Mood disorders encompass a wide range of diagnoses that mental health professionals give to people who have difficulty regulating their mood. Mood disorders have multiple causes, but chemical imbalances in the brain, traumatic experiences, genetics and other psychological and genetic factors are thought to be contributors.
Bipolar disorder is a type of mood disorder that can co-occur with eating disorders, including anorexia, bulimia and binge eating disorder. Bipolar disorder can cause challenges in many areas of life, including work, academics, and relationships with family and friends.
What is Bipolar Disorder?
According to the National Alliance on Mental Illness, bipolar disorder is a mental illness that causes drastic fluctuations in mood and energy. People living with bipolar disorder experience very “high highs” and “low lows”. These shifts are more pronounced than the normal ups and downs everyone feels. Mania and depression, respectively, are the names for these highs and lows, and each has significant health concerns for the person living through it.
An estimated 2.8% of U.S. adults have bipolar disorder. Bipolar disorder is a chronic condition, typically lasting throughout the person’s life. However, the onset of the first symptoms of illness can vary. For most people with bipolar disorder, the first symptoms of the disorder happen during the early to mid-20s. Some patients can experience symptoms as early as the teenage years and as late as the mid-thirties. No matter when onset happens, the condition can be debilitating – an estimated 83% of people with bipolar disorder are considered to have severe impairment, which is very high among the mood disorders.
It’s crucial for patients to work with a team of mental health professionals to manage the disorder and keep the person as healthy, and safe, as possible.
The Bipolar and Eating Disorder Connection
Bipolar disorder on its own is difficult to cope with. Complicating matters is that it’s very common for people with bipolar disorder to have co-occurring disorders. People with bipolar disorder are often prone to anxiety issues, self-injurious behavior as well as addictive behaviors surrounding alcohol or drugs. According to the Substance Use and Mental Health Services Administration, studies show that from 30 to 50% of those with bipolar will also develop a substance use disorder.
Anorexia, bulimia and binge eating disorder can also co-occur with bipolar disorder. Though the reasons for the link between bipolar and eating disorders are not well understood, it is known that people with bipolar disorder are at an increased risk for having an eating disorder.
Research estimates the prevalence of eating disorders in people with bipolar disorder is from 6 to 27%. Females are more likely to be affected by both than males.
One study from 2013 published in the International Journal of Bipolar Disorders found that 68% of the women who sought treatment for eating disorders also had bipolar disorder. Another study also published in 2013 in the same journal conducted among 354 people diagnosed with bipolar disorder found that 2% had anorexia, 13% had bulimia, and 8% had binge eating disorder.
Another commonality between eating disorders and bipolar disorder is a history of trauma, including childhood neglect and abuse, either physical, sexual or emotional. Patients with both bipolar disorder and an eating disorder are more likely to have experienced trauma, and to continue to feel the lingering effects on their thoughts and emotions. Many have also been diagnosed with post-traumatic stress disorder (PTSD).
Signs and Symptoms of Bipolar Disorder
Bipolar disorder, which is sometimes called manic depression, affects each person differently. This can make it especially challenging for family members to notice when extra help is needed, and can make diagnosis difficult even for medical professionals. Bipolar is sometimes misdiagnosed as depression or in younger people, attention-deficit hyperactivity disorder (ADHD). However, there are some signs and symptoms that could indicate either the onset of bipolar disorder, or bipolar disorder that is not being treated effectively.
There are four types of bipolar disorder: Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Other Specified/Unspecified Bipolar Disorders. During the assessment process at Rosewood Centers for Eating Disorders, our team will conduct a full medical history to determine which diagnosis best matches the person’s challenges, and if psychiatric support is needed. An accurate diagnosis can make a major difference in treatment protocol and success.
- Bipolar I Disorder is identified by long stretches of manic and depressive cycles. Manic episodes last at least seven days, while depressive episodes last at least two weeks. During these varying cycles, the patient may require hospitalization. To make matters a bit more complicated, depressive episodes can be “mixed”, which means there can be periods of mania embedded within the longer depressive cycle.
- Bipolar II Disorder is marked by cycles of depression and hypomania (a less pronounced form of mania). That means the manic episodes are not as severe and not as prolonged as those within Bipolar I.
- Cyclothymic Disorder is defined by less severe depressive and hypomanic episodes. While this diagnosis still requires professional treatment, it is much less severe than Bipolar I or II Disorder.
- Other Specified/Unspecified is a catch-all category that includes any bipolar symptoms that are not categorized in the previous three diagnoses.
Family members or friends do not necessarily need to know the specific categories of bipolar disorder. However, it is important that patients – and their loved ones – understand some key symptoms that could signal the need for a medical intervention or check-up.
Signs of Mania
- Abnormally elevated mood, lots of energy
- Inflated self-esteem or grandiose thoughts
- Decreased need for sleep, staying up all night
- More talkative than usual, taking unusually fast
- Racing thoughts, jumping from one topic to another
- Distractibility, agitations, irritability, short fuse
- Impulsivity and taking risks, such as over-spending, promiscuity
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How Eating Disorders and Bipolar Disorder Interact
Those who are living in a manic or depressive cycle can have altered views of their food or nutritional habits, which can cause them to have a disrupted relationship with food.
Manic symptoms can include increased energy, decreased sleep, having racing thoughts, or making risky decisions. Depressive symptoms can include sleep disruption, feeling a lack of interest about things the person once enjoyed, decreased energy, or thoughts of self-harm. Manic and depressive cycle symptoms can also include issues surrounding food and eating; mania or depression can trigger eating disruption, which could be a trigger for eating disorders.
For many individuals with bipolar disorder, an eating disorder can progress quickly. According to a 2013 study, the impulsivity and anxiety associated with bipolar disorder can fuel eating disorders. (Anxiety disorders include social phobia or other phobia, obsessive compulsive disorder (OCD), panic disorder, and agoraphobia.) The authors recommended that those with bipolar disorder be screened regularly for eating disorder symptoms, along with anxiety and alcohol use disorders
Types of Eating Disorders
- Anorexia nervosa is a type of eating disorder identified by extreme calorie restriction, which leads to dramatic weight loss that is not healthy for the age, height, or frame of the person. People living with bipolar disease may struggle with body image issues during both the manic and depressive cycles, which could lead to restrictive eating. Further, people living with anorexia can also become obsessed with exercise. Those who are in a simultaneous manic cycle can spend countless sleepless hours working out.
- Bulimia is another type of eating disorder that is characterized by binging and purging, or over eating and then using methods (such as vomiting or use of laxatives) to get rid of the food. People living with bulimia and bipolar disorder can struggle with the ritual of binging and purging, which can be exacerbated by any manic or depressive cycles.
- Binge eating disorder is the most common eating disorder in the United States. Research has also found binge eating disorder is the most common eating disorder associated with bipolar disorder. Binge eating disorder is characterized by eating large quantities of food, to the point of discomfort, while feeling shame or distress after the binge episode. People living with bipolar disorder can be already predisposed to feelings of shame or being out of control, which can trigger binge eating episodes. The impulsivity that often occurs during a manic episode can also prompt people to overeat to an extreme degree, as can the deep feelings of sadness and hopelessness that accompanies severe depression.
Since people with bipolar disorder have cycles of mood disruption, it’s not unusual for there to be more than one eating disorder present, or for eating disorders to change over time. For example, a manic cycle may trigger anorexic behavior, while a depressive cycle could trigger bulimia. Binge eating can also be in the mix, occurring during manic episodes or depressive ones. The binge itself can then make the depression worse, by prompting overwhelming feelings of guilt or shame.
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Integrated Treatment for Eating Disorders and Bipolar Disorder
To give patients the best chances of recovery, it’s necessary to manage the mood swings and other symptoms of bipolar disorder, as well as treat the eating disorder. When co-occurring disorders are identified and treated simultaneously, there is a higher rate of long-term success.
Treating bipolar disorder can be tricky, as the treatment protocols must be customized for each individual. Further, treatment often needs to be adjusted throughout the person’s lifetime. Fortunately, a combination of psychotherapy and medications can give people living with bipolar disorder the chance to lead an otherwise happy and healthy life. At Rosewood, we offer:
- Psychotherapy, including cognitive behavioral therapy, can make it easier for individuals to identify triggers for manic or depressive cycles, as well as how those cycles make it more difficult to make good decisions about eating.
- Medications that can control the intense mood swings of bipolar disorder.
- Trauma-informed care, which helps patients process past trauma to minimize the ability of those experiences to cause emotional or psychological distress, while being careful to avoid re-traumatizing the individual during treatment.
Many individuals living with bipolar disorder and an eating disorder enter into treatment in crisis. Onset of bipolar disorder typically happens quickly, and often without warning. Many times, the individual has never experienced mania or depression before, and therefore has no way of coping.
For the majority of individuals, residential treatment is the first step to recovery. This intensive environment allows medical professionals to assess and diagnosis the individual, while keeping the individual safe during this time of crisis. Most individuals leave their inpatient experience feeling clearer and ready to handle their long-term treatment plan.
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Medications for Bipolar Disorder
Medication is very important to control the symptoms of bipolar disorder and improve mood stability. This alone can help the individual make better decisions when it comes to food and nutrition. At the same time, mood stability can help individuals feel better mentally and physically, so that they can address any issues with anxiety, trauma or body image that contributed to the eating disorder. Medications can also be used to treat the eating disorder. Medication use must be carefully managed and monitored. Some medications that treat one condition can exacerbate the other condition.
Bipolar disorder often involves dramatic shifts in mood, from high to low and back again. Mood-stabilizing medications may help even out mood. Examples include carbamazepine (Tegretol, Equerto), Divalproex sodium (Depakote), lithium (Lithobid), and lamotrigine (Lamictal).
Physicians may prescribe an antidepressant medication if severe depressive episodes are present or occurring regularly. Antidepressants, such as SSRIs, may also help manage symptoms of eating disorders. It’s common for people seeking treatment for eating disorders to already have been prescribed an SSRI. But antidepressant use in patients with bipolar must be carefully monitored, and often combined with other medications, because of the risk that an antidepressant could trigger a manic episode, or induce more rapid cycling between depression and mania.
Manic episodes may lead to psychosis, including hallucinations and delusions. An antipsychotic medication can help manage these symptoms and may be combined with a mood stabilizer. A partial list of antipsychotic medications include risperidone (Risperdal), haloperidol (Haldol), aripiprazole (Abilify), olanzapine (Zyprexa), and quetiapine (Seroquel).
that may be prescribed include anti-anxiety medications to relieve severe anxiety or sleep medications, which may help alleviate insomnia or sleep disorders related to the bipolar disorder.
Recovery Is Possible
Only a few decades ago, the connection between bipolar disorder and eating disorders was not well researched or understood. Now, eating disorder and mental health professionals are more aware of how these two disorders can be intertwined, and how to treat each appropriately. Treating bipolar disorder, along with an eating disorder, can be challenging. But treatment is much more successful than it was even just decades ago.
Through a combination of psychotherapy, medications, long-term support from a treatment team and support from family and friends, individuals can have a long and happy life.