Bipolar Disorder with Co-Occurring Eating Disorders: Prevalence and Pharmacotherapeutic Implications

Bipolar disorder and eating disorders co-occur more often than expected by chance alone, yet little is known about the recognition and treatment of these disorders when they co-occur. This article briefly reviews studies examining the co-occurrence of these disorders, compares studies of their treatment, and presents preliminary suggestions for the management of the patient with bipolar disorder with an eating disorder. The objective was to provide an update on the scientific evidence examining the comorbidity among bipolar disorder and eating disorders and potential treatments for patients with both disorders. The authors updated two earlier reviews of all published English language studies addressing the occurrence of anorexia nervosa, bulimia nervosa, and binge eating disorder in patients with bipolar disorder and studies of comorbidity of bipolar disorder in patients with eating disorders. In addition, the authors discuss treatment implications for the patient with comorbid conditions from reviewed studies of pharmacotherapy and psychotherapy strategies used in both conditions. Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with bipolar disorder and of bipolar disorder in patients with eating disorders indicate high rates of comorbidity among these illnesses, particularly when subthreshold and spectrum manifestations of these disorders are included. Pharmacological treatment approaches to patients with bipolar disorder and a co-occurring eating disorder require examination of the possible adverse effects of treatment of one syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.