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Eating Disorders and Type 1 Diabetes
Published in Jonna Fries, Veronica Sullivan, Eating Disorders in Special Populations, 2017
Carolyn Costin, Gail Prosser, Jacque Mular
Most people are familiar with the now widely known eating disorders, anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED), but only recently has the co-occurrence of diabetes mellitus, type 1 (DM1) and insulin restriction been seen as a new variant of eating disorder manifestation. Some have referred to this condition as “diabulimia” because restricting insulin can be used as a way of purging or eliminating calories. Without the necessary insulin, the body's cells cannot utilize the energy from food. Diabulimia is not an official diagnostic term, and the combination of DM1 and an eating disorder is not yet recognized as a separate medical or psychiatric condition. The term diabulimia is also misleading because not all patients with this condition binge, which is one of the main criteria for a diagnosis of bulimia. In order to avoid the shortcomings of the term diabulimia and escape the more lengthy and cumbersome someone who has an eating disorder and diabetes, we have chosen to use the term ED-DM1 for this chapter.
“These Things Don’t Work.” Young People’s Views on Harm Minimization Strategies as a Proxy for Self-Harm: A Mixed Methods Approach
Published in Archives of Suicide Research, 2020
Ruth Wadman, Emma Nielsen, Linda O’Raw, Katherine Brown, A. Jess Williams, Kapil Sayal, Ellen Townsend
Overall 121 participants (16.0%) reported an “other” behavior which they viewed as self-harm, in response to the lifetime ISAS. One hundred and eleven of these participants indicated what this “other” self-harm behavior was (see Table 3). The majority of these related to eating behaviors (food restriction, binging and purging, “eating disorder,” Diabulimia). The next most commonly reported “other” self-harm behavior was snapping elastic bands against the skin (16.2%, 2.37% of the total study sample). Fifteen participants gave an indication of lifetime frequency of engaging in harm minimization strategies as self-harm, reporting engaging in these behaviors between 1 and 1,000 times, representing between 0.5% to 46.5% of their total lifetime self-harm. Thus, reports of snapping an elastic band as a form of self-harm were characterized by these participants as being a repetitive or indeed continuous act, arguably at odds with the intended purpose of such strategies. Of note, one participant who did not provide a lifetime frequency estimate for engaging in sensation proxies which they considered to be self-harm, indicated “snapping myself with a rubber band continuously.” [ID 799].
Disordered eating and insulin restriction in type 1 diabetes: A systematic review and testable model
Published in Eating Disorders, 2018
Tara De Paoli, Peter J. Rogers
Insulin restriction is the practice of purposefully underdosing, or complete omission of, the required insulin for secondary gain (Snyder, Truong, & Law, 2016), including underdosing in order to purge calories via glucosuria (glucose excreted through the urine). Within the literature, this phenomenon has been coined ‘insulin mismanagement’, ‘insulin omission’ or ‘diabulimia’ (Callum & Lewis, 2014). The term diabulimia can be inaccurate, as it only encompasses bulimic symptomatology and is not sufficient in capturing individuals who have purging patterns without bingeing episodes. Furthermore, this tendency to conceptualise insulin restriction only in the context of bulimia nervosa (BN) is reflected in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), which considers ‘other medication’ in its definition of purging in BN, whereas this consideration of medication misuse is omitted from the definition of purging in anorexia nervosa (AN) binge-purge subtype (AN-BP) diagnostic criteria.