by Danielle Keenan-Miller
In an ideal world, our eating would be determined only by our hunger. In reality, however, eating is often related to our emotions-- that’s why we call some foods “comfort foods” or talk about “stress eating.” In fact, negative emotions like sadness, anger, or stress are common triggers for a binge (Leehr et al., 2015). When moods go beyond normal day-to-day fluctuations and cross into the territory of depression or mania, we often see that eating patterns also get disrupted and can morph into binge eating. As many as 10%- 28% of people with bipolar disorder also have binge eating disorder (McElroy et al., 2013; Schoofs, et al., 2011).
Having binge eating disorder on top of bipolar disorder is associated with greater suffering, including higher rates of suicidal feelings, more anxiety, more substance abuse, and greater difficulties managing mood (McElroy et al, 2013; Wildes, Marcus, & Fagiolini, 2007). However, it’s not clear whether having more symptoms is part of what causes people to binge eat or whether the binge eating itself is the cause of people feeling more distress.
A new study (Boulanger et al., 2018) has helped to answer the question of why bipolar disorder and binge eating so often go together. The researchers studied 145 people living in France with diagnosed bipolar disorder, analyzing the presence of binge eating, symptoms of bipolar and other mental health problems, eating habits, and personality factors. One factor that was associated with binge eating was dieting-- the more people restricted calories, the more likely they were to binge (the same pattern observed among people without bipolar disorder). The researchers also found that binge eating was more likely among people who reported being more impulsive, a trait often found among both people who binge eat and those who have bipolar disorder. Having a higher intensity of emotion in response to stressors also made people with bipolar disorder more likely to binge eat. These findings suggest that some of the most important treatment targets for this constellation of problems might be reducing dieting behaviors, increasing mindful instead of impulsive patterns of behavior, and teaching people better ways to manage stress and changes in mood without using food.
Based on what research has shown about the high rates and negative consequences of binge eating problems, doctors and therapists should be checking in about eating concerns with every client who has bipolar disorder. People with bipolar disorder should also be aware that feeling out of control around eating could signal an important (but treatable!) concern that they can and should discuss with their treatment team. There is effective help available that can help people with or without bipolar disorder stop the binge eating cycle, leading to better health and a happier and healthier relationship with food and their emotions.
Boulanger, H., Tebeka, S., Girod, C., Lloret-Linares, C., Mehueus, J., Scott, J.,... & Delavest, M. (2018). Binge eating behaviors in bipolar disorders. Journal of Affective Disorders, 225, 482-288.
Leehr, E.J., Krohmer, K., Schag, K., Dresler, T., Zipfel, S., & Giel, K.E. (2015). Emotion regulation model in binge eating disorder and obesity- a systematic review. Neuroscience and Biobehavioral Reviews, 49, 125-134. doi: 10.1016/j.neubiorev.2014.12.008
McElroy, S.L., Crow, S., Biernacka, J.M., Winham, S., Geske, J., Cuellar Barboza, A.B…. & Frye, M.A. (2013). Clinical phenotype of bipolar disorder with comorbid binge eating disorder. Journal of Affective Disorders, 150, 981-986.
Schoofs, N., Chen, F., Braunig, P., Stamm, T., & Kruger, S. (2011). Binge eating disorder and menstrual cycle in unmedicated women with bipolar disorder. Journal of Affective Disorders, 129, 75-58.
Wildes, J.E., Marcus, M.D., & Fagiolini A. (2007). Eating disorders and illness burden in patients with bipolar spectrum disorers. Comprehensive Psychiatry, 48, 516-521.