Bipolar disorder is not the same as being “moody”, nor are the “highs and lows” of bipolar disorder always as “extreme” as the media makes it out to be. A lot of people struggle with this disorder, and may not even realize it — because bipolar disorder exists on a spectrum. Many people on the spectrum will be misdiagnosed, which can cause a lot of serious problems down the road, especially for those with co-occurring bipolar disorder and an eating disorder.
If you’ve ever wondered whether your mood swings were “normal”, whether they have an effect on eating patterns, or whether simultaneous eating disorder and bipolar disorder treatment is effective, this post is for you.
Get answers to all your questions, including:
- What is bipolar disorder, exactly?
- Why does the “spectrum” part of the bipolar disorder spectrum matter?
- How common is it to have bipolar disorder and an eating disorder?
- Which eating disorders are the most associated with bipolar disorder?
- How does having a co-occurring disorder affect eating disorder treatment?
- What should you do if you struggle with both these illnesses?
Bipolar Disorder: Definition, Causes, and Symptoms
Bipolar disorder is a brain disorder that causes intense emotional states that may occur over a period of days or weeks. Researchers believe that bipolar disorder is a complex illness with genetic, neurological, and environmental causes. 80-90% of individuals with bipolar disorder have someone else in the family with it.
A person with bipolar may feel “on top of the world”, invincible, with an incredible amount of energy one week, and then quickly come down into a deep depressive episode.
These are called mood episodes, and are classified in the following ways:
MANIC EPISODES
Manic episodes are defined by the DSM-V as a period of at least one week when an individual is very high-spirited or irritable most of the time on most days, has more energy than usual, and experiences at least three of these behavioral changes:
- Elevated self-esteem, self-confidence, or feelings of grandiosity (which is an unrealistic sense of superiority)
- Decreased need for sleep; feeling more energetic despite getting less sleep than normal
- Increased or faster speech
- Uncontrollable racing thoughts/distractibility when speaking
- Too much activity at once, such as working on several projects at once without finishing any of them
- Increased risky behaviors, such as reckless driving, spending sprees, engaging in risky sexual encounters
To classify as a manic episode, symptoms must be severe enough to cause dysfunction at work, in relationships, with responsibilities, or in social activities. Manic episodes are usually noticeable by one’s friends and family because it is a distinct departure from the person’s normal state.
Some manic episodes include psychotic features, such as irrational thinking, false beliefs, extreme paranoia, and/or hallucinations. Individuals experiencing these symptoms may require hospital care because they are a danger to themselves or others.
HYPOMANIC EPISODES
Hypomanic episodes share similar, though less severe, symptoms of manic episodes. Symptoms only need to be present for four days, rather than a week, in order to qualify as a hypomanic episode.
These episodes do not cause the extreme dysfunction that mania typically causes. People are usually able to carry on with most of their daily activities during hypomanic episodes, but can still make risky decisions.
To diagnose someone with bipolar disorder, doctors rule out other causes of heightened moods. They also look for signs of depression before or after a manic or hypomanic episode, as bipolar disorder includes at least one episode involving manic symptoms, and episodes of depression.
DEPRESSIVE EPISODES
According to the American Psychiatric Association, a depressive episode is a period of at least two weeks where an individual experiences at least five of the following symptoms (and including one of the first two symptoms):
- Intense sadness or despair
- Loss of interest in activities you once enjoyed
- Feelings of worthlessness or guilt
- Fatigue
- Increased or decreased amounts of sleep
- Increased or decreased appetite
- Restlessness or slowed speech/movement
- Difficulty concentrating
- Frequent thoughts of death or suicide
If you or someone you know is having thoughts of suicide, call or chat the National Suicide Prevention Lifeline at any time of the day. These thoughts and feelings are temporary, and there is help out there for you.
Bipolar as a Spectrum Disorder: Bipolar I, Bipolar II, and Everything In-Between
For a long time, bipolar disorder was separated into distinct subtypes:
- Bipolar I: Diagnosed when individuals have had at least one manic episode. Individuals in this category also typically experience the other types of mood episodes.
- Bipolar II: Diagnosed after at least one hypomanic and one depressive episode.
- Cyclothymic disorder: Diagnosed if you have had bipolar-like symptoms for at least two years, without mood swings stopping for more than two months, but the mood swings do not meet all the requirements for the above subtypes of bipolar.
However, many in the mental health field have shifted to viewing bipolar disorder (and mental health disorders in general) as a spectrum disorder, rather than an illness with specific subtypes.
The best way to think of it is like this: Imagine yourself holding out two hands. On one hand is bipolar I, with features of full-blown mania. And on the other is major depression (or unipolar depression.) Everyone with bipolar falls somewhere in the space between, as everyone experiences similar symptoms with different levels of frequency and severity.
For example, someone with bipolar I may engage in risky behaviors, but someone with bipolar II may struggle more with suicidal ideation during depressive episodes, which they have more frequently.
Why does the “spectrum” part matter?
Trying to fit unique individuals into very specific boxes often leads to misdiagnosis. In fact, studies have found that around 40% of people with bipolar are misdiagnosed with depression.
However, understanding an illness as a spectrum of symptoms with varying intensities offers more people a way of being seen and properly diagnosed. It also helps treatment providers offer more holistic treatments, especially when it comes to proper medication to manage bipolar disorder.
Specifically, what often happens is that individuals only go to see someone in a depressive episode. That’s when it’s most “obvious” that something is off. A medical professional may initially diagnose them with depression, then prescribe them with antidepressants, which can cause a manic or hypomanic episode.
How common are comorbid bipolar disorders and eating disorders?
Someone with “comorbid” disorders has two disorders at the same time. Studies vary widely when it comes to figuring out how common comorbid bipolar disorder and eating disorders are, mostly because of the different ways researchers identify eating and bipolar disorders.
Studies have found that anywhere from 5.3-31% of individuals on the bipolar spectrum have a co-occurring eating disorder.
Related: Learn more about what comorbid disorders are and how common they are in individuals with eating disorders.
Which types of eating disorders are most associated with bipolar disorder?
People with a comorbid eating disorder and bipolar are more likely to have binge eating disorder, then bulimia, then anorexia binge-purge subtype.
Researchers believe this is due to the fact that individuals with bipolar disorder, on average, have higher levels of impulsivity, which is associated more with binging behaviors than restriction.
How does having bipolar disorder and an eating disorder affect treatment and recovery?
IMPACT ON SEVERITY OF ILLNESS
Individuals suffering from a co-occurring eating and bipolar disorder typically have an increased severity of illness, higher levels of depressive episodes, and more attempts of suicide.
Related: This is what to do if you struggle with substance use and an eating disorder.
IMPLICATIONS FOR MEDICATION MANAGEMENT
There are a lot of different medications that are used to treat bipolar disorder, and it can take a long time to find the one that works. The bipolar spectrum is wide, and medication may focus more on treating depression, psychotic episodes, or both. The trickiest part is finding a medication that helps an individual manage depression, while also keeping them from “upswinging” to a manic or hypomanic state.
There are also a lot of side effects that come with various medications, which prescribers have to take into consideration when working with bipolar patients.
Why does having an eating disorder make finding the right medication even more difficult?
People in treatment for an eating disorder are often prescribed antidepressants or antianxiety medications, as feelings of depression and anxiety are either already present before treatment, or surface throughout treatment.
But if a patient has bipolar and it has gone undetected, prescribing them antidepressants can cause them to swing into a hypomanic, manic, or even psychotic state. This raises the risk of self-harm, risk-taking, and suicide.
Ideally, for patients with co-occurring eating and mood disorders, psychiatrists could help patients find a medication that helps them manage both. However, if that doesn’t happen, psychiatrists strive to find medications that can at least help with one disorder without making the other one worse.
Each individual responds differently to medications, so there really is no exact formula for finding what works.
TREATMENT APPROACHES
It’s hard to find an eating disorder treatment provider that works for you. It’s even more difficult to find a provider capable of treating both an eating disorder and bipolar disorder.
Two treatments that have shown promise for both eating disorders and bipolar disorder are cognitive based therapy and dialectical behavioral therapy.
Getting adequate amounts of sleep, following a regular schedule, and doing self-care are also useful for regulating mood when recovering from an eating disorder as well as managing or mitigating mood episodes.
If you struggle with bipolar disorder and an eating disorder, treatment can and will literally save your life. But you need to find an eating disorder treatment provider that understands comorbid diagnoses and all your other individual needs. Then, you can confidently walk down the path of recovery from two disorders, which is absolutely amazing and completely possible.
Related: This is how to find the eating disorder treatment center that’s right for you.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.
