Patients with bipolar disorder must work to control mood swings that range from manic to depressive. Evidence is mounting that many bipolar patients also must struggle to control their appetite, as they are likely to have some sort of eating disorder.

Research has found that many people with bipolar disorder have eating issues like bulimia nervosa, anorexia nervosa, and binge-eating disorder. A recent study found one in five bipolar patients in its group of participants met the criteria for a lifetime eating disorder.

These studies are far from conclusive, as they often focus on small samples, or groups of patients. However, evidence does suggest that bipolar patients are more likely than the general public to have an eating disorder. Researchers are also trying to identify the links between bipolar disorder and eating disorders.

At Risk: Eating Disorders Among Bipolar Patients

The eating disorders most closely associated with bipolar disorder are:

  • Bulimia nervosa. People with bulimia tend to gorge themselves on food, then immediately “purge” or rid their bodies of the food by vomiting or using laxatives or diuretics. Bulimia is the eating disorder most closely associated with bipolar disorder, as current research firmly supports a connection between the two.
  • Anorexia nervosa. People with anorexia tend to develop an adversarial relationship with food. They generally avoid eating and skip meals. When they do eat, they may obsessively weigh their food and count calories or eat small amounts of a few, carefully chosen "acceptable" foods. Anorexics also tend to exercise obsessively. Anorexia is not as closely associated with bipolar disorder, although some studies have found a link between the two.
  • Binge-eating disorder. Binge eaters tend to compulsively overeat, but unlike bulimics, they do not purge afterward. They tend to feel shame or guilt over their eating and often eat by themselves and very quickly. Many bipolar patients report periods of binge eating, although whether they have a full-fledged disorder is not certain. Some medications for bipolar disorder promote binge eating.

The Bipolar-Eating Disorders Connection

Researchers aren't yet sure why bipolar disorder seems to be linked with eating disorders. However, the two problems share many characteristics, including:

  • Eating irregularities
  • Weight problems
  • A tendency to act impulsively and rashly
  • Behaving in a compulsive manner, repeating purposeless acts or following odd but well-established sets of rules
  • A tendency to "cycle" — with eating disorders, it’s between bulimia and anorexia; with bipolar disorder, it’s between depression and mania

The severity of a person's bipolar disorder may influence the development and severity of an eating disorder. One study found that people with worse bipolar symptoms and deeper mood swings were more apt to develop either bulimia or bulimia combined with anorexia.

Treating Both Bipolar and Eating Disorders

Managing both a bipolar disorder and an eating disorder can be challenging. For example, antidepressants are often used to treat eating disorders, but these medications are not recommended for bipolar patients, as they can prompt a manic mood swing. Doctors also need to be careful about prescribing mood stabilizers or anti-psychotics to bipolar patients who are either obese or binge eaters, as these drugs have been known to trigger binge-eating episodes.

Therapy can be helpful for coping with eating disorders. Psychotherapy, family therapy, and behavioral therapy are known to be beneficial in treating anorexia, bulimia, and binge eating.