**9.3 Psychological therapy**

Psychotherapy individual, group, and family therapy are the most common ways to treat ED. There are no studies showing the best psychotherapy modality for patients with type 1 diabetes and ED or DEB. Some authors propose individual therapy to help patients to recover from ED and diabetes mismanagement (Krokoff, 1991). Adolescents with type 1 diabetes often struggle with emotional issues related to having the illness and use an ED as a maladaptive coping mechanism. Individual therapy can help patients to develop more healthy coping strategies. Often families of patients with diabetes and ED have not adequately coped with the feelings of grief related to having a chronic illness in the family and thus they have not adequately supported the patient with diabetes. Dysfuntional family dynamics can exacerbate difficulties of adjusting to the illness and of resolving issues of grief and loss associated with the diagnosis. Family therapy is recommended to help the family in developing more functional ways of relating and in addressing issues of grief and loss that may be contributing to ED symptoms.

Psychoeducation is a useful method to aid the patient to develop skills that will help him or her to cope with a chronic disease. Therefore, it can be helpful in type 1 diabetic patients who have difficulties accepting the disease.

Psycho-pharmaceutical agents may be useful to treat comorbid mental health problems (Rosen, 2003). Table 2.

One uncontrolled study of cognitive behavior therapy (Peveler & Fairburn, 1992) and several case reports of other treatment approaches for ED associated with type1 diabetes have been reported (Nielsen et al, 1987; Peveler & Fairburn, 1989; Ramirez et al, 1990). Further research is needed to demonstrate whether more intensive, prolonged or alternative interventions may have a more significant impact on metabolic control and other diabetesrelated outcomes.


Table 2. Components for the treatment of type 1 diabetic patients with ED or DEB.
