The New Eating Disorder We’re Failing to See by Angela Wurtzel
Not long ago two high-profile 30-something women, Brittany Murphy and Casey Johnson, died suddenly of “natural causes.” This news hit me, as I’m sure it hit most people, as both alarming and deeply disturbing. Although the circumstances that led to their deaths were both unclear and confusing, as an eating disorder specialist, I believe that this is a case where speculation could actually shed light on a highly overshadowed fatal disorder and can save the lives of others.
Both Brittany Murphy and Casey Johnson are said to have had type 1 Diabetes. Today, diabetes can be contained with little complication. However, skipping or titrating insulin dosages causes blood sugar levels to rise and results in frequent urination, as the kidneys must work overtime to rid the body of excess sugar in the bloodstream. Some people with diabetes type 1 intentionally restrict, delay or decrease their insulin to purposely induce hyperglycemia to rapidly purge calories in the urine in the form of glucose (New England Journal of Medicine, Vol. 336, June 26, 1997, JDRF). This behavior has recently been referred to as “diabulimia,” and it is a serious medical danger and trend. It is the most common method of purging in girls with type 1 Diabetes and becomes progressively addicting with age. A startling 30-39 percent of diabetic women in their late teens and early adult years report using deliberate insulin omission as a means of purging calories, according to Diabetes Spectrum.
In general, eating disorders are more common in individuals with type 1 diabetes than in the general population. On their own, eating disorders can cause electrolyte abnormalities, as in the case of Terry Shiavo, a woman battling bulimia and below normal potassium, but who we know as being on life support for many years after a heart attack put her in a coma, cardiac conduction abnormalities and gastrointestinal complications, all of which may be worsened in the presence of type 1 Diabetes.
Anorexia is the number one cause of death of all mental illnesses and in a three-site, case control prevalence sturdy, eating disorders were twice as common in teenage girls with type 1 diabetes as in their non-diabetic peers. I create this connection between Ms. Murphy, Ms. Johnson, diabulimia and eating disorders, not to diagnose these particular cases but as a means to provide a platform to discuss both the psychological and medical seriousness of eating disorders.
One of the most common myths about eating disorders is that they are solely about food, weight and image. Unfortunately, these disorders have far deeper psychological sources and have serious lines to disrupted attachment history, interpersonal instability and emotional dysregulation. For many, eating disorders become the means to self-sooth a pained and agonizing psyche and deflated sense of self.
A person with an eating disorder or associated behaviors is using their body to express what he or she does not yet have words to say. The use of the body to communicate and hence, target, becomes both the path to destruction and to containment. When a person has succumbed to deliberate self-injury like diabulimia, something has gone awry, and the person needs assistance in untangling the confusion and distortion in the mind as well as support physiologically and medically.
The superficial stereotypes associated with eating disorders further isolate and shame those who suffer and already feel misunderstood. Allowing these unfounded stereotypes about eating disorders to continuously creep through the public’s consciousness is a dangerous game with potentially lethal consequences. In this same way, ignoring afflictions such as anorexia and diabulimia, fails to alert the public of the deadly risks of eating disorders. My hope is to not only confront these stereotypes but to expose the painful, life-threatening battle that is occurring in the minds and bodies of those with eating disorders.