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

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

doi:10.1111/dme.14578

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

Diabet Med. 2021 Jul;38(7):e14578. doi: 10.1111/dme.14578. Epub 2021 May 6.

Authors

Amy Harrison^{1

2

3}, Natalie Zaremba¹, Jennie Brown^{1

4}, Jacqueline Allan¹, Emmanouela Konstantara¹, David Hopkins⁴, Janet Treasure³, Khalida Ismail⁵, Marietta Stadler^{1

5}

Affiliations

¹ Diabetes Research Group, Weston Education Centre, King's College London, London, UK.
² Department of Psychology and Human Development, University College London, London, UK.
³ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁴ Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
⁵ Department of Psychological Medicine, Weston Education Centre, King's College London, London, UK.

PMID: 33797072
DOI: 10.1111/dme.14578

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: cognitive behavioural therapy; disordered eating; qualitative; type 1 diabetes mellitus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adaptation, Psychological
Adolescent
Cognitive Behavioral Therapy
Cross-Sectional Studies
Diabetes Mellitus, Type 1 / psychology*
Feeding and Eating Disorders / psychology*
Female
Humans
Interviews as Topic
Models, Psychological*
Self Care

Abstract

Publication types

MeSH terms

Grants and funding