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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Years before I was diagnosed with type 2 diabetes, The Other Half came out of a doctor's appointment with a diagnosis of "borderline diabetes" and an ADA exchange diet sheet. His health insurance agency followed up on the diagnosis with a glucometer and test strips. After a year or so of trying to follow the diet plan and test his glucose levels, things appeared to be back in "normal" range, and stood there until a couple of years after my own diagnosis. Shortly...