At least 14% of people with bipolar disorder suffer from lifetime eating disorders. Compare this to 4-9% in the general population. Bipolar disorder alone is difficult to manage, even if the person is high functioning. It requires daily monitoring of symptoms and behaviors. That’s just when we’re well. Experiencing depression or mania adds an extra challenge. Adding an eating disorder to that creates an even more debilitating experience requiring careful treatment. Among the 14% of people with bipolar disorder who also have eating disorders, 34% of these patients have a lifetime diagnosis of bulimia nervosa.
1.5% of women in the general population suffer from bulimia. In people with bipolar disorder, that percentage jumps to approximately 8% of women and 5% overall. This is a serious mental illness that takes a toll both on the body and mind. People who experience bulimia will often binge on food in secret only to purge later with induced vomiting or laxatives. Using diet pills is also common in an attempt to control body size and weight. People with bulimia nervosa tend to be overweight, even with extreme efforts to control their bodies.
Obsessive-compulsive behaviors are common as well as increased anxiety. Irritability and moodiness can also be signs of bulimia. The complication with this is that these are also signs of bipolar disorder, so the eating disorder may be hidden within these symptoms. Because of this it’s important to know the criteria for bulimia nervosa in order to better recognize it. The Diagnostic and Statistical Manual of Mental Disorders describes the criteria for bulimia as:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Bingeing and purging are what distinguish bulimia. In the case of anorexia, there is little to no bingeing, but there is purging. In binge eating disorder there may only be occasional purging. The purging in this case can have several physical health detriments.
- Sore throat
- Stomach pain
- Teeth enamel erosion
- Gum disease
- Kidney damage
- Electrolyte imbalance
- Hormone imbalance
- Irregular menstruation (including infertility)
- Low blood pressure
- Damage to the heart/heart failure
Adding bipolar disorder to bulimia provides extra complications. Those with both illnesses tend to have an earlier age of onset of symptoms, more episodes of hypomania/mania and depression. They also experience rapid cycling at a higher rate as well as an increased risk in comorbid anxiety disorders and substance use disorders. Rates of suicide and suicide attempts also increase in those with bulimia.
Treatment for bulimia nervosa can be difficult. Some people with the illness deny they have a problem at all, something else that is common in bipolar disorder.
When the person is willing to seek and accept help, the most effective treatment for bulimia is typically cognitive behavioral therapy. CBT teaches people to recognize unproductive thoughts and behaviors. Then, patients can begin to build skills to prevent these unproductive thoughts and behaviors and replace them with productive ideas and actions. This type of therapy can also be effective in treating bipolar disorder.
Another challenge in treating both disorders simultaneously is that bulimia is often treated with antidepressants. They have been found to decrease the desire to binge as well as the desire to vomit. The problem with this is that antidepressants are not only generally ineffective in treating bipolar disorder, but they can cause complications such as inducing mania and rapid cycling.
Avoiding lithium is recommended because of risks of toxicity and further kidney damage. Mood stabilizers have not shown to be as effective at treating bulimia nervosa as antidepressants, but they may be the best option when dealing with comorbid bipolar disorder.
Bulimia and bipolar disorder are serious mental illnesses. They both promote distortion of thoughts and behaviors that often produce devastating results. It is vital to treat these illnesses as severe medical conditions and all attempts should be made to get the person the help they need to live a full and healthy life.
Image credit: Mike Cicchetti