Bipolar disorder increases eating disorder risk
Mental health conditions are complex. Some people may experience one at a time while others experience more than one at a time. Symptoms may ebb and flow. One day may go very well while the next few days are spent in distress. One of the most commonly misunderstood yet undeniably important mental health concerns is the combination of bipolar disorder and eating disorders.
Research shows that eating disorders occur more frequently among people with bipolar disorder than in the general population, particularly bulimia nervosa and binge eating disorder. When these illnesses intersect, they can reinforce one another in ways that complicate recovery.
Bipolar mood states can accompany binge eating, loss of control around food, or severe food restriction. Treating the full picture of these co-occurring conditions makes a real difference in recovery.
What does the research say about bipolar disorder and eating disorders?
Research suggests that binge eating may be more common in people living with bipolar disorder than in the general population. However, the relationship between the two conditions is complex.
Clinical studies have found rates of binge eating ranging from 13% to 38% in bipolar patients.[1] Compare this to the general population, where 2.8% of people will face binge eating disorder in their lifetime.[2]
Bipolar patients with a history of eating disorders may experience more frequent depressive episodes.[1]
Why do bipolar disorder and eating disorders often occur together?
Clinically, I often see a few common factors contributing to the overlap between bipolar disorder and eating disorders, particularly around binge eating although that’s not always the case. Several factors contribute to this relationship.
Shared neurobiology
Both bipolar disorder and eating disorders involve disruptions in the brain reward systems, impulse regulation, and emotion processing. These shared pathways, particularly those involving dopamine, may increase vulnerability to both conditions.[5]
Mood states influence eating patterns
During hypomanic or manic episodes, individuals may experience:
Increased impulsivity
Reduced need for sleep
Decreased awareness of hunger and fullness cues
Increased risk taking behaviors
These symptoms can contribute to chaotic eating patterns, binge eating, or purging behaviors. Interestingly enough, some research suggests that even some genetic overlap between bipolar disorder and eating disorders may reflect shared biological vulnerability as well.[6]
Depressive episodes may lead to:
Reduced or increased appetite
Louder food noise due to restriction
Decreased motivation to eat
Increased body dissatisfaction
Feelings of hopelessness
These experiences can reinforce restrictive eating behaviors or worsen existing eating disorders.
Emotional coping with food
For some, eating disorder behaviors can be a way to manage hard emotions that accompany bipolar disorder. Food restriction and purging can help individuals feel more in control and binge eating can be a way to numb emotions. These behaviors are temporary fixes to alter mood and emotions, reinforcing the cycle of both disorders [7]. Over time, this interaction can cause both illnesses to become more entrenched, which is why effective treatment is critical.
“The biggest thing I tell myself during those ‘highs’ is: You are not invincible. Every action has consequences.’ I also try to give myself at least a week before making impulsive decisions. During the ‘lows,’ I remind myself that using my eating disorder won’t make the situation better — if anything, it will make me more miserable. I remind myself that these feelings don’t last forever.” - Maddy, Eating Recovery Center alum
Why does treating both conditions together matter?
When bipolar disorder and an eating disorder occur together, treating only one condition often leads to an incomplete recovery. Clinically, I see a few common examples:
Malnutrition can worsen mood instability, impair cognitive functioning, and reduce the effectiveness of psychiatric medications.[8]
Mood instability can worsen eating disorder behaviors, particularly during periods of impulsivity or emotional dysregulation.
Of course, every patient is different, but the message still stands. The most effective care entails treatment of the root cause and the behavior simultaneously. This requires mood stabilization and nutritional rehabilitation.
Is recovery more challenging when bipolar and eating disorders are both present?
Co-occurring bipolar disorder and eating disorders can make recovery more complex, but recovery is possible, especially when both disorders are treated equally.[3]
The following factors make treatment more complex:
Mood fluctuations affecting appetite and motivation
Impulsivity during hypomania and manic episodes
Low energy, low motivation, social withdrawal during depressive episodes
Sleep disruption, which can worsen both conditions
Important elements that support recovery include:
Consistent nutrition
Regular sleep schedule
Medication adherence
Emotion regulation skills
Strong social support
Education and understanding
Co-occurring conditions and eating disorders make treatment more complex, but the combination is more common than many people realize. That’s why it’s crucial to find a team that looks at the root cause rather than just the symptoms.
“To anyone out there who feels like their mood symptoms and eating behaviors are connected, my best advice would be to keep track of your mood symptoms and what your eating behaviors are like when those symptoms are present. Write about how you feel and what you believe in those moments, too. The other big piece of advice is to find a psychiatrist who is educated on bipolar disorder and how to treat it. Also, try your hardest to find a therapist who is educated on both!” - Maddy, Eating Recovery Center alum
How can I support a loved one with an eating disorder and bipolar disorder?
Supporting someone with both bipolar disorder and an eating disorder can feel overwhelming. Education and support can make a meaningful difference. Caregivers should keep in mind the following.
Remember that both conditions are serious medical conditions
These disorders involve biological, psychological and environmental factors. They are not vanity issues or self-control issues. They aren’t matters of willpower or choice.
Watch for early warning signs
Both eating disorders and bipolar disorders can present with physiological and behavioral change. Changes in sleep, energy level, interests, appetite, mood or behavior can signal the need for additional support.
Encourage consistency
Medication adherence, meal plan adherence, adequate nutrition, balanced activity, therapy participation and structured daily routines are not just “nice to have” but protection for your loved one.
Take care of yourself
Caring for someone who is struggling is emotionally heavy for parents and caregivers. Support groups, education programs and professional guidance can help caregivers maintain their own well-being so they can support their loved one better. We invite you to attend one of our free online eating disorder support groups for caregivers.
The Eating Recovery Center approach
At Eating Recovery Center, our first priority is to help patients become safe and medically stable. From there, treatment focuses on addressing the full picture of both conditions. This means getting accurate diagnoses, matching individuals with the level of care that will best meet their needs, and treating patients with compassion using evidence-based therapies.
Medication management
Mood stabilizers, antipsychotics and other psychiatric medications may be used to treat bipolar disorder. However, medication decisions must be carefully tailored because:
Malnutrition affects medication effectiveness.
Some medications influence appetite or weight.
Eating disorder symptoms may interfere with medication adherence or medication absorption and metabolism.
Psychiatric oversight is built into our higher levels of care to keep treatment safe and effective.
Nutritional rehabilitation
Eating disorders can cause profound medical complications in those who are severely malnourished. Research shows that inadequate nutrition can worsen irritability, concentration problems and depressive symptoms [8]. Structured nutritional support helps interrupt the damage created by the eating disorder, restoring brain function and emotion regulation.
Evidence-based psychotherapy
Treatment often integrates multiple therapeutic approaches with trauma-informed care, including:
These approaches help patients develop healthier ways of coping with emotional distress.
You aren’t alone if you’re struggling
If you’re reading this, you’re probably feeling overwhelmed and grasping for hope. Please remember that we’ve treated thousands of patients for eating disorders and co-occurring conditions.
Recovery from bipolar disorder and eating disorders is not about perfection. It’s about building stability – stable nutrition, stable sleep and stable support.
And yes, it’s possible.
Talk to a specialist about what you’re experiencing. Click here to schedule a free introductory call or give us a call at 866-622-5914. Calls require no commitment and are 100% confidential.
Related Reading
Dealing With Burnout in Recovery
Eating Disorder Relapse Is Common: Here's Why and What to Do About It
How to Create an Eating Disorder Relapse Prevention Plan
How to Help Someone With an Eating Disorder — From a Mom Who’s Been There