What you need to know
Eating disorders are common among adults with bipolar disorder but have not been widely studied in young people. This study included people between 13 and 20 years old who were referred to a specialized youth bipolar disorder clinic. The participants or their parents filled out questionnaires that asked whether the young person had received a diagnosis of any type of mental health problem or eating disorder. The questionnaires also asked at what age each participant started having mania or hypomania and if they had any family history of mental health problems.
The researchers found that eating disorders were common in young people with bipolar disorder. They also found that those with bipolar disorder and an eating disorder had more emotional instability, suicidality, trauma and other psychiatric disorders. It is important to incorporate this complexity in treatment planning.
What is this research about?
There is growing recognition that many people with bipolar disorder may also experience disordered eating or eating disorders. This includes anorexia, bulimia and eating disorders that are problematic but do not fit neatly into the anorexia or bulimia categories. This can include binge-eating patterns, anorexia symptoms that do not lead to severe weight loss, as well as other situations in which weight-related body image, eating and/or dieting cause significant problems for the person.
Researchers have found that rates of eating disorders are higher in adults with bipolar disorder than in the general population. While some studies have examined eating disorders in young people with bipolar disorder, most of the research on this topic has only included adults.
Ontario researchers decided to fill this knowledge gap by assessing the prevalence of eating disorders, and their associated features, in a group of young people with bipolar disorder.
What did the researchers do?
The study included 197 young people between 13 and 20 years old who looked for or received treatment for bipolar disorder in a specialized clinic. The participants and their parents took part in interviews and completed questionnaires to confirm the diagnosis of bipolar disorder and other mental health disorders, including eating disorders.
The interviews and questionnaires also included questions about the participants’:
- age when they started having symptoms
- family history of mental health disorders
- ability to regulate their emotions
- other aspects of their mental health.
What did the researchers find?
Almost one-third of the youth said they had received an eating disorder diagnosis at some point in their life. Of those, about four per cent said they had been diagnosed with anorexia, eight per cent said they had been diagnosed with bulimia and 17 per cent said they had been diagnosed with an eating disorder not otherwise specified.
The average age when participants first started having symptoms of an eating disorder was 13 years and ranged from seven to 18 years old. The eating disorder started first in about 60 per cent of participants and bipolar disorder started first in 17 per cent. In 23 per cent of participants, the two disorders started within the same year.
Participants who identified as female and those with bipolar disorder type II had the highest risk of having an eating disorder diagnosis at some point in their life.
Participants who had a history of eating disorders reported more severe depression at their worst lifetime episode and more severe emotional dysregulation. They were also more likely to report non-suicidal self-injury, suicide attempts, sexual abuse and cigarette smoking. Those with an eating disorder were also more likely to have other mental health disorders, including anxiety, post-traumatic stress and substance use disorders. Finally, they were also more likely to have a family history of anxiety disorders.
Limitations of the research
The researchers pointed out that because of the study design, they were not able to determine if one condition led to the other. Also, the researchers focused on eating disorders at any point in the person’s life. For some people, this could be ongoing. For others, it may have been in the distant past.
In addition, this study enrolled participants who were receiving treatment in a psychiatric hospital setting, so it may not be possible to generalize the findings to those receiving care in community clinics.
How can you use this research?
These findings suggest that clinicians who provide services to young people with bipolar disorder should consider the possibility that they may also have an eating disorder. This is especially the case for females with bipolar disorder. Also, clinicians should assess for trauma history and sexual abuse, and they should prioritize delivering trauma-informed care.
The researchers also recommend that treatment approaches that address depression, suicidality and self-injury, and borderline personality traits (such as emotional dysregulation and impulsivity) should be considered when providing mental health services to young people with bipolar disorder and a history of eating disorders.
About the researchers
The lead author on this study, Diana Khoubaeva, has been working at the Centre for Youth Bipolar Disorder for the past four years. Diana finds it very rewarding to work with youth with bipolar disorder and has been inspired to continue her training so that she can provide high-quality mental health care for these youth. Diana is looking forward to starting her Master of Social Work training in September 2022.
Diana Khoubaeva1, Mikaela K. Dimick1,2, Jessica L. Roane1, Vanessa H. Timmins1, Rachel H. B. Mitchell3,4, Benjamin I. Goldstein1,3,2
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada