found that people with bipolar disorder are much more likely to live with an eating disorder than the general population. One review found that up to one-third of people with bipolar disorder also have an eating disorder, compared to around only 5% of the general population.

Binge eating disorder (BED) is the most common eating disorder that people with bipolar disorder face, followed by bulimia nervosa, then anorexia nervosa.

People who live with bipolar disorder cycle through two (or, sometimes, three) moods. These include:

• Depression: Depressive episodes in bipolar disorder look the same as they do for people with major depression. 
• Mania: Mania (or hypomania) is the other “pole” on the bipolar mood spectrum for people with bipolar I, the more severe type of bipolar disorder. Mania can cause excessive energy, a feeling of elation, irritation, and a sense of invincibility. During manic episodes, people have a decreased need for sleep, often going days without sleeping. Their inflated sense of invincibility can also cause impulsive and dangerous behaviors like reckless driving, excessive gambling, substance use, or unsafe sex.
• Hypomania: People with bipolar II, on the other hand, go through hypomanic episodes, which are similar to manic episodes but less intense. They might experience the same impulsivity and energy but not engage in such extreme behaviors. 

Each of these mood episodes can contribute to and are affected by eating disorder behaviors in different ways.

Depressive episodes and eating disorder risk factors

In a depressive episode, you might lose your appetite altogether. Change in appetite is a core symptom of depression, so it’s common to lose your desire to eat when you’re in a depressive episode. You could also start having a hard time keeping up with basic self-care tasks, including eating a healthy diet. This reluctance to eat when you’re depressed can devolve into an eating disorder for some people.

For others, depressive episodes can lead to significant weight gain. You could overeat comforting high-calorie foods as a way to cope with painful emotions, like hopelessness, that come along with depression. Weight gain during depressive episodes can contribute to body image issues, one of the major risk factors for eating disorders.

In addition, the “crash” of depressive episodes can often impact your self-esteem. People in depressive episodes may feel worthless or guilty. This poor self-esteem can also lead to body dysmorphia, a mental health condition where people become preoccupied with perceived flaws in their appearance. This can heighten the risk of an eating disorder.

Hypomanic or manic episodes and eating disorder risk factors

Hypomania or mania can cause impulsive behavior, which can sometimes include impulsive eating behaviors. In a manic (or hypomanic) episode, you might crave a sense of reward and pleasure and excessively binge eat or use excessive amounts of alcohol to try to get it. It can feel impossible to resist the urge to eat.

While this might feel good during mania, these binge-eating episodes can come with significant weight gain, which can be hard to deal with when you cycle into a depressive episode. This cycle of binge eating and shame is characteristic of binge eating disorder (BED), the eating disorder that most commonly co-occurs with bipolar disorder.

Some people also become obsessed with their appearance during manic or hypomanic episodes because of the increased confidence they feel. This obsession with your body size and appearance could remain even after the manic/hypomanic episode has passed, which could leave you vulnerable to developing an eating disorder.

You might also feel so invincible during manic or hypomanic episodes that you believe you don’t need to eat to live. You could feel so preoccupied with your elevated mood and risky pleasure-seeking behaviors that you forget to eat. Or you could try dangerous extreme diets without fully considering the consequences. These behaviors can become an eating disorder if left unchecked.

Symptoms of co-occurring bipolar disorder and eating disorder

If you live with both bipolar disorder and an eating disorder, it can be tricky to differentiate between the symptoms of each. People with bipolar disorder can experience any eating disorder, including anorexia nervosa, bulimia nervosa, and binge eating disorder.

Studies show that people who live with both bipolar disorder and an eating disorder have more trouble with impulsivity and emotion regulation.

If you live with bipolar disorder in addition to an eating disorder, you might:

• Experience more intense emotional highs and lows
• Have rocky or intense relationships and feel more isolated
• Be more likely to experience suicidal thoughts and feelings
• Misuse drugs or alcohol to self-medicate or cope
• Have a harder time keeping up with your treatment plan
• Notice that your body image changes with your mood

Breaking the cycle with professional support

It can be incredibly difficult to live with both bipolar disorder and an eating disorder, and it might feel like you’re caught in a trap of emotional ups and downs that dictate your eating patterns. But there’s a way to break out of this cycle — professional treatment can help you manage the symptoms of both disorders.

Because bipolar disorder and eating disorders appear together so frequently, experts say that health providers should always screen for the other when one of them is present. It’s essential to get the right diagnosis and address both conditions.

This can be tricky, because the symptoms of one condition can sometimes hide the symptoms of the other. But if you only treat one and leave the other unaddressed, then it may be hard to improve your overall mental health. You could get caught in the never-ending cycle of bipolar disorder and eating disorders until you finally address the underlying mood fluctuations that are making your eating disorder worse (or vice versa).

Therapy for bipolar disorder and eating disorders

Therapy is one of the most effective treatment methods for both eating disorders and bipolar disorder. If you live with both, it’s essential to find a therapist who’s well-versed in both of these conditions and how they interact. Living with both of these conditions is a unique situation, and it shouldn’t be treated the same as if you lived with only one or the other.

A qualified therapist will be able to prioritize treatment needs. For example, they may decide your eating disorder symptoms need to be stabilized before addressing bipolar disorder symptoms. They’ll outline the most effective options for treatment.

Some therapy techniques that could be used for both bipolar disorder and an eating disorder include:

• Cognitive behavioral therapy: This approach, often shortened to CBT, can help you identify and change the underlying thought patterns and core beliefs that could be affecting your mood and behaviors. 
• Interpersonal therapy: If you’re dealing with increased emotional outbursts, this type of therapy can help you work toward improving interpersonal relationships and learn new skills. 
• Motivational interviewing: This type of therapy helps you stick to healthy behavioral changes, like eating a nourishing diet or taking medication, and stop harmful behaviors, like unhealthy substance use, with motivational interviewing. 
• Dialectical behavior therapy: This type of therapy teaches you how to regulate intense or painful emotions, which is a helpful skill for managing both bipolar disorder and eating disorders.
• Nutritional counseling: Working with a nutritional counselor can help you stabilize your weight and maintain a healthy diet. 

Medications for bipolar disorder and eating disorders

Bipolar disorder is typically treated with a combination of medication and therapy. Currently, there are no research studies supporting any medication that is used to treat both bipolar disorder and eating disorders. Because of this, you may need to treat these two conditions separately with medication. However, speak to your provider first to determine if medication is the right option for your situation. 

Find care with Rula

Living with bipolar disorder and an eating disorder can be hard, particularly as the symptoms of each condition can overlap. But it’s important to remember that there’s treatment available, and working with a therapist who’s trained in these conditions can help you manage symptoms and get healthier — both mentally and physically. 

At Rula, we can connect you with a therapist who’s taking new clients and accepts your insurance so you can get the support you need. With Rula’s user-friendly therapist-matching program, you can find the right provider for your needs in less than 30 seconds and begin treatment as early as this week. And if medication management is part of your treatment plan, we can connect you with a psychiatrist to find the right solution for you.

Find a therapist with Rula