Chief Medical Officer Dr. Joel Jahraus, MD, FAED, CEDS is well-known and respected for his two decades of specialization in the medical management of patients with eating disorders. A board-certified physician for over 30 years, he is a recognized expert on diabetes and the medical complications of eating disorders. In this week’s blog post, Dr. Jahraus shares his insight and knowledge regarding diabulimia, a contemporary term for individuals with both Type I diabetes and an eating disorder where the individual purges by withholding his or her insulin.
1. How would you define diabulimia?
Diabulimia is a contemporary term for individuals with Type 1 diabetes and an eating disorder where the individual purges by withholding his or her insulin, thereby, making food ingested ineffective for use by the body. This action results in weight loss and severe systemic complications, including diabetic ketoacidosis which is potentially lethal.
2. Do you consider diabulimia to be a real diagnosis, or just a way to describe a variation of bulimia (since it is not specifically in the DSM 5)?
It is a contemporary word that bridges the terminology between diabetes and bulimia, but is not stated specifically as diabulimia as a mental health diagnosis in the DSM V.
3. How common is this type of eating disorder? Especially for women?
I co-chaired an international consensus panel on this evolving illness in 2009 in Minneapolis, MN. In doing that literature search we found it exists in the following percentages among different age populations:
2% of preteen girls
11-15% of midteen girls
30-39% of late teen girls
4. What are the top signs of this eating disorder?
The typical presentation is similar to other eating disorder patients with body image issues, and other mental health concerns. However, the difference is these individuals “purge” by withholding their insulin. Insulin is important in effectively utilizing calories ingested for health. Without insulin the body does not utilize these calories and the individual loses weight; the net impact is similar to anorexia or bulimia. However, the typical complications of diabetes are then much accelerated and the mortality or death rate from premature death increases dramatically:
Mortality rates (Nielson 2002):
Type 1 DM: 2.5%
Anorexia nervosa: 6.5%
Combined Type 1 DM and Anorexia nervosa: 34.8%
Jennifer Kreatsoulas, PhD, RYT is a yoga teacher and yoga therapist specializing in eating disorders and body image. In recovery herself, Jennifer is extremely passionate about helping others reconnect with their bodies and be empowered in their lives. Jennifer works with clients in person and via Skype. She also teaches yoga at the Monte Nido Eating Disorder Center of Philadelphia, is a partner with the Yoga and Body Image Coalition, and leads trauma-sensitive yoga classes. In this week’s post, Jennifer gives insight into her own recovery journey and how she learned to respect recovery as a lifestyle.
“I’m not going to help you manage an eating disorder,” my dietician flat out said to me shortly after I discharged from intensive outpatient treatment. “I’ll continue to work with you, but I won’t help you be a functioning anorexic.”
Whoa! Harsh, right? Brutally harsh, I’d say.
Her words hit me hard in the gut. I felt nauseas and defensive. I was at once insulted and found out by her remarks. After months of inpatient, day, and IOP treatment, and a commitment to long-term outpatient work with my team, I was insulted that my integrity and dedication to recovery wasn’t obvious. Had I not just left my family for a month, taken leave from my job, eaten meals I was terrified of, gained weight, persevered through calorie increases and exercise restriction, and turned myself inside out every day to heal my mind and body? Honestly, what else did she or anyone else want from me?
Still, way, way deep down, I knew my dietician was right. Yes, I had done and accomplished quite a bit during all that treatment; no one was taking that away from me. However, I admit, at the time, living as a “functioning anorexic” was quite appealing. The perfect solution.
If I could pull off being a “little sick and a little well,” if I could do just enough to keep my team and my family off my back, then surely, I’d be “doing” recovery. I’d just be doing it on my terms—or, I should say, the eating disorder’s terms. I’d prevent weight gain, still have room for a little hunger, and feel in charge of my life.
Living this way did not get me very far, and it wasn’t long before I was weary of performing, pretending, and being untruthful to myself and those I love. Merely functioning wasn’t as “safe” as I’d thought it would be. In fact, it was the exact opposite, as the threat of returning to treatment consistently came back in play every few weeks.
I may have dabbled with how “recovered” I was willing to be, but there was positively no way I would settle for being a chronically ill mother and wife. That’s where I drew the line.
And so, I kicked myself into gear by taking a more genuine and sincere approach to healing from rather than merely managing the eating disorder. I did this by adopting the attitude that recovery is a lifestyle, not a side job or something “extra” we must do.
Between therapy appointments and going to groups and keeping food logs, recovery can feel like a time-consuming side job. Over time, this attitude toward recovery can cause us to become resentful. The more resentful we become, the less motivated we are to keep up our efforts.
When respected as a lifestyle, recovery serves as the foundation from which we must attend to everything in our lives to keep us well and moving forward. To make recovery a lifestyle, I strive to let every choice I make be informed by this question: Is “x” going to support me in my healing or is it going to work against me?
Reflecting on this question guides me to honesty with myself about the people, places, and things in my life that merely help me manage an eating disorder versus those that support me in healthful ways. I choose to avoid the landmines and replace them with things that empower me and build me up. It’s not always easy, but this system of self-accountability has made a profound difference in my approach to recovery and deepened my commitment to myself.
Take a pause and ask yourself: Am I managing or healing the eating disorder? Are there thoughts, rituals, and behaviors in place that covertly are in cahoots with the eating disorder?
There’s no shame in your answer. What’s most important is taking this time to get brutally honest with yourself. I encourage you to tap into your resilience and slowly but steadily begin to loosen the grip on things that do not serve you in healthful ways and replace them with thoughts, rituals, and behaviors that do.
As you shift away from the “functioning” and “managing” mentality and embrace an intention of healing, life will ultimately become more filled with you and the goodness you have to offer this world—your gifts, talents, and passions. And I promise you, it is so worth it!
Vice President of Admissions Dr. Melissa Orshan Spann, PhD, LMHC, CEDS shares her journey to joining the Monte Nido & Affiliates team in this week’s Meet Our Team. She gives insight into the work she does with the admissions team and what inspires her to be so dedicated and passionate in her role. Read on to learn more about Dr. Spann…
What is your name and what are your credentials?
Melissa Orshan Spann, PhD, LMHC, CEDS
Please give us a brief description of your background.
When I decided to go to graduate school in a helping profession it was no shock to my friends and family. Growing up as the oldest of four kids, involved in community service and social action organizations, it was a natural path for me. During my doctoral training, I was introduced to a program called Rosh Hodesh: It’s a Girl Thing!, a proactive approach for building healthy self-esteem in adolescent girls. Through my work facilitating girl-only groups, I reaffirmed my dedication to working with girls and women. I decided an essential part of my training would need to include integrating a systemic perspective and holistic approach to my work. Through this, I moved to Philadelphia and attended a Ph.D. program in Couples and Family Therapy. While I was in Philadelphia, I was introduced to The Renfrew Center in Philadelphia. There, I began my training in the field of eating disorders. I developed a specialization for working with couples and families who were struggling to cope with an eating disorder in their families. When I returned to home to Miami, I was introduced to Oliver-Pyatt Centers. From the moment I walked into the building, I knew OPC was the type of environment I had always hoped could exist; a place where women and their families could be provided a multi-systemic integrated approach to health and healing. Following my time as a Primary Therapist at OPC I became the Director of Admissions. After two years as Director of Admissions where we sought to build a clinical focus for a best-in-class admissions department, my role evolved to the VP of Admissions for Monte Nido & Affiliates. It was a dream for me to work in the broader role for all MNA brands including Monte Nido, OPC and Clementine.
What does a typical day look like for you?
What I love about my job is that there isn’t really a “typical” day. In my current role, I have the unique opportunity to interface with many people on a daily basis. I am talking with potential clients, meeting families, working with providers and interfacing with all of our outstanding teams across the country. I feel fortunate that I often have the opportunity to connect with an individual as their first point of contact for one of our programs. Placing that initial call is often the most difficult decision to make. Myself and the highly specialized and trained admissions staff understand how critical this initial contact is and seek to meet every individual who connects us with the connection, empathy and support they receive in our care. Our goal is to provide support, consultation through a therapeutic lens during every interaction we have.
In your own words, please describe the philosophy of Monte Nido & Affiliates.
To me, our philosophy is about balancing acceptance and change, integrating mindfulness in all aspects of life, and focusing on a highly interpersonal model that through connection and meaningful relationships, recovery is possible.
What is your favorite thing about Monte Nido & Affiliates?
I have held many roles throughout the organization. No matter what I am doing, by far the best part of my job is the amazing group of people that I work with. Everyone shares a common vision and goal, respect one another, and share a life both professionally and personally with each other. Through our outstanding staff, we are able to model what it means to share in strong female relationships that provide support and care – something that is translated to the women we work with.
What are three facts about you that people do not know?
Oh boy, here it goes: 1- I have played the guitar since I was five and love to rock out. 2- I have two kids, Violet age six and Archer age eight who teach me more on a daily basis than any book I’ve ever read. 3- I am a third generation Miami native.
Is there any additional information you want to share with our readers?
I’m always ready to talk – call me and we’ll figure it out together!
How can someone contact you and your team?
Monte Nido Admissions Line: 888.228.1253
Clementine Admissions Line: 855.900.2221
Oliver-Pyatt Centers Admissions Line: 866.511.4325