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A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in people with type 1 diabetes mellitus
Author(s) -
Harrison Amy,
Zaremba Natalie,
Brown Jennie,
Allan Jacqueline,
Konstantara Emmanouela,
Hopkins David,
Treasure Janet,
Ismail Khalida,
Stadler Marietta
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14578
Subject(s) - disordered eating , type 2 diabetes , medicine , feeling , diabetes mellitus , cognition , grounded theory , clinical psychology , eating disorders , psychology , qualitative research , psychiatry , social psychology , social science , sociology , endocrinology
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.