A Thematic Analysis of Letters Written by Individuals with Type 1 Diabetes and Disordered Eating

It is estimated that 40% of individuals with type 1 diabetes mellitus (T1DM) will struggle with disordered eating (T1DE) (Goddard & Oxlad, 2023) and those with T1DE have a 3.2.x higher mortality rate than other eating disorders (ED) (Goebal-Fabbri et al., 2008). There is, however, minimal qualitative research on T1DE (Goddard & Oxlad, 2023; Wisting & Snoek, 2020). Clinical understanding of T1DE is therefore limited, and therapeutic interventions are not adapted to its specific needs, meaning therapy attrition and relapse are higher than in other EDs (Banting & Randle-Phillip, 2018). Research on identity and feelings towards diagnosis are prevalent in the fields of T1DM and EDs (Abdoli et al., 2020; Campbell et al., 1996; Commissariat et al., 2020; Nordbo et al., 2012; Williams & Reid, 2010). A qualitative systematic literature review (Chapter 2) explores current literature that discussed the impact T1DM has on identity. The results emphasise how important identity is in someone’s feelings towards and response to their T1DM. Using qualitative methodology, the qualitative empirical study (Chapters 3-5) aimed to explore the role of identity and feelings towards diagnosis in the development and maintenance of T1DE. A convenience sample of 11 female adult participants responded to a research poster or were recruited from an adult NHS ED service. They completed a letter addressed to their ED and another to their T1DM, focusing on their feelings towards both diagnoses and the impact both have had on their identity. Letters were analysed using reflexive thematic analysis (Braun & Clarke, 2019). Six main themes were identified: “This resentment I had for you”, “You must do diabetes, or you die”, “Why did you become my whole identity”, “Something I needed”, “Like a slave to a master” and “like yin and yang”. Findings are discussed in relation to existing literature, before discussing the strengths, limitations and clinical implications of this research and invitations for future research.