ambivalent (idealusion) wrote in ed_ucate,


i read an article today about "diabulimia" -- diabetics who skip their insulin shots while eating a refined-carbohydrate diet in order to lose weight. of course, it addresses the serious health complications of doing so and why no one in their right mind should attempt it.

but i don't know what to think about their classification of it as a bona fide "eating disorder." i've included a few snippets of the article under the cut (the actual article is pretty long, but can be found here) that talk about this condition as an eating disorder.

"Thousands of the approximately 1 million people with Type 1 (or juvenile-onset) diabetes are willing to take the risk. Mostly teenagers and young women, they suffer from a unique eating disorder called diabulimia."
"This is the temptation thousands of young people with diabetes face. Diabulimics can eat delicious, fattening foods and remain thin, or they can live by draconian rules and battle to squeeze into their clothes."
"The mortality rate from diabetes alone is roughly 2.5 percent annually. For anorexia nervosa, it's 6.5 percent. But patients with diabulimia -- which is referred to in healthcare circles as "dual diagnosis" -- have a mortality rate of a whopping 34.8 percent, per year.

"Both diabetes and eating disorders are high-risk conditions," says Dr. Joel Jahraus, director of the Eating Disorders Institute (EDI) at Park Nicollet Health Services in St. Louis Park, Minn., one of the few centers in the country with a program specifically to treat diabulimics. "But put them together and the risks are just wildly incremental."

According to anecdotal research done at Park Nicollet, patients with diabulimia routinely suffer from retinopathy, neuropathy, metabolic imbalance, depression and other mood disorders, kidney disease and heart attacks."
"For females in the general population, the risk of developing an eating disorder during college is between 20 and 40 percent; for those with diabetes, it doubles. In a recent study conducted by the EDI, of 87 patients diagnosed with diabetes in childhood, 36 percent admitted to misusing insulin in order to control their weight -- but only when they were asked a decade later.

Whether diabulimia is on the rise or only now being noticed, experts cannot say. What they do know is that more and more patients -- mostly young women -- come to them every year with the signs of voluntary insulin deprivation. It's become a standard question for diabetes specialists to ask patients with high A1C results. And it's now listed in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as a separate illness with criteria specific to insulin-dependent patients."

(NOTE: i do not believe they are correct about this DSM bit ... it sounded fishy to me, so i poked around and from what i could find, there is no such diagnosis. maybe in the DSM-V there will be, but nothing right now. please comment if you know otherwise.)
"Some doctors theorize that the Internet is partly to blame: Teens with diabetes are posting information about insulin withholding, they say, much as young women have traded dieting tips and guidelines for traditional purging techniques (vomiting, laxative abuse, excessive exercise) for many years."
"Katie...was admitted to the Eating Disorders Institute in 2003, one of its pilot diabulimia patients. ... "They didn't understand diabetes," she says. "I was one of the first [diabulimics] to enter their program and I challenged them to recognize what a weird struggle this was for me. For instance, I was told never to look at numbers or labels. But I have to look at the carb number on a food, or I won't know how much insulin to take. I can't get around the numbers.""

i had never heard of this before, but a quick google search returns a multitude of results. i guess this has a lot to do with the question, what constitutes an eating disorder? is it, like i think this article suggests, a willingness to go to physical extremes and endanger one's own life in order to lose weight? and thereby being more about a person's actions than their psychiatric state, which is what i have always thought of as key to an eating disorder diagnosis? what do you all think?

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