Psychological Impact of Type 1 Diabetes: A Focus on Disordered Eating Behavior in Female Adolescents.

Abstract

Type 1 diabetes is a risk factor for developing mental health disorders, particularly disordered eating. Female adolescents are vulnerable to abnormal eating behaviors when transitioning from childhood to adult diabetes management. The challenge of achieving glycemic stability while navigating developmental changes during adolescence can lead females to unhealthy eating patterns as a coping mechanism. Disordered eating behavior is a term that encompasses a variety of patterns that do not meet the criteria for a formal eating disorder diagnosis. Such behaviors include dietary restriction, binge eating, and purging methods, including self-induced vomiting, excessive exercise, and medication misuse. The intentional omission of insulin is a purging method specific to diabetes, and especially type 1 diabetes. Without insulin, the body is unable to take up glucose from the bloodstream, resulting in hyperglycemia. A prolonged state of hyperglycemia can lead to serious complications, including diabetic ketoacidosis. A persistently elevated A1C is one of the few objective findings of disordered eating in patients with type 1 diabetes. Disordered eating instruments, including the SCOFF and Diabetes Eating Problem Survey-Revised questionnaires, have been adjusted to inquire about insulin misuse. Positive screening results and clinical findings of sustained hyperglycemia are pathognomonic of disordered eating behavior. Treatment of the concurrent conditions includes cognitive behavioral therapy with a multidisciplinary approach to regain glycemic stability. Health care providers must maintain a high index of suspicion for signs of psychosocial distress in female adolescents with type 1 diabetes to ensure that appropriate interventions are made before long-term complications arise.