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by: Susan M. Julien

Although the following story is purely fictional, the factual information conveyed in it is accurate and substantiated.

The story of Charlene, a Type I diabetic struggling with an eating disorder.

When Charlene was diagnosed with juvenile diabetes at the age of eight, my husband and I were heartbroken. At the time, we knew so little about diabetes. Would our precious daughter be able to live a normal life? She was our only child and we wanted her to be happy and successful - not burdened by a chronic illness. Although we never discussed the diabetes with her, we knew Charlene's life was bound to be more difficult because of this disease and because of its deadly complications.

As a result, we smothered her with love and concern, yet Charlene seemed to take the changes in her lifestyle in stride. Not once did she complain about the insulin shots, the sugar highs and lows, or the meal plan she followed faithfully. In fact, she rarely talked about it. I fussed over meals, encouraged her to write down everything she ate, and demanded she monitor her blood sugar frequently. And she did. We were so very proud of our little girl. As the years passed, she developed into an attractive, athletic and popular young woman. She appeared to be a normal, healthy child.

The summer before Charlene's sophomore year in high school, we noticed our cheery, talkative daughter seemed moody. At that time, we were convinced it was due to hormonal changes. It never occurred to us that it could be more. After all, Charlene had never seemed bothered by her diabetes, school, friends or anything. But both my husband and I had read that the physical and emotional stress of diabetes exacerbates depression. I encouraged her to talk about her feelings. I inquired about her weight loss. But Charlene assured her father and I everything was fine. She admitted her weight had dropped some from running every day, but that it was important she keep in shape for cheerleading competitions. She also said she would speak to the doctor about her frequent trips to the bathroom. We believed her.

A month later, I awoke late at night to the sound of someone vomiting. I rushed to Charlene's bathroom, and found her clutching the edge of the toilet seat, tears streaming from her bloodshot eyes. At that moment, I realized just what was happening. And how blind we had been. Here, in front of our eyes, our darling daughter had developed an eating disorder. She was bingeing and purging her food. She was ignoring her sugar highs and lows. She was even skipping insulin shots to control her weight. I think I knew it, but didn't want to acknowledge it. I told myself, Charlene would never do that. But she did. On that night I realized Charlene is bulimic as well as diabetic. I vowed I would do everything I could to help her. I thought my husband and I could make it better, even if we couldn't "fix" the diabetes. Later, I learned the cold-hearted fact: it was my daughter's responsibility to "fix" the eating disorder.

Charlene is recovering slowly and steadily. We sought out help through Charlene's doctor, the Juvenile Diabetes Foundation, and the National Association for Anorexia Nervosa and Associated Disorders (ANAD). Through them, we learned more about the disease and what we could do to support Charlene in her recovery. Most importantly, Charlene was referred to a therapist specially trained in the treatment of eating disorders in diabetics.

The first step was to get Charlene back on a healthier track. In short, to stabilize her blood sugars and help her maintain a nutritious meal plan. Once a somewhat normal routine was established, Charlene began to have more energy, feel less moody and sleep better. Only then was she ready to tackle the bigger issues in therapy like body image and self-esteem.

For Charlene and most bulimics, anorexics and binge eaters, the illness is not about food and weight, although it appears to be. It is about self-esteem and body image. It is about independence and identity. It is about being your own caretaker and loving yourself unconditionally. That is why therapy is so essential. Without it, recovery is virtually impossible. And when the eating disorder involves a child, the parents and siblings are encouraged to participate in family therapy.

The physical consequences of an eating disorder are serious, but when someone with an eating disorder also has diabetes, the effects are more immediate and devastating. For diabetic bulimics and anorexics, it is crucial to treat the symptoms of bingeing and purging, starvation and insulin manipulation immediately. It is important to seek out a physician and a dietitian who are both willing to work with this therapist. As we found with Charlene's recovery process, a professional team approach to guide and support the diabetic with an eating disorder holds a brighter promise of recovery. The team needs to understand how eating disorders dovetail with diabetes. By the nature of the illness and the treatment of it, diabetes can create a preoccupation with food. Secondly, it can lead a child to view food as "the enemy", as something dangerous. If a diabetic feels his or her life is out of control because of the diabetes, an excessive control of food and weight may be the outcome of wanting to feel in control. And as my husband and I learned, teens with diabetes often feel their families are overly involved in their lives. To rebel and strive for independence, food and weight obsession becomes a teen's power, and an eating disorder becomes his or her identity. In my daughter's case, this was true.

Months have passed since the night I discovered my daughter is bulimic. As Charlene's parents, my husband and I have learned to support rather than smother, encourage instead of demand, and love without conditions or expectations. It has not been easy for Charlene or for us. In family therapy, we have admitted to making mistakes, shed more than a few tears, raised our voices in anger, but always, ended our sessions with hugs of love. As parents, my husband and I did the best we could, but often, in our efforts to raise a smart, successful daughter, we criticized too frequently and praised too little. Today, we focus on the positive, listen more often, and encourage Charlene to be her own person.

Even after participating in Charlene's treatment and therapy, supporting my daughter in her daily struggle to recover, and reading numerous books, I remain somewhat baffled by the complexity of eating disorders. But I have learned enough to recognize the symptoms, share my story with others as a means of support, and help prevent eating disorders.

In conclusion, I ask you to consider:

Because bulimia and anorexia are body image disorders, it is important to recognize and help reduce the societal pressure on women to be pretty and thin. This pressure fuels eating disorders among women, and as long as women feel judged solely on appearance, eating disorders will continue to thrive in our society.

Poor self-esteem drives bulimics and anorexics to find a means to feel important, significant and powerful at any cost, even one's health. As parents, we must make a conscious and consistent effort to raise children with healthy self-esteem. Unconditional love, acceptance of a child's individuality and praise rather than shame and blame will enable them to make their own healthy choices. If a person is self-confident and feels worthy of love, he or she will be able to develop healthy coping mechanisms, free of alcohol abuse, disordered eating or other addictive behaviors.

To treat only the symptoms of self-induced starvation or the binge-and-purge cycle is to ignore the underlying causes of disordered eating. A strong need (yet intense fear) of separation and individuation from parents, siblings, even spouses is at the root of most eating disorders. Therapy is a necessity in recovery, and often, anti-depressants help alleviate the emotional pain that accompanies the challenge of eliminating old behaviors and replacing them with healthy ones. With the help of an understanding physician, an eating disorder therapist and a knowledgeable dietitian, the process of accepting and loving one's self unconditionally is not only possible, it is highly probable.

read more about Diabetes and Eating Disorders

Susan M. Julien
Newsletter Editor
The Turning Point
West Michigan Chapter of Juvenile Diabetes Foundation (JDF),
Grand Rapids, Michigan
email: smjwriter@msn.com
© 1997, WordWise, Grand Rapids, MI

special thanks to two friends for their assistance:
Rosalyn Baker, M.S.W., a Grand Rapids-based therapist who specializes in eating disorders among diabetics.
Amy Grabowski, M.S.W., Director of The Awakening Center for Eating Disorders in Chicago.

©1998 Susan M. Julien. Reprinted with permission.

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