People with bipolar disorder have to deal with the ups and downs of mood swings. Mania can come with extreme euphoria and reckless behavior. It can also come with extreme irritability. The sadness and hopelessness that come with depression can be debilitating. Bipolar disorder is not easy to ignore. We have to deal with it every day. To complicate this even further, other illnesses are more common in people with bipolar disorder. For example, eating disorders, including anorexia nervosa, are more common in people with bipolar disorder than the general population.
At least 14% of people with bipolar disorder qualify for a lifetime eating disorder. Around 2-3% of people with bipolar disorder also suffer from anorexia nervosa. While many people consider anorexia a vanity issue, it is actually a serious and often deadly mental illness. Around 4% of those with anorexia will die from it. Because of this, it’s important to recognize symptoms of anorexia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines anorexia nervosa this way:
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Anorexia often comes with purging after eating. This can be done by inducing vomiting, misusing laxatives or diuretics or over-using enemas. Many people with anorexia will exercise compulsively. Also, weight loss does not alleviate the fear of becoming fat, but may actually increase it. People with anorexia spend an abnormal amount of time assessing their weight and body and finding themselves unacceptable. Any weight gain is seen as a failure.
All of this is complicated when bipolar disorder is involved. People with anorexia will often develop symptoms of depression including depressed mood, social withdrawal, irritability, sleeping problems and diminished sex drive. All of these are compounded by bipolar disorder. Impulsivity is also present in both illnesses, leading to further negative behaviors.
Treating both anorexia and bipolar disorder can be challenging. Many medications for bipolar disorder come with a side effect of weight gain. This can cause distress in people with anorexia to the point that they stop taking the medication in order to avoid the side effects, thus losing the mood stabilizing care needed for bipolar disorder. Even if medication is taken consistently, purging can affect the levels of medication in the system, making treatment unpredictable.
Medication as a treatment for anorexia can be complicated when bipolar disorder is also present. Many people with anorexia are treated with antidepressants, which can induce mania in people with bipolar disorder. In order to avoid this, mood stabilizers should be prescribed instead to treat depressive symptoms.
Treatment for anorexia includes cognitive behavioral therapy, which can also be effective in treating bipolar disorder. In these situations patients learn to cope with negative feelings and behaviors and also learn to develop more constructive behaviors and thought patterns.
Bipolar disorder combined with eating disorders is associated with numerous complications. Onset of bipolar disorder symptoms start at a younger age and with mixed episodes. There is also a greater likelihood of rapid cycling. The rate of anxiety disorders is higher in people with anorexia and suicide attempts are more common. Because of these factors, it is imperative that anyone with these illnesses receive adequate treatment as quickly as possible.
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