Bipolar disorder is hard to deal with even on good days. Medications help keep it “under control” but there is always the chance of breakthrough symptoms. To make matters worse, bipolar disorder is often accompanied by other, physical symptoms that may seem unrelated at all. Arthritis? Asthma? It hardly seems fair to get an extra portion of illness on the side. What is not surprising is that bipolar disorder often has other mental health issues often tag along. By often, I mean 65% of us have to deal with other psychological problems like additional anxiety, ADHD or substance abuse.
Less likely, but equally potent, are eating disorders. About 5% of bipolar disorder patients have some form of eating disorder throughout their lifetime including anorexia, bulimia and binge-eating disorders. Unfortunately, the earlier the symptoms of bipolar appear and the more rapid cycling in a person, the more likely they are to also have an eating disorder.
Binge-eating disorder is the most common in patients with bipolar. It’s characterized by eating considerably more than one would normally, combined with a sense of lack of control. Though it may seem so to some, it’s not necessarily about a lack of willpower. It’s actually about disinhibition. That may seem like splitting hairs, but there is actually an important distinction. Implying that binge-eating is a lack of willpower or a sign of weakness gives the illusion that a person could control their behavior if they really wanted to. Disinhibition, on the other hand, is about brain chemistry and physiology. The part of your brain that keeps you from saying exactly what you’re thinking is remarkably similar to the part that prevents binge-eating episodes. Your brain isn’t sending the right signals that what you’re doing is a not the best idea. Then what’s done is done. There’s the thing about popping and stopping. It’s pretty accurate, actually. Then you get a little guilt piled on for good measure. It’s cliche to say it, but it is a vicious cycle.
Lack of inhibition manifests differently for each person. Some people develop drinking or drug problems. Some get caught up in gambling. In binge-eating, the brain wants food. Eating stimulates the pleasure centers in the brain, which produces that sweet dopamine and serotonin. To complicate things more, the stomach actually produces quite a bit of serotonin itself, which can be stimulated by eating. Depression and anxiety are the hallmarks of bipolar disorder, so the thought of ignoring something you know will bring pleasure is incredibly difficult. It’s hard enough for the general population to deal with cravings. With the lack of inhibition that bipolar brings to the table, food-addiction is a real possibility. As I said, addiction is not hard to come by with bipolar disorder. The thing about binge-eating is that food is not something you can give up. With treatment, those addicted to alcohol or other substances can separate themselves from the triggers more easily than those with binge-eating disorder. You can’t quit food. It’s everywhere, and, it turns out, you need it to survive.
Having a healthy relationship with food is difficult. It’s no surprise that those with binge-eating disorder are often overweight or obese. In fact, over half of those with bipolar disorder are obese compared with 35% in the general population. Add to that highly-processed foods that contain addictive properties (yes, sugar can be addictive) and you have a recipe for trouble (unintended pun, but I’m keeping it). Obesity in general increases the likelihood of poor food-choice decisions. Bipolar sufferers report even more difficulty in choosing healthy food than the general population. Think about it. If you encounter junk food that you know will make you feel good because it’s done so before, disinhibition comes back into play with your brain telling you the junk food is going to give you satisfaction. We’re back to dopamine and serotonin again. They can be extremely convincing when it comes to binge-eating, or any addiction for that matter.
So what do we do about it? Slap on yet another medication? A lot of bipolar treatments come with weight-gain and increased appetite as it is. Lovely. Medication, behavioral therapy and nutritional therapy are the go-to standards right now, and these don’t always work for every individual. The good news is that we’re still looking. New treatments can come along that fight the disinhibition that is tied to food. In the meantime, take a deep breath and give yourself a little break.