Question: I am a 24-year old female with bipolar type 2 but no other underlying health conditions. For the past month, I have had no appetite nor desire to eat. I feel occasional hunger pains, but the thought of eating completely drains my energy and at times even makes me feel nauseated and anxious. At first, I was managing to eat 500-700 calories a day by nibbling on things here and there, but for the past week I have been well under the 500 mark, and as of 2 days ago have had nothing but water and green tea.

No doubt this is largely psychological, I don't know if I have an eating disorder but I do have a history of low self-esteem, gender dysphoria, and associated dysregulated eating. Could there also be a physiological explanation, though? I've had episodes like this in the past (the earliest I can recall was when I was 19, but they have occurred more frequently in the past 2 years) where 3-4 times a year I will wake up one day and suddenly one, feel no desire to eat, and two, decide this is a good thing and take advantage by not eating.

Typically these have lasted 1-2 weeks, but the most recent episodes have gone on for as long as 2-3. Then, of course, there is my current one, which is now entering the 5th week. Other than loss of appetite (causing me to feel cold, dehydrated, and occasionally lightheaded), I have had no other physical symptoms. These episodes do seem to overlap with brief periods of hypomania, but the undereating continues even after the hypomania has subsided. Is it possible the hypomania is causing the loss of appetite, and the loss of appetite is then triggering my obsession with not eating?

I have been on lamotrigine for the past 3 years but am not on anything else. I am currently taking multivitamins to combat any malnutrition. I want to have a healthy relationship with food, and I feel like I usually do, but then these episodes roll around and I realize just how much control it has over me. I want it to end but I also don't want it to end, I feel both in control and completely out of it. My appetite has always slowly returned in the past, but this time feels different.