What would you sacrifice for a perfect body? A cheesy slice of pizza? Or perhaps a vanilla yogurt with generous quantities of Oreo and rainbow sprinkles? 29-year-old Becky, from Aberdeen, England sacrificed her legs, in her arduous battle with diabulimia (“Diabulimia: The World’s Most Dangerous Eating Disorder,” 2017).
Diabulimia is an eating disorder that affects individuals with Type 1 diabetes, which is a form of diabetes that manifests in an individual’s childhood and requires the life-long intake of insulin. While some individuals with diabulimia may show signs of bulimia (binge eating and purging), diabulimia is distinctly characterized by the affected individual’s refusal to take insulin. Symptoms often include: high blood sugar levels, dehydration, frequent urination, and unexplained weight loss (“Diabulimia,” n.d.).
What makes diabulimia so dangerous is the sensitivity of individuals with Type 1 diabetes to insulin dosage. According to Professor Khalida Ismail, the lead psychiatrist for diabetes at King’s Health Partners—a London-based academic health science center—when individuals with Type 1 diabetes decrease or stop their insulin intake, their blood sugar levels increase, making them vulnerable to damages to their eyes, kidney, and nerve endings, as well as heart failure, loss of limbs, and in severe cases, death (2017). Additional consequences include severe dehydration and coma (Karidis, 2015).
The BBC Three documentary, Diabulimia: The World’s Most Dangerous Eating Disorder follows the stories of women with diabulimia, including Becky and 21-year old Nabeelah, from Leicester, England. Becky’s struggles with diabulimia have resulted in the disintegration of her leg bones, requiring her to walk with crutches, and led to her 16 month-stay as an inpatient at an eating disorder unit. Similarly, the disorder has caused Nabeelah multiple health complications, including the worsening of her eyesight; nerve pains in her feet, hands, and fingers; migraines; and kidney pains.
Despite the perils of diabulimia, sufferers continue to skip their insulin, because as with any other eating disorder, the fear of weight gain outweighs the medical consequences. In the words of Professor Ismail, “People with Type 1 diabetes have a fear that insulin causes weight gain…this fear is so strong that it leads them to omit the amount of insulin they take, in order to have weight loss,” (2017).
Nabeelah’s hands tremble when her EpiPen is in close proximity and she says, “Me being completely recovered would be me being able to inject on a daily basis without the big cloud of depression or the big cloud of weight gain standing over my head,” (2017).
Like many other comorbid disorders, treating diabulimia is challenging, with relapse rates at a whopping 53% (2015). A major challenge to treatment plans is the extreme consequences of skipping insulin, as Professor Ismail states, “If the person with Type 1 diabetes does not take insulin, they will die very quickly.”
The mental and physiological characteristics of diabulimia also contribute to the difficulties in treatment. “With diabetes, there is a focus on numbers: What is your blood sugar? …How many carbohydrates have you consumed?..with eating disorders, people need to learn to let go of the obsession with numbers. So there is a conflict in treatment approaches,” says Marcia Meier, a diabetes nurse educator at the Melrose Center in Minneapolis (2015).
Treatment often includes cognitive and behavioral therapy, as well as group therapy, counseling, therapeutical activities (“Best Diabulimia Treatment Center & Rehab,” n.d.), and in severe cases, surveillance by professionals in treatment facilities (2017).
Approximately 40% of women between 15 and 30 with Type 1 diabetes suffer with either Diabulimia or another form of eating disorder. Additionally, it is estimated that 60% of women with Type 1 diabetes will have encountered an eating disorder by 25 years of age (Colton et al., 2015). However, diabulimia has yet to be recognized on the Diagnostic and Statistical Manual of Mental Disorders (DSM), and awareness is still low.
In England alone, the number of individuals with diabulimia is estimated to be 400,000 (Ollerenshaw, 2016). Despite the sheer magnitude and severity of this disorder, awareness on it runs low. This is further exacerbated by the stigma surrounding mental health and the ever-increasing standards on body image. As this is a childhood disorder, perhaps a possible solution can be incorporating lessons on body image and self-love into elementary/middle school curriculums.
Best Diabulimia Treatment Center & Rehab. (n.d.). Retrieved October 7, 2017, from http://www.sierratucson.com/eating-disorders/diabulimia/
Colton, Olmsted, et al. “Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence.” Diabetes Care, vol 38, no. 7, Jul. 2015, pp. 1212-1217.
Diabulimia. (n.d.). National Eating Disorders Association. Retrieved October 1, 2017, from https://www.nationaleatingdisorders.org/diabulimia-5.
“Diabulimia: The World’s Most Dangerous Eating Disorder.” Youtube. Uploaded by BBC Three, 24 September, 2017, https://www.youtube.com/watch?v=tSLjM6cZaTo.
Karidis, A. (2015, October 28). When Diabetes Leads to an Eating Disorder. Retrieved October 7, 2017, from https://www.theatlantic.com/health/archive/2015/10/when-diabetes-leads-to-an-eating-disorder/412849/
Ollerenshaw, T. (2016, September 8). Diabulimia: Diabetes and eating disorder service launching in UK. Retrieved October 7, 2017, from http://www.bbc.co.uk/newsbeat/article/37155459/diabulimia-diabetes-and-eating-disorder-service-launching-in-uk