Key Takeaways:
- Women with diabulimia—a dangerous intersection of type 1 diabetes and eating disorder behaviors like insulin omission—face unique risks, including poor glycemic control, higher HbA1c, risk of ketoacidosis, and elevated mortality. Early, specialized care is essential.
- DBT for Eating Disorder recovery offers skills in emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness that are particularly helpful for treating the overlapping behavioral, cognitive, and affective challenges in diabulimia.
- Combining DBT with a multidisciplinary treatment team, including standard DBT, nutritional counseling, medical monitoring, therapist consultation team, and relapse prevention protocols, leads to better primary outcome measures (weight stabilization, reduced disordered eating disorder symptoms, improved quality of life).
- Intensive levels of care, such as intensive outpatient or partial hospitalization, DBT skills training, and behavioral research and therapy programs, are often necessary until eating disorder and diabetic management stabilize.
Introduction
Women who struggle with type 1 diabetes and deliberately underdose or omit insulin for weight control—commonly known as diabulimia—are facing not just a medical crisis but a psychological and behavioral storm. Their condition combines the physiological demands of diabetes with the complex psychopathology of eating disorders: distorted body image, guilt, anxiety, and the addictive pull of controlling one’s body through disordered eating behaviors. It’s here that Dialectical Behavior Therapy for Eating Disorder recovery becomes especially critical.
When standard diabetes treatment meets the behavioral and cognitive challenges of an eating disorder, DBT provides a way forward: helping a woman with diabulimia manage her eating disorder symptoms, reduce insulin misuse, cope with diabetes distress, and achieve a stable treatment outcome.
What Is Diabulimia, And Why Is It So Dangerous?
Diabulimia refers to a pattern of eating disorder behaviors in people with an eating disorder and type 1 diabetes (T1DM) who deliberately reduce or skip insulin to lose weight. These behaviors are often secretive, medical consequences are severe, and the diagnostic criteria are not fully standardized in the Diagnostic and Statistical Manual (DSM-5). However, the behaviors overlap with diagnosable eating disorders like anorexia or bulimia in many respects.
PubMed research shows a strong prevalence: in one U.S. study, ~1 in 11 adult patients with T1DM screened positive for diabulimia; those with diabulimia had significantly higher rates of major depressive diagnoses and emergency department visits.
Furthermore, young women with T1DM show higher rates of co-occurrence of eating disorder diagnoses. Severity of insulin omission correlates with poor glycemic control, increased risk of diabetic ketoacidosis, cardiovascular risk, organ damage, and even mortality. The eating disorder examination must also include assessments of psychological distress (anxiety, depression, shame), appetite issues, body image, and the addictive nature of control.
How Can DBT For Eating Disorder Therapy Help Women With Diabulimia?
Dialectical behavior therapy is a version of therapy rooted in both behavioral and cognitive frameworks, adapted to treat emotional regulation difficulties and harmful behaviors. In the context of eating disorder treatment, DBT helps by:
- Teaching DBT skills training—mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness—that give clients tools to cope instead of resorting to insulin omission or purging behaviors.
- Providing a behavior therapy program for people with complex disorders, including those with eating disorders and borderline personality, self-harm, or co-substance use issues or addiction. DBT’s structure includes individual therapy, group skills training, phone coaching, and a therapist consultation team.
Several controlled trials and program evaluations, as published in PubMed Central, demonstrate that partial hospital and intensive outpatient programs informed by DBT lead to significant improvements in psychopathology, emotion regulation, and medical stability.
What Does An Effective DBT-Based Treatment Program Look Like?
An effective standard DBT or modified dialectical behavior therapy program for diabulimia should include:
- Multidisciplinary Treatment Team: endocrinologists, therapists, dietitians, psychiatric care, and nurse educators. Collaboration ensures that insulin management and medical risks are monitored in conjunction with psychological recovery and dietary rehabilitation.
- Therapist Consultation Team: DBT requires therapist adherence to DBT protocols, supervision, and peer consultation to maintain fidelity and prevent drift away from evidence‐based practices.
- Levels of Care: For many women with diabulimia, intensive outpatient programs or partial hospitalization are needed initially, followed by step-downs to outpatient.
- Relapse Prevention: Given the addictive nature of insulin misuse and the risk of regressing into harmful eating disorder behaviors, a strong relapse prevention plan is essential. This means DBT skills training, ongoing support, and addressing triggers like shame or diabetes distress.
- Behavioral Research and Therapy: Ongoing evaluation of treatment completers, including which version of DBT is most effective and which comorbid diagnoses influence recovery, helps refine approaches.
- Example of care model: Children’s Hospital of Philadelphia research highlights structured DBT-informed group therapy, family involvement, and nutritional supervision, providing an intermediate level of care between weekly outpatient treatment and more intensive programs
Conclusion
For women with diabulimia, recovery is not just about stopping insulin omission—it is about healing the underlying emotional, cognitive, behavioral, and medical systems that have become intertwined in harmful ways. Dialectical Behavior Therapy for Eating Disorder recovery offers hope by teaching coping skills, building professional treatment teams, offering relapse prevention, and addressing co-occurrence with conditions such as depression, borderline personality features, or addiction.
Virtue Recovery offers specialized care for eating disorders and diabetes integration—don’t wait to begin the path to healing. Call Virtue Recovery now at Tel: 725.777.2619.
FAQs:
1. What exactly defines diabulimia?
Diabulimia involves deliberate restriction or omission of insulin in people with an eating disorder and T1DM for the purpose of weight loss.
2. Is DBT proven to reduce insulin omission and medical risks in diabulimia?
Specific randomized trials are limited, but DBT has been shown to reduce eating disorder behaviors and improve coping with emotion regulation, indirectly reducing insulin misuse. DBT-informed eating disorder treatment programs report better treatment outcomes and stability.
3. How long does DBT therapy typically last for someone recovering from diabulimia?
Dialectical behavior therapy may last 6–12 months or more. Patients often start with a higher level of care (PHP or intensive outpatient) before transitioning to outpatient DBT. Ongoing relapse prevention is key to sustaining recovery.
4. Can DBT be used alongside other treatments in eating disorder recovery for women with T1DM?
Yes. Effective treatment combines standard DBT or a modified version of DBT with nutritional counseling, medical management of diabetes, psychiatric care, and a structured treatment team approach.
Citations:
American Diabetes Association. Type 1 Diabetes and Eating Disorders: Association Between Type 1 Diabetes Mellitus and Eating Disorders. 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11005101/.
Ip, E. J., et al. “A Risky Trend Among Adults with Type 1 Diabetes Mellitus.” Diabetes Care, vol. 46, no. 8, 2023, https://pubmed.ncbi.nlm.nih.gov/37567472/.
Mochrie, Kirk D., John Lothes II, Eric Guender, and Jane St John. “DBT-Informed Treatment in a Partial Hospital and Intensive Outpatient Program: The Role of Step-Down Care.” Research in Psychotherapy: Psychopathology, Process and Outcome, vol. 23, no. 2, 7 Sept. 2020, pp. 109-120. PMC, https://pmc.ncbi.nlm.nih.gov/articles/PMC7513610/.
Children’s Hospital of Philadelphia (CHOP). Intensive Outpatient Program (IOP) for Eating Disorders. https://www.chop.edu/centers-programs/eating-disorder-assessment-and-treatment-program/intensive-outpatient-program-iop-eating-disorders/
