Mental illness and diabetes

Daniel Sher discusses the common forms of mental illness that people with diabetes may encounter, why diabetes and mental illness are linked, and pointers for getting help.

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As people with diabetes, we’re well aware that we risk running into medical complications later down the line, if we don’t get the right support for our condition. We’ve all heard about retinopathy, foot damage, kidney issues and so on. Why then, are we not talking about the impact that this condition can have on the brain?

Common culprits

As people with diabetes (Type 1 or Type 2), we are more likely to develop certain forms of mental illness. Why is this the case? Well, quite simply, diabetes is a hugely challenging condition to live with. If we don’t have the right support, we can become overwhelmed by the burden of this condition.

At the same time, though, we are vulnerable to mental illness because of the way in which blood glucose fluctuations affect the parts of our brain that are responsible for mood and cognition. As a result, many people with diabetes will encounter struggles with the following:

Clinical Depression (or Major Depressive Disorder)

Depression involves a deep and unrelenting fog of sadness. Other symptoms include a loss of pleasure in previously enjoyable activities, concentration difficulties, fatigue, low sex drive, insomnia, shifts in appetite and significant changes in body weight. Research suggests that people with diabetes are two to three times more likely to develop depression.

Anxiety Disorders

We’ve all felt stressed out from time-to-time. But if your stress levels are extreme and you are feeling this way all or most of the time, you may have an anxiety disorder. People with anxiety struggle immensely to stop themselves from worrying. In some cases, they may experience panic attacks: brief episodes of intense fear and physical reactions that seem to come out of nowhere.

How common are anxiety disorders in people with diabetes? Research suggests that 14% of us have a diagnosed anxiety disorder. Anxiety has a negative impact on glucose control due to the release of stress hormones and the fact that anxiety stops us from engaging in healthy behaviours.

Eating Disorders

Given how much emphasis is placed on our dietary intake, it’s no surprise that we risk developing disordered relationships to food and eating. We are constantly exposed to reminders that we need to watch what we eat, which leads some to feel that their value as a person is linked to their diet and blood glucose levels.

We also encounter so much stigma, blame and judgment when it comes to our dietary choices, which results in huge doses of shame – an emotion which often drives eating disorders. People with diabetes, therefore, are at risk of developing conditions, such as anorexia, diabulimia (intentional insulin restriction for weight loss) and binge-eating disorder.

What about sugar addiction?

Is food addiction real? Although this has not yet been recognised as a formal psychiatric disorder (more research is needed), there is a good body of evidence to suggest that certain foods release dopamine in a way that can hijack the brain’s reward centres, mirroring the effect that drugs and alcohol have on our brain.

For people with diabetes, an unhealthy relationship with food can set you up to experience some serious difficulties, both in terms of your mental health and your diabetes management.

Signs of sugar addiction include intense cravings, binge-eating, emotional eating, feelings of withdrawal and a sense of being completely out of control with regards to your diet.

In particular, foods that are high in sugar are more likely to affect the brain in this way, because of the rush that they provide. Remember, high sugar foods do not always taste sweet: starchy complex carbs, such as white rice, bread, pap, potatoes and pasta are all culprits here.

Is diabetes burnout a mental illness?

No: diabetes burnout is a natural response to living with a hugely challenging condition. People with diabetes burnout tend to feel overwhelmed and powerless when it comes to their diabetes management and lifestyle. They may find themselves skipping doctor’s appointments or intentionally avoiding glucose monitoring.

Although diabetes burnout is not a psychological disorder, it can cause massive blood glucose fluctuations which render a person’s brain that much more vulnerable to depression and anxiety.

Can mental illness cause diabetes?

The answer is yes: having a psychiatric disorder puts you at risk for Type 2 diabetes. Why? Medications which people take for certain conditions (like bipolar or psychosis) can trigger the development of diabetes.

At the same time, people who are struggling with a mental illness may find it harder to engage in behaviours that reduce the risk of developing Type 2 diabetes, such as frequent exercise, abstaining from drugs, cigarettes and alcohol, and making healthy food choices.

Finally, having a psychiatric disorder can change the way that your body and brain metabolise food for energy. This can make a diabetes diagnosis more likely.

How to get help

Do you feel like your emotional difficulties are stopping you from looking after your physical health? Do you often feel alone and overwhelmed? Are you mentally uncomfortable, despite your efforts at changing your lifestyle and mindset? Have you ever contemplated suicide?

If you answered yes to any of these questions, it’s advisable to get some support. Start by reaching out to your general practitioner or diabetes specialist, so that you can ask for a referral to a clinical psychologist and, if needed, a psychiatrist.

How can psychology sessions help?

If you have diabetes and an additional psychological disorder, there are various ways in which talk therapy can help. In my own practice, I use Diabetes Focused Psychotherapy,which is an individualised treatment plan designed around the specific diabetes and mental health needs of each client that I work with.

Diabetes Focused Psychotherapy draws on several other therapy approaches, including:

Motivational Interviewing helps people to change their behaviour by resolving their ambivalence and generating motivation.

Cognitive-Behavioural Therapy empowers you to take control of unhelpful thinking patterns which lead to unpleasant emotions (like hopelessness or frustration) and unhelpful behaviours (like binge-eating and avoiding testing).

Mindfulness-Based Stress Reduction involves using mindfulness meditation techniques to help improve psychological resilience.

Psychoanalytic Psychotherapy helps you to understand how past experiences and unconscious dynamics impact your life in the present. This involves helping a person to understand and take ownership of diabetes in relation to their identity, while also addressing patterns of unhelpful behaviour, such as self-sabotage and denial.  

Play Therapy and Family Therapy are useful approaches for helping children or adolescents to cope with diabetes.

Dialectical Behaviour Therapy is an approach which helps people to regulate their emotions and overcome eating disorders and/or other forms of self-harm.

Summing up

As people with diabetes, we have a higher risk for developing certain forms of mental illness. Managing a psychological disorder in addition to diabetes is never easy. Furthermore, suffering through such a condition can take a serious toll on your diabetes management and physical health. For these reasons, we need to keep an eye out for the signs of psychological distress; and we need to reach out for support when necessary. Know this: all of the disorders discussed in this article can be treated. With the right support, you can find a way to thrive with diabetes.

References

• Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co‐morbid depression in adults with Type 2 diabetes: a systematic review and meta‐analysis. Diabetic medicine, 23(11), 1165-1173.
• Gearhardt, A. N., Yokum, S., Orr, P. T., Stice, E., Corbin, W. R & Brownell, K. D. (2011). Neural correlates of food addiction. Archives of general psychiatry, 68(8), 808-816.
• Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002). Prevalence of anxiety in adults with diabetes: a systematic review. Journal of psychosomatic research, 53(6), 1053-1060.
• McIntyre, R. S., Kenna, H. A., Nguyen, H. T., Law, C. W., Sultan, F., Woldeyohannes, H. O., … & Rasgon, N. L. (2010). Brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders? Advances in therapy, 27(2), 63-80.
• Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes care, 28(3), 626-631.

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