Type 1 diabetes is a dangerous disease, if not properly treated. Eating disorders, for their part, are the deadliest of psychiatric conditions. Here's a scary statistic I learned while reporting a health story for PT and our partner MSN: Women with Type 1 diabetes are at least twice as likely to develop an eating disorder as other women.
What's really disturbing is their method. These teens and women are reducing or skipping their insulin doses in order to drop pounds. It works, but it also puts them at grave risk: In the short-term, they could fall into a coma and die. And too-high blood glucose levels can cause blindness, kidney damage, and circulatory problems over time.
The press has dubbed the phenomenon "diabulimia," but the expert I spoke with, Ann E. Goebel-Fabbri, a psychologist at Joslin Diabetes Center in Boston, warned me that diabulimia is not an official medical term or diagnosis. A girl or woman with Type 1 diabetes who restricts her insulin intake for weight loss purposes to the point where it constitutes an eating disorder would be diagnosed with both conditions.
I asked Dr. Goebel-Fabbri how women could keep skipping their shots when the consequences are so dire, especially since the immediate effects of forgoing insulin are so negative—excessive thirst, low mood, a lack of energy. She explained that the risk/reward equation isn't even factored into the decisions of someone in the grips of an eating disorder. "These women know they feel bad," she said. "They know the risks are severe, but their eating disorder has control over their lives. It's no longer consciously driven."
Some become terrified of insulin. A Salon story that came out last year includes some vivid personal accounts of diabulimia struggles. One young woman was the envy of her college dorm because she could scarf down as much pizza as she wanted and stay a size 2, as long as she missed her insulin shots. She had an advantage over her peers in the fight to be slim, even as she was doing untold damage to her body and effectively shortening her life.
The dorm scene reminds me of Hara Estroff Marano's recent article, The Skinny Sweepstakes. She argues that strict age segregation has turned dieting into a competitive sport in high school and college: May the thinnest girl win.
But what makes eating disorders so hard to understand and treat is how they take on a life of their own until they have nothing to do with being thin.
Diabulimia is fascinating because it's such an extreme behavior. Hopefully the newfound interest in this combination of disorders will help women who are restricting their insulin from falling down to where taking care of themselves no longer feels possible.
War on bodies
I have read that eating disorders are somehow linked to expressing anger defiance and despair towards the physical body. That when women become enraged by unfair and unobtainable perfection and hypocritical views of female sexuality and desire, they seek revenge on the body, a body that is ironically viewed as the most important part of self. This is then linked to control and taking back control by railing against an obscene cultural exploitation.
I wonder if Type 1 diabetics have a greater tendency to develop such distorted relationhips with thier bodies in that they have been in a sense waging a constant battle with thier bodies just to survive. I have a female client who has type 1 diabetis and she often laments "I'm just so tired of having to always cater to my body." She also has purposefully skipped insulin shots and her explanation for this speaks to the idea of winning back control over her body by getting what she wants ( thiness) vs. what her body wants ( balance). She claims that she doesn't really want to harm herself but that her body is so out of control that she sometimes stops caring what she does to it. She doesn't feel fully in control of her condition and copes with this by taking control over her weight.