Diabetes and Eating Disorders (Continued)
Causes of Eating Disorders
Causes of eating disorders are complex, and there is rarely one specific cause. Rather, as with other emotional difficulties, there are biopsychosocial reasons for their development and continuation. Non diabetes-specific reasons they may develop are:
- having a family history of eating disorders, depression or substance misuse
- being female (although men are also increasingly vulnerable and do also develop eating disorders)
- being overweight
- experiencing early puberty compared to peers.
- being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job (which can happen, for example,to ballet dancers, models or athletes)
- certain characteristics, for example having an obsessive personality, an anxiety disorder or low self-esteem, or being a perfectionist
- dietary restraint and dieting.
- being criticized for one's eating habits, body shape, or weight
- particular experiences, such as sexual or emotional abuse, or the death of someone special
- difficult relationships with family members or friends
- stressful situations, for example problems at work, school, or college
- disturbed family functioning
- disturbed parental eating attitudes
- peer and cultural influences.
Considerable evidence has also accumulated to suggest that living with type 1 diabetes in itself is a risk factor for disturbed eating behavior and eating disorders. Eating disorders have been found to be twice as common in teenage girls with type 1 diabetes as in their peers without diabetes. It is also argued that the diabetes treatment goals can ‘teach' or intensify some of the vulnerability to an eating disorders mindset.
Diabetes management increases the focus on controlled food intake, and can be experienced as restrictive. This means you are following an eating plan which is not completely dependent on responding to your own internal cues for hunger and fullness. This results in these cues becoming less reliable. If you undereat you are likely to feel deprived, which can trigger overeating and binge eating episodes. Knowing that bingeing is not good for your health or weight, you may then skip insulin doses in order to avoid weight gain, getting trapped in a cycle of dieting, further binge eating, and weight control behavior.
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One of my ongoing dietary issues has been one of protein. Right after diagnosis, I ran a bit scared of all of the "excess protein kills the kidneys" lines and into the old-school health-foods' "you don't need as much protein as you think you do" train of thought. Combined with the calorie and sodium restrictions of my initial diabetes diet, a move away from animal-based proteins because of my cholesterol levels, and a medication which seemed to block nutrient...