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Diabulimia

Diabulimia causes: environmental and biological factors

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Reviewed by
Eric Patterson
LPC
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Health disclaimer

Diabulimia is a complex and dangerous eating disorder that involves the deliberate underuse or restriction of insulin in people with Type I diabetes as an attempt to control or lose weight.

As is true for all eating disorders, diabulimia doesn’t have a single cause. Instead, the interaction of several biological, psychological, and social factors likely contributes to the development of diabulimia.

5
 minutes read
Last updated on 
April 10, 2024
April 10, 2024
Diabulimia
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Diabulimia causes: Biological factors

Family history of diabetes or eating disorders
While eating disorders were once thought to be primarily social disorders, research has increasingly found them to be heritable or able to be genetically passed down through generations.1 Having family members with anorexia nervosa, bulimia nervosa, or other eating disorders does increase the risk factor of developing an eating disorder.1

Having Type 1 diabetes is also considered a high risk in terms of developing disordered eating behaviors, including those involved in diabulimia.4 And while there are likely several contributing factors to Type 1 diabetes, the condition is also known to pass genetically.5
Co-occurring mental disorders
Eating disorders rarely occur alone. Most of the time, someone struggling with these conditions is also dealing with co-occurring mental health disorders.

Depression and anxiety disorders of all types are the most common co-occurring or comorbid conditions with eating disorders.6 It's difficult to tell sometimes whether the eating disorder drives the other mental disorder or vice versa, though both likely impact each other in a bidirectional way. In any case, having anxiety or depressive disorders increases the risk of developing disordered eating behaviors.6
Weight gain due to insulin injections
Insulin therapy for diabetes, including Type 1 diabetes, can lead to weight gain in many cases, sometimes even excessive weight gain.7 When paired with other risk factors for developing eating disorders, this can be a particularly large risk factor for developing diabulimia or other disordered eating behaviors.4
Recommended reading

Environmental factors of diabulimia

Diabetes management
Diabetes may have more than genetic links to disordered eating behaviors. Controlling diabetes can be especially difficult and time-consuming, requiring frequent and thorough consideration of things like diet, meal planning, food-related rules, food restrictions, and reading labels for ingredients.

The constant need to keep these considerations in mind can frequently lead to anxiety, and anxiety mainly focused around food and eating, which is at the heart of many eating disorders.4 For those with diabetes, anxiety has been shown to present as binge eating or self-induced vomiting in many patients and as diabulimia—the manipulation of insulin doses to control weight—in as many as 39% of adult patients.4
Difficulty regulating emotions
Emotional dysregulation is another key factor in many eating disorders, including binge eating disorder, anorexia nervosa, bulimia nervosa, and other eating disorders.8 In many cases, the unhelpful behaviors that develop around food and eating, such as binge eating, are maladaptive coping mechanisms the person uses to attempt to deal with unresolved stress or unpleasant emotions.8

While few empirical studies focus on diabulimia specifically, it's likely that the condition can also evolve as a maladaptive way to deal with difficult emotions. And those with certain personality traits may be at an even higher risk of developing these behaviors. Perfectionist tendencies, obsessive-compulsiveness, harm avoidance, and low self-assertiveness have all been tied to disordered eating behavior.10

Diabulimia causes: environmental factors

History of trauma
Childhood trauma or life-altering events at any point in life are all closely tied to eating disorders.3 Post-traumatic stress disorder (PTSD), specifically, is one of the most significant risk factors for developing eating disorders, with studies finding as many as 25% of people with eating disorders struggle with comorbid PTSD.9
Cultural and societal pressure
The outside pressure to look a certain way has long been tied to eating disorders.2 In fact, these types of social pressures were once thought to be the primary cause of eating disorders. The "ideal" body type varies from culture to culture, but in Western or Western-influenced areas, that has generally translated to thin or lean bodies for women and a lean, muscular physique for men.

Nowadays, that pressure can be felt even more strongly, thanks to a mix of traditional media, social media, diet culture, and wellness-focused accounts. In particular, social networking sites—and their ability to promote and proliferate ideas about diet, exercise, and "wellness"—have been tied to several mental health concerns, including body image issues and psychological distress.11 And, accounts about wellness have been linked to issues like cycles of weight loss and weight gain, depression, and chronic stress.11

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Finding appropriate care for diabulimia

Diabulimia is a serious eating disorder that requires appropriate care, but treating diabulimia can be particularly difficult due to the complexities involved in both diabetes management and eating disorder recovery.

Often, treating this type of condition requires a multidisciplinary approach from a team with knowledge of both eating disorders and diabetes. Special care needs to be taken to ensure that someone can develop healthier mental health outlooks and coping mechanisms while maintaining the physical regimen required to control their blood sugar and insulin levels.

Generally, the main priorities of treatment include stabilizing eating behaviors, maintaining optimal glucose control, and addressing issues involved with purging or, in the case of diabulimia, intentional insulin restriction.3

If you or a loved one are struggling with diabulimia or another eating disorder, it's important to seek out help.

Contacting your primary care physician or therapist is a good place to start. These experts can help you determine your next best steps and may be able to recommend specific programs or treatment courses.

Remote treatment is available

Within Health gives you the opportunity to work with a multidisciplinary team, who will create individualized treatment plans that can be followed entirely remotely. Contact us today to see how we may be able to help.

Get help today

‍

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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Berrettini, W. (2004). The genetics of eating disorders. Psychiatry, 1(3), 18–25.
  2. Miller, M. N., & Pumariega, A. J. (2001). Culture and eating disorders: a historical and cross-cultural review. Psychiatry, 64(2), 93–110.
  3. Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: focus on PTSD. Eating Disorders, 15(4), 285–304.
  4.  Kınık, M. F., Gönüllü, F. V., Vatansever, Z., & Karakaya, I. (2017). Diabulimia, a Type I diabetes mellitus-specific eating disorder. Turkish Archives of Pediatrics, 52(1), 46–49.
  5. Type 1 Diabetes. MedlinePlus. Accessed January 2024.
  6. Himmerich, H., Kan, C., Au, K., Treasure, J. (2021). Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacology & Therapeutics, 217, 107667.
  7. Russell-Jones, D., & Khan, R. (2007). Insulin-associated weight gain in diabetes--causes, effects and coping strategies. Diabetes, Obesity & Metabolism, 9(6), 799–812.
  8. Ruscitti, C., Rufino, K., Goodwin, N., & Wagner, R. (2016). Difficulties in emotion regulation in patients with eating disorders. Borderline Personality Disorder and Emotion Dysregulation, 3, 3.
  9. Eating Disorders and Posttraumatic Stress Disorder. (n.d.). National Eating Disorders Association. Accessed January 2024.
  10. Levallius, J., Clinton, D., Backstrom, M., Norring, C. (2015). Who do you think you are? - Personality in eating disordered patients. Journal of Eating Disorders, 3. 
  11. Marks, R. J., De Foe, A., Collett, J. (2020). The pursuit of wellness: Social media, body image and eating disorders. Children and Youth Services Review, 119, 105659.
  12. Shaban, C. (2013). Diabulimia: a mental health condition or media hyperbole? Practical Diabetes, 30, 3.
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FAQs

Further reading

Diabetes and eating disorders

Diabetes and eating disorders are both serious conditions that can negatively affect a person’s physical...

Diabulimia causes: environmental and biological factors

Diabulimia is a complex and dangerous eating disorder that involves the deliberate underuse or restriction...

Diabulimia treatment & recovery

Diabulimia is a complex eating disorder that involves the deliberate underuse or restriction of insulin in...

Diabulimia symptoms and warning signs

Diabulimia is an eating disorder that occurs in people with Type 1 diabetes where...

What is diabulimia?

Diabulimia is an eating disorder that people with Type 1 diabetes exhibit by lowering...

Further reading

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