Eating Disorders in Type 1 Diabetes

Jacqueline Allan, PhD candidate and Associate Lecturer in Psychology, at Birkbeck discusses the little known but extremely dangerous prevalence of eating disorders in Type 1 Diabetics, and her charity Diabetics with Eating Disorders.

In 2014 I was lucky enough to be granted a Bloomsbury scholarship to undertake a PhD focussing on Eating Disorders in Type 1 Diabetes, including one known as ‘Diabulimia’, at Birkbeck. I’ve worked in this area since 2009 when I founded the registered charity Diabetics with Eating Disorders.

First, let me explain what Type 1 Diabetes is.

Type 1 Diabetes is an autoimmune disorder where the insulin-producing beta cells of the pancreas are mistakenly destroyed, making sugar in the body impossible to process. Insulin is one of the most vital hormones in the body – it ferries energy we consume in the form of carbohydrates to our muscles, organs and brain, so it is essential for every bodily function. For this reason, those with Type 1 must check their blood sugar every few hours and administer synthetic insulin to keep themselves safe. There are two main ways for administering insulin – Multiple Daily Injections using both long acting and short acting insulin, or Subcutaneous Infusion using an insulin pump.

Most of us utilise a carbohydrate-counting approach, whereby we know how many insulin units we need for every 10 grams of carbohydrate consumed and what our general background levels should be. If it sounds like a simple equation, it’s not.  Everything affects blood sugar – not just the obvious stuff like sports, illness or alcohol but stress, the weather, sleep, menstruation – its educated guesswork.

When it goes wrong, we are in immediate danger of death. Too much insulin and we can’t think as there is not enough fuel in the cells of the body. We shake, seize, our bodies have a fight or flight reaction and if not treated with sugar in a timely manner we risk falling into a coma and/or dying. Too little insulin and the body has to find other ways to get rid of sugar and provide energy for itself; sugar escapes into the bloodstream and is excreted in the urine while the body starts burning fat and muscle for fuel. The calories consumed can’t be processed and are not utilised, so the body is forced to cannibalise itself for energy. This process is called Diabetic Ketoacidosis – it is a life-threatening condition and the main symptom is massive weight loss. In this sense, we are borne into a world where everything is about food, injections, the looming threat of complications, hospitals and numbers with the knowledge that ignoring it all results in a substantial reduction in body size.

For decades, research has shown that those with Type 1 Diabetes have higher levels of eating disorders that their non-Diabetic counterparts. Anorexia, Bulimia and eating disorders not otherwise specified (EDNOS) are twice as prevalent, and insulin omission is present in around 40% of female patients. The statistics for men are not as clear but levels have been rising steadily since the early 90s.

My research looks at risk factors for the development of Eating Disorders in Type 1 Diabetes. I started my PhD in 2014 and found that there is a psychological vulnerability which, when combined with Diabetes-specific distress predicts higher eating disorder symptomology and higher levels of blood sugar. Having modelled these risks, I developed a multidisciplinary intervention delivered online to address them. I am in the process of writing them up at the moment, but initial results are positive.

I am also looking at another important question – are we measuring the right thing? One common feature of standard eating disorder questionnaires is that they ask questions which could directly relate to diabetes regimen, rather than eating disorder symptomology – for example, questions like ‘do you avoid specific food groups?’ Many Type 1 Diabetics deliberately avoid carbohydrates in order to control blood sugar as a lifestyle choice rather than an eating disorder. Similarly, many people investigate this population by asking these standard questions that are fundamentally flawed, without acknowledging the issue that insulin omission leads to weight loss.

We have made substantial inroads into treating Eating Disorders in Type 1 Diabetes and it has been a privilege to be involved centrally with that research. The National Institute for Health and Care Excellence (NICE) guidelines published earlier this year marked a watershed in recognising the issue, as did the documentary and radio piece with the BBC. There are now two NHS Trust programmes that deal with diabulimia which is more than when I founded the charity in 2009. We still have a long way to go.

The next big hurdle is recognising that Eating Disorders in Type 1 Diabetes is fundamentally different due to the nature of the illness itself and that insulin omission and diabulimia are unique. Hopefully, my research will help with that.

Watch: Diabulimia: The World’s Most Dangerous Eating Disorder

Share
. Reply . Category: Science . Tags: , , , , , , , , ,

What’s in a face? Birkbeck researchers delve into what facial expressions reveal

Quote

Birkbeck scientists in residence at the Science Museum have recently run a live experiment with members of the public, to discover how much we understand about people simply by looking at their faces. Two members of the team report on their experiences.  

Ines Mares, postdoctoral research assistant in the Department of Psychological Sciences: As humans, we possess the remarkable ability to extract a wealth of information from even a brief glance at a face: we can identify people, judge the emotion they are feeling, assign character traits (rightly or wrongly), and in doing so, continue to thrive as a social species. Because faces are so interesting and processing them well is so important to us as humans, they made an ideal topic to explore in the context of the Science Museum’s ‘Live Science’ initiative.

In the Science Museum we ran a series of experiments to understand what factors make faces more rewarding or appealing – such as how attractive they were, the emotions they were displaying or how old the faces were. We were especially interested to see how these judgements related to our ability to recognise faces, and to see how our results would change for younger and older participants (our experiments tested children from five years of age to adults of almost 90!).

Dr Ines Mares explains the experiment to a participant.

Dr Ines Mares explains the experiment to a participant. 

“This was a great opportunity for us to engage directly with people and discuss the type of research we do and the questions that motivate us. It is also a unique chance to reach out and test a much more diverse set of people than we are conventionally able to do, with anyone aged from five to 105 invited to take part in our studies.”

Dr Marie Smith, Senior Lecturer, Lead Scientist with Dr Louise Ewing (UEA) and Professor Anne Richards (Birkbeck)

Conducting this type of study, in which we focused so closely on individual differences with such a broad audience was outstanding.  It was a unique opportunity to interact with people from very different backgrounds and ages – something that can be challenging to do in the university labs.

To begin with, we were concerned about people’s willingness to take part in our experiments, but after the first day at the museum we understood that people were interested in being involved and actually wanted to know more about our hypothesis and what motivated us to do this type of work. It was an amazing chance to discuss these topics with members of the public and get feedback on our work directly from them. Initially this idea seemed quite daunting to me, but I ended up loving it, since the majority of people who took part in our experiments (and we had almost 2500 participants) were really motivated and interested to know more – not only about face processing, but also about other aspects of science in general.

Being part of a team running experiments in the Science Museum was an amazing opportunity.  Without a doubt, I would repeat this experience, not only because of the amazing breadth of data we were able to collect, but also because of the opportunity it gave us as researchers to disseminate our work and discuss science in general.

sciencemuseum_ar

Professor Anne Richards explains the purpose of our study to an interested volunteer. 

Michael Papasavva, PhD student in the Department of Psychological SciencesEven when working in a hub-science such as psychology, lab life can become monotonous. Surrounded by friends and colleagues who share similar views and challenges, it’s very easy to lose yourself in the bubble of academia.

Michael Papasavva signs up another keen volunteer!

Michael Papasavva signs up another keen volunteer! 

I was thrilled when presented with the opportunity to get out of the lab and be a scientist in residence at the London Science Museum. This prospect invoked childhood memories of navigating this huge and stimulating environment on school trips and family days out; I knew that the experience was going to be awesome (in the nerdiest way possible).

Working as part of a team of 12 researchers, we ran experiments in the ‘Who Am I? Gallery.’ This is perhaps one of the more interesting areas of the museum; the space houses visiting scientists from various disciplines and facilitates their research. Members of the public are free to wander over and volunteer to participate in experiments (or query the location of the toilets or dinosaurs). Our team conducted a range of different face processing experiments that examined the role of development and individual difference on face memory and emotion processing. By the end of the residency, almost 2500 people had participated (832 children, 1487 adults), creating masses of data for us to explore once we were back in the lab.

In addition to generating novel information, it’s the responsibility of a scientist to disseminate that knowledge to the wider public. Our residency provided us with an opportunity to engage with a very wide demographic. I must admit, it was heart-warming to see our younger participants having so much fun with the masks and games we had set up to help draw in the crowds and that so many of our  older participants chose to stay back to discuss our project with us. People genuinely enjoyed giving back to science.

I would strongly recommend the Live Science project.

Photo credits: Science Museum Group Collection

The full science museum team: Dr Marie Smith (Senior Lecturer, Birkbeck), Professor Anne Richards (Birkbeck), Dr Louise Ewing (Lecturer, University of East Anglia), Dr Ines Mares (Post-doc, Birkbeck), Michael Papasavva (PhD Student, Birkbeck), Alex Hartigan (PhD Student, Birkbeck), Gurmukh Panesar (PhD Student, Birkbeck), Laura Lennuyeux-Comnene (RA, Birkbeck), Michaela Rae (RA, Goldsmiths College), Kathryn Bates (MSc student, Birkbeck), Susan Scrimgeour (MSc student, Birkbeck), Jay White (Intern, UCL Institute of Education).

Further information:

Share

Training attentional control improves cognitive and motor task performance

This post was contributed by Emmanuel Ducrocq, a PhD student in Birkbeck’s Department of Psychological Sciences. It is about a paper based on research he and his supervisor (Professor Naz Derakhshan) did in collaboration with Dr Mark Wilson and Dr Samuel Vine, and which is published today in the Journal of Sport and Exercise Psychology. Emmanuel tweets at @manuduc and Professor Derakhshan at @ProfNDerakshan

tennis-player-676310Successful performance in sports is usually evaluated in terms of technical, tactical or physical abilities. However a crucial index of performance is the ability to perform under stress and high pressured situations. This is especially relevant sports demanding a high level of attention, such as tennis, golf, archery or shooting.

Recent research in sports psychology has shown that a key factor responsible for poor performance in sports under pressure is the inability to focus on what needs to be done and reduce distraction. This is often referred to as attentional control: the ability to resist distraction and attend to task goals efficiently. If athletes can’t exercise attentional control efficiently then they cannot plan and execute a skilled movement flexibly. The pressure to perform well, increases anxiety and so maintaining attention focus on task goals becomes exceptionally challenging giving way to worries, and doubts about performance  as well.

Attentional control has usually been targeted in sports by trying to promote specific gaze behaviours which has proven to show benefits to motor performance in sporting tasks such as golf or basketball. Crucially though, while this method is useful, it hasn’t been able to identify the underlying mechanisms responsible for sports improvement.

In a series of three exciting studies we wanted to improve motor task performance and we specifically focussed on tennis, which requires good attentional control to flexibly resist distraction. To this end, we trained inhibitory control using a computer-based training task to see how it could improve performance in a tennis task.

In the first experiment, participants were allocated to a training or control group and underwent six days of training on a visual search task that included task-irrelevant distractors requiring inhibition (training) or contained no distractors (control). Performance was measured pre- and post-intervention using an antisaccade task measuring distractibility. We found that training elicited a near-transfer effect; as performance on the antisaccade task was improved in the training group, and not in the control group. This was important to establish, as it showed that training on the visual search task could improve inhibition on another unrelated task.

In the second experiment training on the same paradigm showed transfer benefits on an attentional control index that we validated for tennis performance. Tennis players were assessed on a return of serves task and we found an initial far-transfer effect of training. Participants in the training group displayed an enhanced ability to focus on the ball around the time of contact with the ball.

The third experiment pushed the boundaries of this work further by assessing the potential effect of the training task on an objective gaze measures of inhibitory control during performance of a tennis task. Participants’ pre and post intervention performance was assessed on a volleying task performed under pressure while their gaze behaviour was recorded. We found a substantial effect of training on tennis performance when levels of pressure were elevated. Transfer effects of training were also observed on a specific gaze behaviour index of ‘inhibition’ in the field, confirming the mechanism by which training protected participants against the negative impact of anxiety.

Taken together, we have shown that a simple computer-based training task that reduces distraction and improves attentional control can have direct transfer benefits to tennis performance under pressure. This can obviously have great implications for improving motor performance in any competitive sport that needs to be performed under pressure.

Share
. Reply . Category: Science . Tags: , , , , , ,

Make fear your friend

This post was contributed by Professor Naz Derakhshan of Birkbeck’s Department of Psychological Sciences

 

“Fear is often thought of as a negative emotion, but a new idea in psychology suggests that using it the right way can turn it into an incredibly positive force in your life.”

 

So starts a three page health feature article in the February edition of Top Sante. Showcasing the expertise of Birkbeck’s Prof Naz Derakhshan, the article posits that  fear can be turned into a positive force in our lives – all we need to do is listen to it, trust in it, and learn from it. In other words, we need to befriend it.

“Instead of thinking of fear solely as a negative emotion, embrace it as an
important warning system,’ says Professor Derakhshan in the article. “Being afraid of something is a signal that its consequence is important to you so it should be attended to.”
Click below to read the full piece, which includes some handy tips on how to welcome fear as a positive friend in your life, and how to ultimately become its boss.
Make Fear Your Friend - page 1 (article copyright of Top Sante)

Make Fear Your Friend – page 1 (article copyright of Top Sante)

 

Make Fear Your Friend - page 2 (article copyright of Top Sante)

Make Fear Your Friend – page 2 (article copyright of Top Sante)

 

Find out more

Share
. 1 comment . Category: Categories, Science . Tags: , , ,