Author: Jennifer Rollin, MSW, LCSW-C, Therapist & Founder Of The Eating Disorder Center
It is very common for individuals with eating disorders to come to therapy while also struggling with other mental health concerns. Eating disorders rarely occur in isolation. In fact, many people navigating an eating disorder are also coping with conditions such as anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or mood disorders.
In my clinical work, I have frequently supported individuals at the intersection of eating disorders and bipolar disorder. Additionally, The NIH reports that lifetime prevalence of eating disorders in individuals with bipolar disorder ranged from 2.2 to 31%. Further, they found that ‘the prevalence rates of BD among patients with ED varied from 11.3% to 68.1%.’ Yet there are surprisingly few resources that address what it is like to live with both conditions at the same time. Supporting individuals who are navigating both bipolar disorder and an eating disorder has become a particular passion area in my work. I believe there is a real need for more nuanced conversations, resources, and treatment approaches that acknowledge the complexity of these overlapping experiences.
The Link Between Eating Disorders and Depression
When someone is experiencing depression, it can feel as though they are viewing the world through a pair of dark sunglasses. Everything may appear dimmer and more hopeless. A person may start to believe that something is deeply wrong with them or with their life circumstances, and it can feel as though things will never improve.
Often, when we are depressed, we do not realize that our thinking has become distorted. Instead, it simply feels like reality.
Something similar can occur when someone is struggling with an eating disorder. Eating disorders also act like a pair of tinted glasses, distorting how someone sees their body, food, and even their own worth. These distorted lenses can cause someone to become hyper-focused on food, weight, and body appearance, often at the expense of other meaningful parts of life.
When depression and eating disorders occur together, recovery can feel even more challenging. Depression can significantly affect appetite and energy levels. It can also diminish motivation and the ability to experience joy or hope. When someone is feeling depleted and discouraged, it can become harder to engage in the behaviors that support recovery, such as eating consistently, attending appointments, or caring for basic needs.
While eating disorders are never a choice, they can sometimes function as a way for individuals to subconsciously cope with painful emotions or experiences such as depression, trauma, or low self-worth. Depression often brings an overwhelming sense of helplessness. For some people, eating disorder behaviors may temporarily create the illusion of control during an otherwise painful and unpredictable time.
Through specialized therapy that addresses both depression and eating disorders, individuals can begin to build healthier coping skills, reconnect with their values, and gradually remove the “distorted lenses” that are shaping how they see themselves and their lives. Therapy can also help address deeper underlying experiences that may be contributing to both conditions.
Seeking treatment for both depression and an eating disorder is incredibly important. Both conditions can take a profound toll on someone’s sense of self. Many individuals describe feeling like a shell of who they once were.
Experiencing a depressive episode can be deeply destabilizing. Living with an eating disorder can also be traumatic. Trauma, in this context, can be broadly understood as experiences that overwhelm the nervous system and disrupt a person’s sense of safety and stability.
For some individuals who have experienced trauma, eating disorder behaviors may emerge as an attempt to regulate overwhelming emotions or a dysregulated nervous system.
There is a well-documented connection between trauma and eating disorders. One treatment that can help address both is EMDR therapy (Eye Movement Desensitization and Reprocessing). EMDR works to help the nervous system process difficult experiences and can support meaningful improvement in both trauma symptoms and eating disorder recovery.
Eating Disorders and Bipolar Disorder
Bipolar disorder involves shifts in mood that can include episodes of mania (in bipolar I) or hypomania (seen in bipolar I and bipolar II), along with episodes of depression. Because depressive episodes are common in bipolar disorder, many of the dynamics discussed above regarding depression and eating disorders can also apply to individuals with bipolar disorder.
However, bipolar disorder can add additional layers of complexity to eating disorder recovery.
During manic or hypomanic episodes, individuals often experience increased energy, reduced need for sleep, impulsivity, and lowered inhibitions. For someone who is already vulnerable to eating disorder behaviors, these mood states can sometimes intensify symptoms. For example, impulsivity may lead to increased bingeing, purging, excessive exercise, or other disordered behaviors.
Mania and hypomania can also disrupt appetite and eating patterns. Some individuals feel so energized, distracted, or mentally “wired” that they forget to eat or have little interest in food. Others may experience shifts in impulsive eating behaviors. These changes can make maintaining consistent nourishment (an important component of eating disorder recovery) more difficult.
Mood episodes can also significantly affect a person’s relationship with their body. During periods of mania or hypomania, some individuals experience heightened confidence or grandiosity, which may temporarily alter how they perceive their body or their need for self-care. When the mood episode shifts into depression, this can be followed by intense shame, self-criticism, or hopelessness.
In addition to other aspects, if someone experiences more confidence and improved body image in mania-this can (for some) lead to an appeal of continued mania. However, it is well-documented just how destructive mania can be to someone’s life from large amounts of money spent, to ruined relationships, and impulsive decisions that the person later regrets.
Living with bipolar disorder can sometimes feel like being on an emotional roller coaster. The unpredictability of mood episodes can be distressing and destabilizing. In some cases, individuals may have experienced hospitalizations or other difficult experiences related to mood episodes, which can themselves be traumatic.
As mentioned earlier, trauma and eating disorders are closely linked. For some individuals living with bipolar disorder, eating disorder behaviors may subconsciously emerge as an attempt to regain a sense of control or emotional regulation during periods of instability.
Because of this, it is particularly important that treatment addresses both conditions simultaneously. Treatment may involve a combination of specialized psychotherapy, nutritional support, and collaboration with psychiatric providers to ensure mood stability.
There Is Hope for Recovery
Full recovery from an eating disorder is possible. Eating disorders are highly treatable, particularly when individuals have access to clinicians who understand the complexity of these conditions.
Because eating disorders often occur alongside other mental health concerns—such as depression, trauma, obsessive-compulsive disorder (OCD), or bipolar disorder—it can be especially helpful to work with a therapist who is knowledgeable about these overlapping challenges.
When both conditions are present, treatment often involves addressing the eating disorder while also helping individuals better understand and manage mood patterns, triggers, and emotional regulation. With thoughtful, specialized care and support, many people are able to recover from their eating disorders and build more stability in their mood and overall well-being.
Jennifer Rollin, MSW, LCSW-C is the founder of The Eating Disorder Center. She specializes in therapy for teens and adults with anorexia, bulimia, binge eating disorder, OSFED, body image concerns, and mood disorders. The Eating Disorder Center offers eating disorder therapy in Rockville, Maryland, serving individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington, D.C. The Eating Disorder Center provides eating disorder therapy in Maryland, Virginia, Washington, D.C., Florida, Pennsylvania, and California.