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Diabetes Mellitus and Eating Disorders

A 28-year-old Caucasian female with a 12-year history of self-described binge eating and a 7-year history of insulindependent diabetes mellitus came for an evaluation of depression and eating problems. She had always been moderately overweight. She had no close interpersonal relationships and lived at home with her family, having tried to move out several times but having returned for financial and emotional reasons. She worked as a medical secretary. The patient said that she felt depressed and indicated a full constellation of neurovegetative signs. She stated that she binged nightly on “junk food,” including carbohydrates and ice cream. She did not purge, fast, or use laxatives but deliberately withheld insulin in order to keep her blood sugar high, which she claimed sped up her metabolism and prevented her from gaining weight. She said that if she managed her blood sugar effectively without eliminating her bingeing, she gained weight. Her blood sugar could measure as high as 600 mg/dl in the evening. The patient had received 2 years of psychotherapeutic treatment with a nurse therapist, who attempted to address her difficulties with diabetes, eating, separation, and depression. Once during this period she was admitted to a psychiatric hospital when she completely refused to take insulin. She terminated with her therapist because she believed that