EATING AND EMOTIONAL DISORDERS IN ADOLESCENT OBESE GIRLS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

OBJECTIVE: To study eating and emotional disorders in adolescent insul in-dependent diabetic (IDDM) girls. METHODS: 98 adolescent girls, aged 13-19 years, were studied: 15 obese and 37 non-obese IDDM girls, 22 o bese non-diabetic and 24 non-obese girls, DSM-III-R eating disorders ( anorexia nervosa, bulimia nervosa, eating disorders NOS) and eating ha bits (snacking, sweet compulsions) were evaluated by a semi-structured diagnostic interview (Kiddie-SADS-E and Eating Habits Interview). Emo tional disorders were assessed using self-questionnaires (State-Trait Anxiety Inventory for Children, Beck Depression Inventory, Coopersmith Self-Esteem Inventory). Psychological characteristics were correlated with BMI and, for IDDM girls, with HbA1C. RESULTS: IDDM and non-diabe tic obese girls showed high rates of eating disorders NOS (sub-clinica l bulimia: 60 and 41%, respectively) and they had more extra-snacks th an non-obese girls, suggesting that obesity was the main risk factor f or additional eating disorders. However, non-obese IDDM girls had more eating disorders NOS (sub-clinical bulimia: 27%) than did the normal girls (4%). Three IDDM girls had typical bulimia nervosa, while none o f the non-diabetic girls did. The risk of depression was increased by both IDDM and obesity (16 and 18% dysthymia, respectively; 8% in norma l girls); both factors cumulated in obese IDDM gills (47% dysthymia), Obesity was linked to marked changes in self-esteem scores and mild ef fects on anxiety. IDDM had little effect on anxiety and none on self-e steem; it even seemed to preserve the self-esteem of obese girls. Pati ents with bulimia nervosa had poorer metabolic control than other girl s with IDDM. There was no correlation between HbA1C and eating or emot ional disorders. CONCLUSIONS: Adolescent IDDM girls are at increased r isk of eating and emotional disorders. Obesity appears to be an import ant factor for psychiatric complications; more obese IDDM girls suffer ed from eating disorders NOS (sub-clinical bulimia), dysthymia, anxiet y disorders, depression and low self-esteem (Family Satisfaction SEI s ub-score) than did non-obese IDDM girls.