Bipolar disorder is a mental health condition characterized by significant shifts in mood, energy, activity levels, and concentration, including periods of elevated mood (manic or hypomanic episodes) and low mood (depressive episodes). Binge eating disorder (BED) is a serious mental illness defined by recurrent episodes of consuming unusually large amounts of food in a short period, accompanied by a feeling of lack of control. Individuals with BED do not typically engage in compensatory behaviors like self-induced vomiting or excessive exercise. These two distinct conditions can occur together.
Understanding the Connection
The co-occurrence of bipolar disorder and binge eating involves various factors. Mood dysregulation, a hallmark of bipolar disorder, can contribute to disordered eating patterns. During depressive episodes, individuals may use emotional eating to manage feelings of sadness or hopelessness. Conversely, during manic or hypomanic states, increased impulsivity can lead to uncontrolled eating behaviors. Studies indicate a strong link, with research suggesting that between 5.3% and 31% of individuals with bipolar disorder also experience an eating disorder.
Medication side effects also play a role. Certain antipsychotic medications, often prescribed for bipolar disorder, may affect the brain’s reward system, potentially increasing activity in areas linked with food rewards. Some antipsychotics can also decrease a person’s ability to recognize fullness, leading to weight gain and potentially furthering a cycle of binge eating. Neurobiological commonalities, such as dysregulation of neurotransmitters like dopamine and serotonin, contribute to the shared vulnerability for both conditions, influencing impulse control and reward processing.
Recognizing the Signs
Recognizing binge eating in someone with bipolar disorder involves observing behavioral, emotional, and physical indicators. Recurrent episodes of eating a significantly larger amount of food than most people would in a similar period, typically within two hours, are a primary sign. During these episodes, a person often feels a distinct lack of control over their eating, as if they cannot stop or regulate what or how much they consume.
Other behavioral patterns include eating much more rapidly than normal, consuming food until uncomfortably full, and eating large quantities even when not physically hungry. Individuals may eat alone due to embarrassment or shame, and they might hoard or stash food. Emotionally, after a binge episode, feelings of disgust, depression, or guilt are common. These symptoms can fluctuate, sometimes intensifying during specific mood episodes of bipolar disorder, such as periods of heightened stress or depressive phases.
Approaches to Treatment
Integrated treatment strategies are necessary for managing co-occurring bipolar disorder and binge eating. Pharmacological interventions often combine medications to address both conditions. Mood stabilizers, such as lithium, carbamazepine, and lamotrigine, are frequently used to manage bipolar disorder’s mood fluctuations. Atypical antipsychotics like quetiapine, olanzapine, and aripiprazole may also be prescribed, particularly for manic episodes or psychosis.
For binge eating disorder, lisdexamfetamine dimesylate (Vyvanse) is the only FDA-approved medication for moderate to severe adult cases. This central nervous system stimulant acts on dopamine and norepinephrine pathways, involved in impulse control and reward processing, potentially reducing binge frequency and cravings. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, escitalopram, and sertraline, have also shown efficacy in reducing binge eating episodes and improving mood symptoms by enhancing serotonin neurotransmission. Topiramate, an anticonvulsant, may also reduce binge eating, sometimes in combination with phentermine.
Psychotherapy plays a significant role, with several beneficial approaches. Cognitive Behavioral Therapy (CBT) helps individuals identify and change negative thought patterns and behaviors related to mood and eating habits. Dialectical Behavior Therapy (DBT), a modified form of CBT, focuses on improving emotion regulation, distress tolerance, and interpersonal skills, showing promise in treating binge eating and co-occurring bipolar disorder. Interpersonal Therapy (IPT) addresses how interpersonal relationships and social circumstances contribute to mood and eating patterns. A multidisciplinary team, including psychiatrists, therapists, and dietitians, often provides the most effective care.
Coping and Support
Daily life management for individuals with bipolar disorder and binge eating benefits from coping strategies and a strong support system. Establishing healthy routines, including consistent sleep and eating schedules, can help stabilize mood and reduce binge eating episodes. Regular physical activity, focused on enjoyment rather than calorie burning, can also help manage stress and improve overall well-being.
Learning to identify triggers for binge eating, such as specific emotions, situations, or thoughts, is an important step in developing alternative coping mechanisms. Stress management techniques like mindful breathing, progressive muscle relaxation, and journaling can help process emotions and reduce the urge to engage in disordered eating. Mindfulness practices, which involve paying attention to hunger and satiety cues and observing thoughts without judgment, can foster a healthier relationship with food.
Building a strong support system, encompassing family, friends, and support groups, is highly beneficial. Eating disorders often thrive in isolation, and connection with others who understand these challenges can provide validation, guidance, and a sense of belonging. Support groups, whether professionally led or peer-based, offer a safe space to share experiences, gain insights, and receive encouragement, fostering hope and motivation in recovery.