Studies have shown that 14 percent of individuals with bipolar disorder also have a co-occurring eating disorder such as bulimia nervosa, anorexia nervosa, and binge eating disorder. Statistics show that 1.5 percent of females are diagnosed with bulimia nervosa and in with those who have bipolar disorder, this number increases to eight percent; which links these two disorders together. Bulimia nervosa and bipolar disorder are both mental health disorders that are characterized by irritability, increased anxiety, obsessive thoughts, compulsive behaviors, and moodiness.
Bipolar disorder is misconstrued as a disorder of rapidly ricocheting moods that go from deep misery to extraordinary elevated self-belief however this common mood disorder is much more complicated than the assumed emotional labile rollercoaster that our society believes. Statistics reveal that 2.5 million Americans over the age of 18 are found to be living with either bipolar I or bipolar II disorder, and that’s not including the ones who haven’t been appropriately diagnosed which is deeply tied to misinformation about symptoms. Bipolar affective disorder or manic-depressive illness is a mood disorder characterized by periods of profound depression that alternate with periods of excessive elation and irritable mood known as mania. Because it is a mood disorder it is in the same category as depression, also a mood disorder but without the mania component. Individuals will suffer from extreme mood swings that interfere with personal relationships, official function, and daily activities. It is common for bipolar disorder to be apart of a co-occurring disorder, which refers to mental health illnesses that co-occur with substance abuse disorders such as opioid, alcohol or cocaine abuse. Bipolar disorder can often co-occur with anxiety disorders such as generalized anxiety disorder and panic disorder. When these disorders co-occur, there is a higher likelihood of substance abuse and suicide attempts. Bipolar disorder can be characterized into two types: bipolar disorder type I (BPI), and bipolar disorder type II (BPII).
Bulimia nervosa is an eating disorder that is most common in among young adults and is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, laxative or diuretic use to avoid weight gain caused by the binging episodes. A binging episode is defined as consuming an excessive amount of food over two hours with accompanying feelings of loss of control and guilt. It is possible for an individual diagnosed with bulimia nervosa to consume as much as 3,400 calories in little more than an hour, and as much as 20,000 calories in eight hours. For a diagnosis to be made, this behavior must occur at least once a week for at least three months in duration. Abnormal perception of body image and prevention of weight gain are the driving forces behind this behavior and must be present for a diagnosis to be made according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Bulimia nervosa can result in severe medical conditions such as liver, heart and kidney failure secondary to electrolyte imbalances specifically potassium, magnesium, and phosphate. Severe gastrointestinal complications arising from bulimia nervosa include gastritis, esophageal tears, and acid reflux and are caused by self-induced vomiting and laxative abuse.
Treatment for bipolar disorder and bulimia nervosa
Antipsychotic medications such as ziprasidone (Geodon) and mood stabilizers such as lithium are the first-line medication approaches to treating bipolar disorder; however, these medications have not been proven to be effective in treating bulimia nervosa. Lithium has been in trial studies for the treatment of eating disorders and bipolar disorder and has been shown to improve symptoms in these co-occurring disorders however it is currently not used in clinical practice due to the lack of research and more significant trials. Although some anti-depressants have been known to be effective in treating bulimia nervosa, they are contraindicated in bipolar disorder because they are known to predispose the individual to acute stages of mania. As a result, co-occurring bulimia nervosa and binge eating disorder are best managed with psychotherapy approaches such as cognitive behavior therapy combined with careful medication management that is closely monitored by a psychiatrist.