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Care 13:65–72, 2007

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       Mary de Groot, PhD, is an Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis, IN.

      Chapter 2 Eating Disorders and Disordered Eating Behavior

      Deborah Young-Hyman, PhD, CDE

       Definition of Eating Disorders (ED) and Disordered Eating Behavior (DEB)

      The American Psychiatric Association [APA] manual of mental health diagnoses (DSM-IV-TR 2000) (American Psychiatric Association 2000) defines disordered eating behaviors as caloric restriction, excessive exercise, use of laxatives and other forms of pharmacologic purging, binge eating, and, in patients with diabetes, intentional reduction or omission of insulin. DEB cognitions, which also contribute to diagnostic criteria, include preoccupation with weight and size and/or shape. Reflecting the predominant behavior type, major diagnostic categories of ED are anorexia, bulimia, and eating disorders not otherwise specified. Diagnosis of ED vs. DEB is based on the frequency of behavior and cognitions. When threshold frequency is documented, either by self-report or interview, behavior and cognitions reach the level of diagnosis (ED). Less frequent behaviors and cognitions are considered subclinical (DEB). Though behaviors vary, shared characteristics are that the person desires to control weight and change appearance, and the behaviors and cognitions interfere with other activities of daily living and are extreme. Concerns about shape and size drive maladaptive weight management behaviors. Behavioral criteria used in the general population are applied to patients with diabetes with the additional behavior of insulin manipulation (omission or reduction) (Crow 1998).

       Patients with Diabetes: A Vulnerable Population

      Patients with type 1 and type 2 diabetes have elevated rates of overweight and obesity (Liu 2009). Weight status is strongly associated with DEB in otherwise healthy individuals seeking weight loss and in individuals with type 1 diabetes (T1D), particularly young women (Neumark-Sztainer 2002a, Young-Hyman 2011b, Young-Hyman 2011c). Although there is evidence regarding weight concerns, elevated BMI, and increased rates of binge eating in patients with type 2 diabetes (T2D) (Pinhas-Hamiel 1999, Papelbaum 2005), evidence linking weight, weight concerns, and development of ED and DEB in patients with T2D is scarce.

      Behaviors and attitudes such as dietary restraint, food preoccupation (such as carbohydrate monitoring and restriction), portion control, control of blood glucose through selective food intake, and programmed exercise are prescribed components of diabetes treatment and are the cornerstone by which good glycemic control is achieved (American Diabetes Association [ADA] 2007). These treatment behaviors can become DEB when they are used inappropriately for rapid weight loss, carried to excess, interfere with activities of daily living, and/or become a health risk (American Psychiatric Association 2000, Daneman 2002).

      Ongoing

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