A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus.

Amy Harrison,Emmanouela Konstantara,Khalida Ismail,Jennie Brown,Natalie Zaremba,Marietta Stadler,Janet Treasure,Jacqueline Allan,David Hopkins

doi:10.1111/dme.14578

Abstract

This qualitative study aimed to develop the first cognitive behavioural therapy model outlining the development and maintenance of disordered eating in type 1 diabetes and report on recovery strategies and resilience factors to improve previous theoretical models of type 1 diabetes and disordered eating. Twenty-three women (n=9 with type 1 diabetes and disordered eating, n=5 with type 1 diabetes recovering from disordered eating, and n=9 with type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using grounded theory and individual cognitive-behavioural formulations were developed for each participant to inform the development/maintenance and resilience models. The development/maintenance model summarises commonly experienced vicious cycles of thoughts, feelings and behaviours in type 1 diabetes and disordered eating. The resilience model summarises strategies and knowledge acquired by those with type 1 diabetes in recovery from disordered eating and individuals with type 1 diabetes who did not develop disordered eating. Early adverse life events, past psychiatric history, perfectionist personality traits, difficult experiences around type 1 diabetes diagnosis and its relentless daily management sensitise individuals to eating, weight and shape cues. Alongside physical symptoms/complications, unhelpful interpersonal reactions and inadequate healthcare, vicious cycles of thoughts, feelings and behaviours develop. 'Good enough' psychological adaptation to type 1 diabetes, integrating type 1 diabetes into one's identity, self care and compassion around eating, weight and shape were key protective/post-traumatic resilience factors. This first cognitive behavioural therapy model of type 1 diabetes and disordered eating informed by personal experience will inform an intervention for type 1 diabetes and disordered eating.

Highlights

Psychiatric comorbidity in type 1 diabetes is high.[1,2,3] Comorbid disordered eating is twice as common in type 1 diabetes than peers without type 1 diabetes.[4]
We first explain the categories obtained from the grounded theory analysis which informed an initial model of the development and maintenance of disordered eating in type 1 diabetes
We explain the findings of the individual cognitive behavioural therapy formulations which informed us further on how the categories were related in the genesis and perpetuation of the disordered eating

Summary

Introduction

Psychiatric comorbidity in type 1 diabetes is high.[1,2,3] Comorbid disordered eating is twice as common in type 1 diabetes than peers without type 1 diabetes.[4]. This model has been further developed to specify maintenance cycles involving dietary restriction leading to hypoglycaemia, binge eating and hyperglycaemia and purging or insulin restriction.[11]

Methods

Results

Discussion

Conclusion