Eating disorder features in bipolar disorder: clinical implications

Abstract

Background

Bipolar disorder (BD) is associated with elevated rates of eating disorders (EDs), but the nature and impact of specific ED features are unclear.

Aims

This study sought to identify which ED features are common in BD, and whether these relate to quality of life (QoL) impairment and body mass index (BMI).

Method

A clinical sample of 73 adults with BD completed self-report measures of health, ED features, emotion regulation ability, impulsivity, and QoL.

Results

Binge eating (45%), excessive dietary restriction (39%), overvaluation of weight/shape (51%), purging (16%) and driven exercise (27%) were common, and associated with a poorer clinical picture, including poorer QoL and poorer emotion regulation. Furthermore, regular binge eating episodes explained a significant proportion of variance in QoL impairment after controlling for other significant predictors. The best predictors of BMI were number of medical conditions, impulsivity and positive beliefs about binge eating.

Conclusions

ED features that may not meet criteria for a fully diagnosable ED – particularly overvaluation of weight/shape and binge eating – warrant greater attention, as they may still significantly worsen QoL. Future research should focus on modifying existing psychological interventions to better target ED features among individuals with BD and thereby improve clinical outcomes.

Keywords:

• Bipolar disorder
• eating disorders
• comorbidity
• emotion regulation
• impulsivity
• binge eating

Acknowledgements

Ms McAulay’s PhD candidature is supported by a Research Training Program stipend and School of Psychology funding schemes to support the costs of research. We have no other funding sources to report.

Disclosure statement

Professor Stephen Touyz has received grant funding from Shire. He has also chaired their Australian BED Advisory Committee, acted as a consultant/speaker and provided commissioned reports. He has also been the recipient of travel grants from Shire to attend international conferences in the field of EDs. He has received royalties from McGraw Hill, Hogrefe and Huber and Taylor and Francis for published books/chapters. He is also a consultant for Weight Watchers.

Prof Gin S. Malhi has received grant or research support from National Health and Medical Research Council, Australian Rotary Health, NSW Health, Ramsay Health, American Foundation for Suicide Prevention, Ramsay Research and Teaching Fund, Elsevier, AstraZeneca and Servier; has been a speaker for AstraZeneca, Janssen-Cilag, Lundbeck, Otsuka and Servier; and has been a consultant for AstraZeneca, Janssen Cilag, Lundbeck, Otsuka and Servier.