Diabulimia, which is a combination of the words diabetes and bulimia, refers to a dangerous behavior in which people who suffer from Type 1 diabetes intentionally take less insulin than they need as a means of weight control.
Diabulimia is not classified as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). However, the DSM-5 does include the misuse of medications as one of the behaviors listed in the diagnostic criteria for bulimia. Also, many mental health experts and advocacy groups, such as the National Eating Disorders Association (NEDA) and the National Association of Anorexia Nervosa and Associated Disorders (ANAD), recognize the intentional underuse of insulin as a dangerous purging behavior. NEDA describes diabulimia as the dual presence of an eating disorder and diabetes.
Type 1 diabetes is characterized by the body’s inability to produce insulin, a hormone that is normally produced by beta cells within the pancreas. Insulin helps to regulate the body’s ability to metabolize carbohydrates and fats, and is essential to the body’s ability to store fats by moving glucose out of the bloodstream and into cells that require this energy source.
People who have Type 1 diabetes are able to avoid problems related to this inability to properly metabolize and store energy by monitoring their blood glucose levels and injecting themselves with insulin when necessary. Failing to inject oneself with sufficient amounts of insulin, and thus impairing the body’s ability to store glucose, will inhibit weight gain. However, it may also lead to a wide range of additional health problems, including damage to one’s blood vessels, heart, eyes, nerves, and kidneys.
Diabulimia, or the intentional underuse of insulin by individuals who have Type 1 diabetes in order to prevent weight gain, is a dangerous form of weight control that exposes sufferers to myriad negative outcomes. However, with effective treatment, people can overcome their compulsion to engage in this dangerous behavior and make the other changes that will allow them to live healthier and more satisfying lives.
Experts estimate that between 11 and 39 percent of individuals who have Type 1 diabetes will struggle with diabulimia. Though both males and females can be impacted by diabulimia, most research has focused on the prevalence of this problem among women and girls.
According to the American Diabetes Association (ADA), about 35 percent of women and girls with diabetes will eventually develop an eating disorder. ADA data indicates that women and girls who have diabetes are three times more likely to develop an eating disorder than are women and girls who do not have diabetes.
Among adolescents and teenagers, the risk of developing diabulimia increases with age. For example, about 2 percent of preteen girls who have Type 1 diabetes engage in behaviors that are consisted with diabulimia. Among girls in their late teens, the prevalence of diabulimia among those who have Type 1 diabetes skyrockets to as high as 40 percent.
Causes and Risk Factors for Diabulimia
As is the case with most eating disorders and other mental health challenges, diabulimia is believed to result from a combination of genetic and environmental influences. The same is true of Type 1 diabetes. The following are among the more common factors that experts believe may contribute to the development of diabulimia:
Genetics: Several studies suggest that a predisposition for developing an eating disorder may be an inheritable trait. For example, individuals whose parents or siblings struggle with an eating disorder are at an increased risk for developing a similar problem. Type 1 diabetes is also influenced, in part, by genetics. For example, men with this form of diabetes have a 1 in 17 chance of having children who have the same condition. Depending upon what age they are when they give birth, women who have Type 1 diabetes have between a 1 in 25 and a 1 in 100 risk of having a child who has the same condition. Studies involving identical twins support the belief that both eating disorders and Type 1 diabetes can be influenced by genetics.
Environmental: Experts have identified cold weather, certain viruses, and the quality of one’s early diet as environmental factors that may trigger the onset of Type 1 diabetes in a person who is genetically predisposed to developing the disease. Environmental factors that may contribute to the onset of diabulimia or other eating disorders include trauma, grief/loss, stress, and bullying or other forms of harassment. Environmental influences that are specific to individuals who have Type 1 diabetes include dealing with the stress of having a chronic condition, restricting oneself to a highly regulated diet, and associating meals with the unpleasantness of checking one’s glucose levels and injecting oneself with insulin.
- Having Type 1 diabetes
- Gender (diabulimia is more common among females than among males)
- Age (diabulimia is most common among older teens and young adults)
- Poor self-image
- Family history of eating disorders
- Family history of mental illness
- Prior failed attempts to lose weight via unhealthy dieting
- Suffering from depression
- Being sexually assaulted or otherwise violently victimized
- Chronic exposure to stress
Signs and Symptoms of Diabulimia
As indicated in an earlier section, the DSM-5 does not include specific criteria for a diagnosis of diabulimia. However, the following signs and symptoms may indicate that a person is dealing with Type 1 diabetes and a co-occurring eating disorder:
- Eating alone or in secret
- Lying about when, where, or how much one has eaten
- Being deceptive about one’s blood glucose monitoring and insulin use
- Repeatedly attempting to control one’s weight via fad or extreme diets
- Wearing extremely baggy clothes to hide one’s body shape
- Social withdrawal and avoidance
- Unexplained weight loss
- Frequent urination
- Increased hemoglobin levels
- Irregular heartbeat
- Muscle weakness
- Inability to think clearly
- Diminished problem-solving skills
- Memory impairments
- Problems concentrating or focusing
- Suicidal ideation
- Dramatic mood swings
- Low self-esteem
- Poor self-worth
Effects of Diabulimia
Any eating disorder has the potential to inflict significant damage on an individual’s physical, mental, emotional, and social wellbeing. Diabulimia poses the additional threat of severe health consequences related to the improper management of Type 1 diabetes. The following are among the many negative outcomes that may occur as a result of a person’s struggle with diabulimia:
- Severe kidney damage and potential renal failure
- Diabetic ketoacidosis
- Irregular menstruation
- Persistent yeast infections
- Retinopathy (damage to blood vessels in the retina)
- Diabetic neuropathy
- Damage to the digestive system
- Urinary tract infections
- Erectile dysfunction
- Bell’s palsy
- Withdrawal and self-isolation
- Family discord
- Substance abuse and addiction
- Impaired performance in school or at work
- Significant decline in quality of life
- Suicidal ideation
Many people who struggle with diabulimia may also be dealing with one or more additional mental health issues, including the following:
- Posttraumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Bipolar disorder
- Borderline personality disorder
- Depressive disorders
- Substance use disorders
Treatment for Diabulimia
Diabulimia is an often-misunderstood condition that, if left untreated, can cause a range of negative outcomes, including death. Because people with diabulimia are dealing with both Type 1 diabetes and a compulsion to engage in dangerous weight-control behaviors, successful treatment must address both the physical and psychological challenges, as well as any underlying issues or co-occurring disorders that may have led to or been impacted by the unhealthy behaviors.
For many people with diabulimia, the most effective solutions are found at residential treatment programs such as those offered through Harmony Point Treatment Centers. One of the immediate initial benefits of entering residential treatment is that individuals are removed from the stresses in their homes, schools, or workplaces that may have led to or exacerbated their problems. Within this safe and supportive treatment environment, Harmony Point Treatment Centers brings people together with dedicated professionals whose training and experience has provided them with significant insights into the challenges faced by those who are attempting to overcome diabulimia.
At Harmony Point Treatment Centers, adolescents and adults who have been struggling with diabulimia will be provided with comprehensive treatment plans that have been specially designed to meet their unique needs. Depending upon the strengths and needs of the individual, diabulimia treatment at Harmony Point Treatment Centers may involve cognitive and behavioral therapies, nutritional counseling, psychoeducational groups, medical support, recreational therapeutic activities, and similar experiences.
When an adolescent or adult chooses to heal at Harmony Point Treatment Centers, he or she will receive quality professional care that will identify and address the physical, mental, and emotional issues that have been causing such significant problems. Most importantly, he or she will have the opportunity to develop the skills and strategies that will promote lifelong recovery and allow him or her to pursue a much healthier and happier future.