The Intersection Between Bipolar and Eating Disorders

By: Madison Piehl, Ph.D.

Facing a dual diagnosis of bipolar disorder and an eating disorder can feel overwhelming and isolating. These are two health conditions that are often misdiagnosed and stigmatized. This can mean you, or a loved one, have been without helpful, potentially lifesaving, treatment and support. If this has been your journey – I want to provide you with hope and encouragement. You are not alone, and healing is possible!

It is common to see patterns of disordered eating occurring within bipolar disorder. Bipolar disorder and eating disorders tend to occur together at rates of approximately 33% (e.g., McAulay et al., 2019; McElroy et al., 2016; Ruiz et al., 2015). People with bipolar disorder experience combinations of depressive and manic or hypomanic mood episodes. When someone experiences a depressive episode, they may notice an increase or decrease in appetite. This may lead to a pattern of over- or under-eating during the depressive period. When someone experiences a manic or hypomanic episode, they often engage in impulsive or harmful behaviors which could include binge eating or purging behaviors. If someone meets criteria for both bipolar disorder and an eating disorder, a provider will diagnose both conditions.

Taking the first step in recovery is often the most challenging part. Below are a few ideas I usually recommend:

  1. Find a therapist you connect with, and engage in therapy that is effective for your goals.There are multiple evidence-based therapies (we know from science that they work!), including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), that help someone with both bipolar disorder and an eating disorder in their recovery. How do they help? These therapies provide you with concrete tools to become more aware of your thoughts, emotions, and behaviors. With awareness, you can build tools to tolerate painful emotions without making them worse and change emotions to be more effective in your behaviors. Therapy isn’t only about making changes; often these therapies involve working on acceptance too. With my patients, I am often discussing how to let go fighting reality, and move toward acceptance of oneself, one’s body shape or size, and one’s experience of emotions and sensitivities. A combination of acceptance and change can help you to live a life of balance and meaning.
  2. Assemble your recovery team. In most cases, working with a team of providers is incredibly helpful for someone with dual diagnoses of bipolar disorder and an eating disorder. Many clients find that working with a therapist, psychiatrist, primary care provider, and dietitian is most supportive of their recovery goals. This helps to ensure that your psychological, physical, and nutritional needs are all adequately supported. Medication management tends to be a frontline treatment option for individuals with bipolar disorder. Many clients I have worked with have found that finding the right medication, or combination of medications, boosts their recovery process and allows for more stability. I know that it can be overwhelming to think about getting started assembling your recovery team. Please know that getting started with any component of treatment often leads to increased hope, motivation, and change.
  3. Don’t do it alone. I often encourage clients to be open with their support system about their experiences, successes, and setbacks in treatment. You can consider sharing with friends, family members, your recovery team, and a support group. Even having one person who knows what you are going through and is willing to support you can make a huge difference!
  4. Become curious (without judgement) about your patterns. One of the things I recommend to my clients with bipolar disorder and an eating disorder is to become an observer – a scientist – observing your own unique patterns of mood, eating, sleep, and other behaviors. This can be helpful to clarify what tools might be most helpful for your unique patterns.
  5. Find your “why”. What is most meaningful to you in life? Why is it worth it to keep showing up? At the end of the day, what matters most to you? Answers to these questions often reflect your values. Values can help keep you anchored in your recovery process – giving you a long–term perspective during the inevitable ups and downs. I have seen clients be willing to take brave steps when they know their why and their purpose.

It is courageous to begin a recovery process. Recovery is not linear for anyone. My hope for you is that you will take your healing process one day at a time. Each day is an opportunity to do the next right thing for yourself. And remember, you are not alone!

 

References

McAulay, C., Hay, P., Mond, J., & Touyz, S. (2019). Eating disorders, bipolar disorders and other mood disorders: complex and under-researched relationships. Journal of Eating Disorders7, 1-4.

McElroy, S. L., Crow, S., Blom, T. J., Biernacka, J. M., Winham, S. J., Geske, J., … & Frye, M. A. (2016). Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder. Journal of Affective Disorders191, 216-221.

Ruiz, E. M. Á., & Gutiérrez-Rojas, L. (2015). Comorbidity of bipolar disorder and eating disorders. Revista de Psiquiatría y Salud Mental (English Edition)8(4), 232-241.