Eating and emotional disorders in adolescent obese girls with insulin-dependent diabetes mellitus.
OBJECTIVE
To study eating and emotional disorders in adolescent insulin-dependent diabetic (IDDM) girls.


METHODS
98 adolescent girls, aged 13-19 years, were studied: 15 obese and 37 non-obese IDDM girls, 22 obese non-diabetic and 24 non-obese girls, DSM-III-R eating disorders (anorexia nervosa, bulimia nervosa, eating disorders NOS) and eating habits (snacking, sweet compulsions) were evaluated by a semi-structured diagnostic interview (Kiddie-SADS-E and Eating Habits Interview). Emotional 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-diabetic obese girls showed high rates of eating disorders NOS (sub-clinical bulimia: 60 and 41%, respectively) and they had more extra-snacks than non-obese girls, suggesting that obesity was the main risk factor for 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 of the non-diabetic did. The risk of depression was increased by both IDDM and obesity (16 and 18% dysthymia, respectively; 8% in normal girls); both factors cumulated in obese IDDM girls (47% dysthymia). Obesity was linked to marked changes in self-esteem scores and mild effects on anxiety. IDDM had little effect on anxiety and none on self-esteem; it even seemed to preserve the self-esteem of obese girls. Patients with bulimia nervosa had poorer metabolic control than other girls with IDDM. There was no correlation between HbA1C and eating or emotional disorders.


CONCLUSIONS
Adolescent IDDM girls are at increased risk of eating and emotional disorders. Obesity appears to be an important factor for psychiatric complications; more obese IDDM girls suffered from eating disorders NOS sub-clinical bulimia), dysthymia, anxiety disorders, depression and low self-esteem (Family Satisfaction SEI sub-score) than did non-obese IDDM girls.
Vila
G
G
Service de Psychiatrie de l'Enfant et de l'Adolescent Hôpital Necker-Enfants Malades, Paris, France.
Robert
J J
JJ
Nollet-Clemencon
C
C
Vera
L
L
Crosnier
H
H
Rault
G
G
Jos
J
J
Mouren-Simeoni
M C
MC
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012649:Self Concept