EATING DISORDERS AND MALADAPTIVE DIETARY INSULIN MANAGEMENT AMONG YOUTHS WITH CHILDHOOD-ONSET INSULIN-DEPENDENT DIABETES-MELLITUS

Objective: To determine the prevalence of DSM-III eating disorder and the conjoint symptoms of maladaptive dietary/insulin management (irres pective of eating disorder) and their psychiatric and biomedical corre lates among youths with childhood-onset insulin-dependent diabetes mel litus (IDDM). Method: Forty-four girls and 35 boys, 8 to 13 years old at IDDM onset, were repeatedly interviewed during an interval of up to 14 years (mean = 9 years) to ascertain psychiatric disorders and beha viors related to diabetes care. Metabolic control and IDDM-related hos pitalizations also were monitored. Results: By the mean age of approxi mately 21 years, 3.8% of the sample had DSM-III eating disorders and 1 1.4% had ''eating problems,'' defined as the conjoint symptoms of seve re dietary indiscretion and repeated insulin omission (irrespective of eating disorders). Youths with ''eating problems'' were nine times mo re likely to have had a psychiatric disorder than the rest of the pati ents, and they had a significantly higher rate of pervasive noncomplia nce with medical treatment. No between-group differences were found in metabolic control and rates of multiple hospitalizations. Conclusions : The diabetes-specific symptom-pair of serious dietary indiscretion a nd repeated insulin omission appears to identify youths who have had o ther problems as well. The association of eating problems with psychia tric disorders (other than eating disorders) suggests that a subgroup of diabetic youths have various difficulties in coping with the medica l illness and require close monitoring and psychosocial intervention.