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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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article numbere14578
JournalDiabetic Medicine
Issue number7
Accepted/In press2021
PublishedJul 2021

Bibliographical note

Funding Information: This work was conducted as part of the National Institute for Health Research (NIHR) funded STEADY project (Safe management of people with Type 1 diabetes and EAting Disorders studY) which examines the perspectives of people with disordered eating and type 1 diabetes and healthcare teams who treat people with type 1 diabetes and disordered eating with the overall objective of informing the development of a complex intervention and a Clinical Lecturer Starter Grant awarded by the Academy of Medical Science and Diabetes UK to MS. N.Z.'s salary was part funded by King's College London, Diversity & Inclusion, parenting leave funds awarded to M.S. and by NIHR via the NIHR Clinician Scientist award to MS; J.T. and K.I. are part funded by the NIHR Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. M.S. was funded through a National Institute of Health Research (NIHR) Academic Clinical Lecturership, NIHR Clinician Scientist Fellowship and Academy of Medical Sciences Starter Grant for Clinical Lecturers (2017); AH's and JB's salaries were in part funded by the NIHR Clinician Scientist Award (CS‐2017‐17‐023) to MS. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. AH is supported by the Medical Research Council. Publisher Copyright: © 2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


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.

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