Diabulimia treatment & recovery

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Diabulimia is a complex eating disorder that involves the deliberate underuse or restriction of insulin in those with Type I diabetes as an attempt to control weight. (1) Diabulimia is severe and potentially life-threatening, but many treatment options are available to help individuals heal and regain control of their diabetes.

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Levels of care for diabulimia

Each person diagnosed with diabulimia will have a different experience with the eating disorder, and therefore will respond best to individualized care. 

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Inpatient

Inpatient care means an individual is receiving 24-hour medical supervision at a hospital. When someone has Type 1 diabetes, their body produces little or no insulin. (2) Without insulin, the body cannot absorb glucose, and blood sugar levels may rise, resulting in complications, such as kidney, heart, and nerve damage. If someone with diabulimia is experiencing life-threatening diabetic complications, a doctor may suggest inpatient treatment. 

Residential

Residential treatment is another type of 24-hour care, but individuals stay in a home-like environment instead of a hospital. A person with diabulimia may undergo residential treatment if they're experiencing diabetic complications that require medical attention, but their condition is stable. 

Partial hospitalization program (PHP)

Partial hospitalization programs (PHP) offer a mix of inpatient and outpatient treatments. If a person with diabulimia is in a PHP, they may spend a few days undergoing inpatient treatment at a hospital and a few days a week in outpatient treatment. Someone with diabulimia may require overnight treatment for a diabetic complication but overwise live at home and receive outpatient treatment. 

Intensive outpatient (IOP)

Intensive outpatient (IOP) treatment means the individual can live at home without 24-hour care but may still benefit from structured and frequent outpatient treatments. People with diabulimia use insulin treatment to manage their diabetes and may require daily check-ins with a medical team to ensure their insulin levels are appropriate to keep the body functioning. 

Outpatient

Outpatient treatment is primarily for those who can manage their diabetes and eating disorder while living at home without constant supervision and seek professional treatment as needed. For someone with diabulimia, this would mean they are not restricting insulin but may still need guidance to help manage thoughts and behaviors to continue healing.

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Psychotherapy for diabulimia

Psychotherapy, also known as talk therapy, is an evidence-based treatment for diabulimia and other eating disorders. (3) There are various types of psychotherapy an individual may undergo depending on their individual needs. 

Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) helps those with diabulimia accept their feelings and thoughts surrounding their eating disorder. Usually, there is a fear of gaining weight when eating and taking insulin. ACT acknowledges an individual will gain weight, and it's okay to feel anxious about it, but insulin and food keep the body strong and healthy. 

Cognitive behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) can help someone with diabulimia understand why they restrict insulin and how they can change their behaviors. The goal is to help the individual manage their insulin treatments so their body can adequately maintain blood sugar levels. 

Cognitive remediation therapy (CRT)

Those with diabulimia not only restrict insulin but also tend to restrict food. Cognitive remediation therapy (CRT) is a promising therapy used to treat eating disorders when food restriction is present. (4) A goal of CRT is to improve self-awareness. For someone with diabulimia, self-awareness can help them understand how food and insulin restrictions affect the body. 

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) helps individuals develop interpersonal skills. (5) These interpersonal skills can include mindfulness to help people build awareness for the present moment and regulate emotions.

Exposure therapy

Exposure therapy for people with diabulimia helps individuals confront their fears. Those living with diabulimia often restrict insulin and food because they have anxieties about gaining weight. Exposure therapy encourages individuals to take insulin and eat and understand that gaining weight may happen, and it is okay if it does. 

Family therapy

Doctors typically suggest family therapy to families with adolescents and young adults with diabulimia, but people of all ages can benefit. Family therapy gives relatives more perspective on what their loved one is going through and helps individuals with diabulimia communicate their thoughts and feelings to their families. 

Group therapy

Group therapy is reoccurring sessions led by a trained therapist where people discuss the struggles and successes of their eating disorder. It's an opportunity for people to learn from each other and see they're not alone in their challenges. 

Interpersonal psychotherapy (IPT)

Many people with an eating disorder have trouble connecting with others. They become preoccupied with their eating disorder and may experience social isolation among peers. Interpersonal psychotherapy (IPT) helps those with diabulimia learn essential skills for building and maintaining relationships.

Nutrition counseling and meal support

A person with diabetes has specific nutritional needs. Nutrition counseling educates those with diabulimia how different foods and insulin affect their body. Nutrition counseling also considers the psychological struggles someone with diabulimia may go through and provides assistance in overcoming mental and emotional hurdles. Someone with diabulimia may also work with a dietitian for meal support. Meal support offers actionable steps for building meal plans with nutritional value for each individual.

Experiential treatments for diabulimia 

Some studies suggest art therapy can be helpful to those living with diabetes who struggle with articulating their emotions verbally. Accepting that someone has diabetes can take an emotional toll on the individual. In some cases, resisting insulin is an emotional response to not accepting their condition. Art therapy may help someone explore and express their emotions and accept their diabetic diagnoses using different media. By acknowledging their diabetes, they can begin their healing journey.

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Treating diabulimia at Within Health

It takes incredible courage to seek help for an eating disorder. Being met with empathy, support, and understanding is important when someone with an eating disorder enters treatment for diabulimia. The experts at Within Health are here to help those with diabulimia start their healing journey. 

Within Health offers PHP, IOP, and OP treatment options for those seeking diabulimia treatment. Each treatment program is designed to meet the unique needs of each individual. Call our team today to start the journey to recovery.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. What is diabulimia: Symptoms, risk factors, and causes. (2021, December 3). Eating Disorder Hope. 
  2. Mayo Foundation for Medical Education and Research. (2021, March 27). Type 1 diabetes. Mayo Clinic.
  3. Herpertz, S., Hagenah, U., Vocks, S., Wietersheim, J. von, Cuntz, U., & Zeeck, A. (2011). The diagnosis and treatment of eating disorders. Deutsches Ärzteblatt International. 
  4. Tchanturia, K., Lounes, N., & Holttum, S. (2014). Cognitive remediation in anorexia nervosa and related conditions: A systematic review. European Eating Disorders Review, 22(6), 454–462. 
  5. What is dialectical behavior therapy (DBT)? Behavioral Tech. (n.d.).

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