Diabulimia is an unhealthy behavior in which individuals who suffer from Type 1 diabetes inject themselves with smaller doses of insulin than they need in an attempt to control their weight. Withholding insulin impairs the body’s ability to store glucose, which results in an inability to gain weight. The negative impact of engaging in this behavior can include damage to the kidneys, nerves, blood vessels, heart, and eyes.
Diabulimia is not included in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), but the DSM-5 does list the misuse of medications as one of the improper compensatory behaviors that are characteristic of the eating disorder bulimia. The National Eating Disorders Association (NEDA) classifies diabulimia as a dual diagnosis in which the afflicted individual has both diabetes and an eating disorder.
Because people with diabulimia are dealing with both Type 1 diabetes and a compulsion to engage in dangerous weight-control behaviors, successful treatment must address both the physical and psychological challenges, as well as any underlying issues or co-occurring disorders that may have led to or been impacted by the unhealthy behaviors and emotional disturbances. But it is important to keep in mind that treatment options are available for diabulimia.
Experts estimate that as many as 40 percent of adults and adolescents who have Type 1 diabetes engage in behaviors that are consistent with diabulimia. Male and female adolescents and adults can both develop diabulimia, but the problem appears to be more prevalent among girls and women, than among boys and men.
The American Diabetes Association (ADA), reports that between 30 and 40 percent of females who have diabetes will develop an eating disorder. This suggests that adolescent and adult females with diabetes are three times more likely to develop an eating disorder than are women and girls who do not have diabetes.
Causes and Risk Factors for Diabulimia
The following are among the more common genetic and environmental factors that experts believe may contribute to the development of diabulimia:
Genetics: People whose parents or siblings struggle with an eating disorder are at increased risk for developing a similar problem. Type 1 diabetes is also influenced in part by genetics. For example, women who have Type 1 diabetes have between a 1 in 25 and a 1 in 100 risk of having a child who has the same condition. Studies involving identical twins also indicate that the development of eating disorders and Type 1 diabetes can both be influenced by genetics.
Environmental: Weather, certain viruses, and the quality of one’s early diet are environmental factors that may trigger the onset of Type 1 diabetes in a person who is genetically predisposed to develop the disease. Trauma, grief/loss, stress, and bullying or other forms of harassment are among the environmental factors that may contribute to the onset of diabulimia or another form of disordered eating.
- Having Type 1 diabetes
- Being female
- Being under the age of 30
- Having low self-esteem
- Family history of eating disorders and/or mental illness
- Prior failed attempts to lose weight via unhealthy dieting
- Personal history of mental illness
- Past trauma
Signs and Symptoms of Diabulimia
As noted earlier, the DSM-5 does not include specific criteria for a diagnosis of diabulimia. However, the following symptoms may indicate that a person has developed Type 1 diabetes and a co-occurring eating disorder:
- Eating alone or in secret
- Lying about one’s eating habits
- Lying about one’s insulin use
- Making negative comments about one’s weight and/or body shape
- Attempting to control one’s weight via extreme dieting
- Wearing baggy clothes to hide one’s weight and body shape
- Weight loss
- High hemoglobin levels
- Irregular heartbeat
- Impaired ability to concentrate or focus
- Diminished problem-solving skills
- Memory problems
- Suicidal ideation
- Oscillating moods
- Withdrawing from family and friends
Effects of Diabulimia
The following are among the many negative outcomes that may occur as a result of a person’s struggle with Type 1 diabetes and the intentional misuse of insulin for purposes of weight control:
- Damage to kidneys and liver
- Damage to digestive tract
- Infection of the urinary tract
- Irregular menstruation
- Yeast infections
- Glaucoma and cataracts
- Bell’s palsy
- Withdrawal and self-isolation
- Family discord and damage to other personal relationships
- Substance abuse and addiction
- Diminished performance in school or at work
- Suicidal ideation
Many people who struggle with diabulimia may also be dealing with one or more additional mental health issues, including the following:
- Posttraumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Bipolar disorder
- Borderline personality disorder
- Depressive disorders
- Substance use disorders