| Type 1 Diabetes and Bulimia: Diabulmia? |
| "Diabulimia" is a term for purging by deliberate insulin omission in a diabetic patient. "A clinician should maintain a high index of suspicion in young women with diabetes who have unexplained, poor metabolic control, repeated episodes of ketoacidosis or weight fluctuations" (p. 288). Diabulimia has similar psychological underpinnings as purging via vomiting or laxatives. This disorder begins as an exciting and quick way to drop weight. Sadly this "trick" becomes habitual and emotionally devastating .There are many long term complications including blindness, kidney disease and renal failure. The link between eating disorders and type 1 |
| Diabetes is controversial, however, a study performed in 2000, the largest to date studying this link, found that "Eating disorders that met DSM-IV criteria for bulimia nervosa or eating disorder not otherwise specified were more than twice as common in subjects with diabetes as in controls…" The earlier the physician identifies this covert behavior, emphasizes appropriate insulin administration and secures psychological support for the patient, the better the prognosis. Rodin, G. (2002) Eating Disorders in Diabetes Mellitus. In C.G. Fairburn & K.D. Brownell (Eds.) Eating disorders and obesity: A comprehensive handbook (2nd ed.) (pp. 286-290). New York: The Guilford Press. |
| Most eating occurs in full consciousness but dissociative states or occasional amnesia also occur. |
| Night Eating Syndrome (NES) |
| Rapid late night eating, insomnia and morning anorexia are a triad of symptoms describing NES. Individuals consume approximately 37% of their daily intake of calories by 6:00 p.m., the rest between 8:00 p.m. and 6:00 a.m. Half of awakenings are associated with food intake. Most eating occurs in full consciousness, but dissociative states or occasional amnesia also occur. Depressed mood is a common feature of this syndrome. NES mostly occurs in obese individuals but |
| similar sleep related disorder syndromes occur in anorexia, perhaps driven by the body's desire to eat. Clinicians report anorexic patients eating foods that would be avoided if conscious, and even non-food substances. Psychotherapy is associated with improvement in this behavior and SSRI's have favorable effects on the disturbances of sleep and mood. Stunkard, A.J. (2002) Night Eating Syndrome. In C.G.Fairburn & K.D. Brownell (Eds.) Eating disorders and obesity: A comprehensive handbook (2nd ed.) (pp. 183-187). New York: The Guilford Press. |
| Binge Eaters: Higher rates of psychopathology |
| About 8% of obese people meet criteria for Binge Eating Disorder (BED), which is usually first diagnosed when one is 30--50 years old. Those with BED have comparable levels of dysfunctional attitudes about weight and shape as those with bulimia. Individuals with BED also have higher rates of lifetime psychiatric disorders, most commonly |
| Major Depressive Disorder and alcohol abuse (Alcohol abuse is slightly more prevalent in men). Anxiety disorders are also elevated. These attitudes and co-morbidities are not reflected in overweight persons who do not binge eat. Grilo, C.M. (2002). Binge Eating Disorder. In C.G.Fairburn & K.D. Brownell (Eds.) Eating disorders and obesity: A comprehensive handbook (2nd ed.) (pp. 178-182). New York: The Guilford Press. |
