Evening chronotype, disordered eating behavior, and poor dietary habits in bipolar disorder

F. Romo-Nava, T. J. Blom, A. Guerdjikova, S. J. Winham, A. B. Cuellar-Barboza, N. A. Nunez, B. Singh, J. M. Biernacka, M. A. Frye, S. L. McElroy

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: Our aim was to evaluate the relationship between evening chronotype, a proxy marker of circadian system dysfunction, and disordered eating behavior and poor dietary habits in individuals with bipolar disorder (BD). Methods: In this cross-sectional study, we evaluated 783 adults with BD. Chronotype was determined using item 5 from the reduced Morningness-Eveningness Questionnaire. The Eating Disorder Diagnostic Scale (EDDS) and the Rapid Eating Assessment for Participants—Shortened Version (REAP-S) were used to assess disordered eating behavior and dietary habits respectively. General linear models and logistic regression models were utilized to evaluate differences between chronotype groups. Results: Two hundred and eight (27%) BD participants self-identified as having evening chronotypes. Compared to non-evening types, evening types were younger (P < 0.01) and, after controlling for age, had higher mean EDDS composite z-scores (P < 0.01); higher rates of binge-eating (BE) behavior (P = 0.04), bulimia nervosa (P < 0.01), and nocturnal eating binges (P < 0.01); and a higher body mass index (P = 0.04). Compared to non-evening types, evening chronotypes had a lower REAP-S overall score (P < 0.01) and scored lower on the ‘healthy foods’ and ‘avoidance of unhealthy food’ factors. Evening types also skipped breakfast more often (P < 0.01), ate less fruit (P = 0.02) and vegetables (P = 0.04), and consumed more fried foods (P < 0.01), unhealthy snacks (P = 0.02), and soft drinks (P = 0.01). Conclusions: Our findings suggest that the circadian system plays a role in the disordered eating and unhealthy dietary behaviors observed in BD patients. The circadian system may therefore represent a therapeutic target in BD-associated morbidity that warrants further investigation.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalActa Psychiatrica Scandinavica
Issue number1
StatePublished - Jul 1 2020


  • binge eating
  • bipolar disorder
  • bulimia
  • chronotype
  • diet
  • evening
  • food

ASJC Scopus subject areas

  • Psychiatry and Mental health


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