Anorexia (anorexia nervosa). Anorexia nervosa (mental) Chronic anorexia
Before we move on to consider the features of anorexia, let’s dwell on what the specified condition is to which it can lead, that is, protein-energy malnutrition (abbr. PEM).
PEM is defined as a nutritional state caused by energy imbalance, as well as imbalance of proteins and other types of nutrients, which in turn produces undesirable effects affecting function and tissue, as well as similar clinical outcomes. In the case of anorexia, PEM occurs against the background of inadequate food intake (although along with it, conditions of the body such as fever, drug treatment, dysphagia, diarrhea, chemotherapy, heart failure, radiation therapy and other effects on it that lead to PEM can be identified) .
Symptoms of protein-energy malnutrition occur in a number of ways. Meanwhile, it is against this background that weight loss occurs in adults (not too noticeable in case of obesity or general swelling), while in children there are no changes in terms of weight gain and height.
Let us dwell on a generalized consideration of the symptoms of the disease that initially interests us. Actually, with anorexia (i.e., lack of appetite), patients lose weight, and this disease itself can be a companion to another type of disease (oncological, somatic, mental, neurotic diseases). Lack of appetite is persistent, accompanied by nausea, and in some cases vomiting occurs as a result of attempts to eat. In addition, there is increased satiety, in which there is a feeling of fullness in the stomach even with a small amount of food eaten.
The listed symptoms can act as the only manifestations of anorexia, or be either the leading manifestations of the patient’s general condition, or be accompanied by many other complaints. Diagnosis in this case directly depends on what symptoms of anorexia accompany it.
Anorexia can occur in a number of conditions, let's highlight some of them:
- neoplasms of a malignant type, having a different nature of manifestation and their own different localization features;
- diseases of the endocrine system (hypopituitarism, thyrotoxicosis, diabetes mellitus, Addison's disease, etc.);
- alcoholism, drug addiction;
- helminthiasis;
- depression;
- intoxication.
What is noteworthy is that the very definition of “anorexia” is used not only in the designation of the symptom that it represents (decreased appetite), but also in the definition of the disease, which in particular is “anorexia nervosa”.
Anorexia determines a fairly high mortality rate for patients. In particular, based on some data, it is possible to determine its rate at 20% for all patients with anorexia. What is noteworthy is that in approximately half of the indicated percentage of cases, mortality is determined by the suicide of patients. If we consider natural mortality against the background of this disease, then it occurs due to heart failure, which, in turn, develops due to the general exhaustion achieved by the body of the sick person.
In approximately 15% of cases, women, carried away by weight loss and diets, reach a state in which they develop an obsessive state in combination with anorexia. In most cases, anorexia is diagnosed in adolescents and young girls. Similar to victims of drug addiction and alcoholism, anorexics do not recognize the fact that they have any kind of disorder, nor do they perceive the severity of the disease itself.
Anorexia can manifest itself in the following varieties:
- Primary anorexia . In this case, we consider states of lack of appetite in children due to one reason or another, as well as loss of hunger due to hormonal dysfunction, malignant tumor or neurological pathology.
- Anorexia mental (or cachexia nervosa, anorexia nervosa). In this case, mental anorexia is considered as a condition with refusal to eat or loss of the feeling of hunger due to suppression of appetite against the background of psychiatric diseases (catatonic and depressive states, the presence of delusional ideas regarding possible poisoning, etc.).
- Anorexia mental painful . In this case, patients with anorexia have a painful feeling of weakening and loss of ability in the waking state to be aware of the sensation of hunger. The peculiarity of this type of condition lies in the fact that in some cases they are faced with almost “wolfish” hunger in their sleep.
- Drug-induced anorexia . This case considers conditions in which patients lose the feeling of hunger, provoking this loss either unconsciously (in the treatment of a particular type of disease) or intentionally. In the latter case, efforts are aimed at achieving the goal of weight loss through the use of appropriate medications, which causes a loss of hunger. In addition, in this case, anorexia acts as a side effect when using certain stimulants and antidepressants.
- Anorexia nervosa . In this case, it means a weakening of the feeling of hunger or its complete loss, which arose as a result of a persistent desire to lose weight (often such a desire does not find an appropriate psychological justification) with patients excessively limiting themselves in relation to food intake. This type of anorexia can provoke a number of serious consequences, including metabolic disorders, cachexia, etc. It is noteworthy that the period of cachexia is characterized by patients excluding their own frightening and repulsive appearance from the attention of patients; in other cases, the achieved results give them a feeling of satisfaction .
We have considered the conditions of mental anorexia and painful mental anorexia sufficiently for a general description of these conditions (in particular, this concerns its painful form; mental anorexia is characterized by a complex clinical picture, determined on the basis of a concomitant psychiatric disease). Therefore, below we will consider the remaining forms of the disease (respectively, with the exception of the forms indicated).
Primary anorexia: symptoms in children, treatment
This type of anorexia is actually a serious problem that exists within modern pediatrics, and this problem is determined by the fact that it occurs quite often and is not so easy to treat. A child has poor appetite - such a complaint often accompanies a visit to the attending physician, and, you see, it does not lose its relevance. Signs (symptoms) of anorexia in a child can manifest themselves in different ways: some children start crying when they need to sit down at the table, thereby refusing this need, others begin a real hysteria, spitting out food. In other cases, children may eat only one of the dishes every day, or even eating at all is accompanied by severe nausea and vomiting.
It should be noted that anorexia in children can be not only primary, but also secondary; in the latter case, it is caused by concomitant diseases of the gastrointestinal tract and other systems and organs that are relevant for the small patient. Secondary childhood anorexia in its own symptoms is considered strictly individually, depending on the disease that accompanies it, but we will focus specifically on primary anorexia, which occurs against the background of eating disorders in healthy children.
The main factors whose influence leads to the development of the form of anorexia we are considering are the following:
- Eating disorders. As our readers probably know, the development of the feeding reflex, as well as its consolidation, is ensured precisely by the regime, in which, accordingly, certain feeding hours are observed.
- Allowing the child to consume easily digestible carbohydrates during the periods between main feedings. These carbohydrates include candy, sweet soda, chocolate, sweet tea, etc. Because of this, in turn, there is a decrease in excitability from the food center.
- Food, monotonous in its composition, the same type of feeding menu. For example, feeding exclusively dairy products or fatty foods, or carbohydrates, etc.
- The child has suffered from a disease of one or another etiology.
- Large portions when feeding.
- Overfeeding a child.
- Sudden change in climate zone.
Anorexia nervosa in children, as one of the forms of primary anorexia, occupies a special place; it is caused by force feeding. For example, in many families, a child’s refusal to eat is almost equated with drama, which is why parents and family members go to all sorts of tricks in order to feed him. Various methods are used, ranging from distracting the child (which implies, for example, distraction with music, fairy tales, toys, etc.), and ending with harsh measures, which, again, are designed to ensure the peace of parents due to the fact that when they are implemented, the child will - I finally ate “as I should.”
Any of the listed methods (naturally, these are only two directly opposite options; different actions can be used that lead to the same result in question) lead to a sharp decrease in the excitability of the food center, and also ensure the development of a negative form of reflex in the child. This reflex manifests itself not only in the form of a negative reaction to the need to feed with the accompanying pushing away of the spoon and the occurrence of vomiting, but also in the form of a specific reaction, which, again, consists in the appearance of vomiting, but which occurs even with just the sight of food.
In removing a child from a state of anorexia, it is necessary to focus on the following step-by-step actions (before this, it is important to determine what the mistake was that led to this state):
- Providing feeding in accordance with age, but with portions reduced by three times. In addition, foods that stimulate appetite are additionally introduced (this measure is permissible if anorexia in children over 1 year of age is eliminated): garlic, lightly salted vegetables, etc. Carbohydrates and fats (sweets, candies, etc.) should be excluded from the child’s diet.
- With the return of appetite, the volume of portions can be gradually increased, leaving proteins at normal levels and excluding half of the fats from the norm established in accordance with age.
- Next, a return to the original diet is ensured; fats in it should also be limited.
To the general recommendations regarding primary anorexia in children, we add the following. So, by the first half of the day it is necessary to give children protein foods and fatty foods, including carbohydrate foods, including dairy products, in the diet in the second half of the day. Gradually it will be possible to make the transition to a standard diet.
In case of physical or emotional fatigue, it is important to reschedule meals until after the child has rested. No less important is the moment of concentrating on the meal, without any distractions. The introduction of new dishes into the standard diet is carried out in small portions, in particular you should pay attention to the design and presentation.
Beautiful dishes are important; in comparison with the serving size, the dishes should look larger - this will allow the child to be “deceived” by the fact that there is not much food. If the child refuses food, you should not force him, wait until the next feeding period. Do not force a child with anorexia to completely eat food; in this case, hungry pauses have their own benefits. In a situation where the child has vomited, do not scold him under any circumstances; on the contrary, try to distract him while waiting for the next feeding. In it, if possible, try to offer the child several options of dishes to choose from, but the “golden mean” is no less important - there is no need to reduce meals to a restaurant meal either.
To top it off, we note that parents mistakenly treat hyperactive games with their interruption for meals. This kind of entertainment for the child should be planned for the period following the main meals.
Anorexia nervosa: symptoms
Anorexia nervosa is primarily common in adolescents (girls), who lose about 15-40% of their normal body weight, and, unfortunately, cases of anorexia nervosa in this category of patients are only becoming more frequent. The basis of the condition under consideration is that the child experiences dissatisfaction with his own appearance, which is complemented by an active, but, as a rule, hidden desire to lose weight. To get rid of what they consider to be excess weight, teenagers sharply limit themselves in nutrition, provoke vomiting, use laxatives, and engage in intense physical exercise.
Hence the desire to take a standing position rather than a sitting one, which, in their opinion, ensures greater energy consumption. The perception of one’s own body is distorted, real horror appears associated with the possibility of obesity; patients with anorexia see only low weight as an acceptable result for themselves.
As a result, children lose weight, and in many cases reaching critical levels, many develop a negative food reflex. Moreover, for many, this reflex reaches such a form that even after the teenager’s own conviction of the need to take food, attempts to do this lead to vomiting. All this causes exhaustion, as well as poor tolerance of high/low temperatures, chilliness, and decreased blood pressure. Changes occur in the menstrual cycle (menstruation disappears), body growth stops. Patients become aggressive and find it difficult to freely orient themselves in the surrounding space.
Anorexia nervosa develops in several stages.
- Initial (or primary) stage
Its duration is about 2-4 years. A characteristic syndrome for this period is dysmorphomania syndrome. In general terms, this syndrome implies that a person has a painful belief, which is delusional or overvalued, regarding the presence of one or another imaginary (exaggerated or overestimated) defect. In the case of anorexia we are considering, such a defect is excess weight, which, as is clear from the definition of the syndrome, may not be such at all. Such a belief in one’s own excess weight is in some cases combined with a pathological idea regarding the presence of another type of defect in appearance (the shape of the ears, cheeks, lips, nose, etc.).
The determining factor in the formation of the syndrome in question is that the sick person does not correspond to the “ideal” chosen for himself, which can be anyone, from a literary hero or actress to a person from his immediate environment. The patient strives for this ideal with all his nature, accordingly, imitating it in everything, and, above all, in external features. In this case, the importance of the opinions of others regarding the results achieved by the patient is lost, however, it is precisely the critical remarks perceived by him from the environment (relatives, friends, teachers, etc.) that can only “encourage” him to achieve the goal due to increased vulnerability and sensitivity.
- Anorectic stage
The beginning of this stage is accompanied by an active desire aimed at correcting appearance; conventionally, the effectiveness of weight loss is reduced to the loss of 20-50% of the initial mass. Secondary somatoendocrine changes are also noted here, changes occur in the menstrual cycle (oligomenorrhea or amenorrhea, i.e. a decrease in menstruation in girls or its complete cessation).
The methods by which results in weight loss are achieved can be very different; patients, as a rule, hide them at first. Here, as already noted, many actions are performed while standing; in addition, patients can tighten their waist using cords or belts (“to slow down the absorption of food”). Due to excessive effort in performing certain exercises (for example, “bending-extension”), in combination with increasing weight loss, the skin is often injured (the area of the shoulder blades, the sacrum, the area where the waist is tightened, the area along the spine).
During the first days of food restrictions, patients may not experience hunger, but often, on the contrary, it is extremely pronounced in the initial stages, which makes it difficult to refuse food and they have to look for other ways to achieve the goal (weight loss itself). Such methods often include the use of laxatives (much less often - the use of enemas). This, in turn, causes sphincter weakness, and the possibility of rectal prolapse (sometimes quite significant) cannot be ruled out.
An equally common companion to anorexia nervosa in the pursuit of weight loss is artificially induced vomiting. Mostly this method is used consciously, although accidental arrival at such a decision is not excluded. So, in the latter case, the picture may look like this: the patient, unable to restrain himself, eats too much food at once, as a result, due to the overcrowding of the stomach, retaining food in it becomes impossible. It is because of the vomiting that occurs that patients begin to think about the optimality of this method of releasing food before it is absorbed.
During the earlier stages of the disease, vomiting with its characteristic vegetative manifestations causes a number of unpleasant sensations in patients, but later, due to the frequent induction of vomiting, the procedure is greatly simplified. So, patients can simply perform an expectoration movement for this (you can simply tilt the torso for this), pressing on the epigastric region. As a result, everything that was eaten is thrown away, and there are no vegetative manifestations.
Initially, they carefully compare what is eaten with the amount of vomit, then perform gastric lavage. Artificially induced vomiting is inextricably linked with bulimia. Bulimia implies an irresistible feeling of hunger, in which there is practically no satiety. In this case, patients can absorb a huge amount of food, and often it can be inedible. When eating a huge amount of food, patients experience euphoria and autonomic reactions appear.
Next, they provoke vomiting, after which the stomach is washed out, then “bliss” sets in, a feeling of indescribable lightness in the body. To top it off, patients feel confident that their body is completely freed from what they have eaten, as evidenced by the rinsing waters being light in color and without the characteristic aftertaste of gastric juice.
And although significant weight loss is achieved, patients experience virtually no physical weakness; moreover, they are very active and mobile, and their performance remains normal. The clinical manifestations of anorexia during this stage often boil down to the following disorders: palpitations (tachycardia), attacks of suffocation, excessive sweating, dizziness. The listed symptoms occur after eating (a few hours later).
- Cachectic stage
In this period of the disease, somatoendocrine disorders become predominant. Following the onset of amenorrhea (a condition, as we indicated, in which there is no menstruation), patients lose weight even more rapidly. During this stage, subcutaneous fatty tissue is completely absent; dystrophic changes affecting the skin and muscles increase, against which myocardial dystrophy also develops. Conditions of hypotension, bradycardia, some loss of skin elasticity, a decrease in temperature and blood sugar levels cannot be excluded, in addition, signs of anemia are noted. Nails become brittle, teeth are damaged, and hair falls out.
Due to prolonged malnutrition and eating behavior, a number of patients are faced with an aggravation of the clinical picture of gastritis and enterocolitis. Physical activity maintained during the initial stages is subject to reduction. Instead, the predominant conditions are asthenic syndrome, and with it adynamia (muscle weakness and a sharp loss of strength) and increased exhaustion.
Due to the complete loss of critical condition, patients also continue to refuse food. Even with an exceptional degree of exhaustion, they often continue to claim that they are overweight, and sometimes, on the contrary, they are satisfied with the results they have achieved. That is, in any case, a delusional attitude towards one’s own appearance prevails, and the basis for this, apparently, is an actual violation of perception regarding one’s body.
With a gradual increase in cachexia, patients often lie in bed and become inactive. Blood pressure is extremely low and constipation occurs. Against the background of water and electrolyte disturbances, painful muscle cramps may occur, in some cases it can lead to polyneuritis (multiple nerve damage). Lack of medical care at this stage can be fatal. Often, hospitalization required in severe cases of this condition occurs in a forced manner, because patients do not realize how serious their condition has become.
- Reduction stage
As part of the stage of elimination from the previous condition, cachexia, the leading positions in the clinical condition of patients are occupied by asthenic symptoms, fixation on emerging gastrointestinal pathologies, and fear of getting better. A slight increase in weight is accompanied by the actualization of dysmorphomania, an increase in the depressive state, and the desire for a repeated scheme of “correction” of one’s own appearance.
Improvement in the somatic condition leads to the rapid disappearance of weakness with the appearance of extreme mobility, within which there is a desire to perform complex physical exercises. Here, patients can begin taking laxatives in large doses, and after attempts to feed them, they attempt artificial vomiting. Accordingly, for the above reasons, they need careful supervision in a hospital setting.
So, let’s summarize what symptoms of anorexia occur in patients, dividing them into certain groups:
- Eating behavior
- obsessive desire to get rid of excess weight, regardless of the real state of affairs (even with existing underweight);
- the appearance of obsessions directly related to food (counting calories consumed, focusing on everything related to the possibility of losing weight, narrowing the range of interests);
- obsessive fear of excess weight, obesity;
- systematic refusal of food under any pretext;
- equating a meal to a ritual, with the accompanying thorough chewing of food; dishes consist of small pieces and are served in small portions;
- the presence of psychological discomfort associated with finishing a meal; avoiding any events in which there is a possibility of feasting.
- Other types of behavioral reactions:
- adherence to increased physical activity, the appearance of irritation as a result of the inability to achieve certain results during overload;
- tendency to solitude, exclusion of communication;
- fanatical and tough type of thinking without the possibility of compromise, aggressiveness in proving one’s own rightness;
- choosing clothes in favor of baggy outfits, which can be used to hide “excess weight”.
- Physiological manifestations of anorexia:
- frequent dizziness, weakness, tendency to faint;
- significant lack of weight in comparison with age norms (from 30% or more);
- the appearance of vellus soft hair on the body;
- problems with blood circulation, which causes constant hunger;
- decreased sexual activity, women experience menstrual cycle disorders, reaching amenorrhea and anovulation.
- Mental state with anorexia:
- apathy, depression, decreased ability to concentrate, decreased performance, self-absorption, dissatisfaction with oneself in all areas (weight, appearance, weight loss results, etc.);
- a feeling of the impossibility of controlling one’s own life, the futility of any efforts, the impossibility of being active;
- sleep disturbances, psychological instability;
- rejection of the existing problem of anorexia and, as a consequence, the need for treatment.
Drug anorexia: symptoms
As we noted in the general description of the disease, drug-induced anorexia occurs either on an unconscious level, which occurs when treating a particular disease when taking certain drugs, or intentionally, when such drugs are used for a specific purpose aimed at losing excess weight. Anorexia can also occur as a side effect, which occurs when taking stimulants and antidepressants.
At the moment, doctors take the problem of side effects when taking medications with specific effects quite seriously. Long-term therapy using such drugs determines the possibility of recovery from quite serious, and in some cases, fatal diseases while simultaneously returning to an active lifestyle. At the same time, the harm caused to the immune system due to this becomes the cause of the development of another type of disease, the result of which can be no less terrible. This, in particular, includes one of the results of taking drugs in significant quantities, drug-induced anorexia, which interests us.
In light of this effect achieved by using drugs, a definition for it called “drug disease” was introduced in domestic medical practice. It should be noted that this definition implies not only drug-induced anorexia, but also other diseases that arise against the background of corresponding exposure, and these are endocrine diseases, allergies, Addison's disease, asthenia, drug addiction, etc. Almost any drug can lead to a drug-induced disease, Accordingly, this does not exclude the possibility of developing drug-induced anorexia against this background.
Symptoms of drug-induced anorexia, in general, fall under the general picture of this disease. So, this includes nausea and lack of appetite, the presence of painful sensations in the epigastric region, and general exhaustion of the body. There is also a frequent urge to vomit, rapid satiety occurs when eating, and this is accompanied by a feeling of fullness in the stomach. Patients with anorexia in this form in every possible way deny the existing problem, continuing to use drugs that cause weight loss. In the latter case, the signs of drug-induced anorexia become decisive for this disease, therefore it is important to pay attention to them in time, thereby preventing progression.
Anorexia in men: symptoms
Anorexia, although considered to a greater extent as a female disease due to the desire of the fair sex to achieve “ideal” parameters, is not an exclusively female disease. Anorexia in men is a common and growing phenomenon; moreover, male bulimia is also associated with this condition, and men experience bulimia three times more often than women.
Male anorexia, the symptoms of which we will consider, is also based on the desire to achieve ideals in terms of one’s own complexion. Obsessing over it, men exercise vigorously, deliberately refusing food and tracking calories. What is noteworthy is that the age of males introduces this disease to a younger group. Thus, the first symptoms of anorexia, manifested in a decrease in muscle mass, are increasingly found among schoolchildren.
Similar to the female self-perception, male anorexia in combination with bulimia comes down to weight control and breakdowns due to fullness in the stomach with the intention of getting rid of what has been eaten by artificially inducing vomiting. After this, a feeling of guilt appears, against the background of which, in turn, psychosomatic disorders develop.
The difference between male anorexia and female anorexia is that it generally develops at a later age (despite the initially indicated tendency to increase the incidence of this disease in schoolchildren). Moreover, anorexia, the symptoms of which are diagnosed in men, in many cases is inherently associated with the relevance of schizophrenic processes for them.
There are certain risk factors for the occurrence of this disease in men, we will highlight them:
- the presence of a problem of excess weight in childhood;
- engaging in exhausting sports (in this case, runners have a higher risk of developing anorexia compared to, for example, weightlifters and football players);
- the presence of a hereditary predisposition to mental illness;
- cultural features (when fixing the environment on external physical appearance, diets, etc.);
- a type of activity in which it is important to be “in shape” (artists, male models, etc.).
Before the onset of the disease, patients, as a rule, have problems in the form of short stature, underdevelopment of the vascular and muscular systems, problems associated with the gastrointestinal tract, appetite disturbances, and intolerance to certain types of food.
There is a certain picture that future anorexics fall into, in addition to the problems mentioned above. Thus, they are brought up mainly in “greenhouse” conditions, their parents protect them as much as possible from certain difficulties. Due to such dependence on parents, there is a constant shifting of one’s own problems onto the shoulders of the environment. As they grow older, such men become more unsociable, withdrawn, and emotionally cold (which determines the presence of schizoid traits). It is also possible to evaluate themselves as incompetent, helpless and unbearable individuals (which, in turn, determines the presence of asthenic personality traits). Symptoms of anorexia in women in terms of personal manifestations determine the predominance of hysterical traits in them.
What is noteworthy is that some men with anorexia are initially convinced of their own excess weight, but in this case such a belief is delusional, that is, we are talking about false judgments that cannot be corrected. Accordingly, such beliefs are appropriate for them even if there is already a problem of underweight. When fixated on fictitious fatness, anorexic men stop reacting to really existing, and often ugly, defects in their appearance.
As already indicated, weight loss is achieved through the same measures as in women, that is, by refusing to eat, inducing vomiting and excessive physical exertion, due to which the result is determined in the form of severe exhaustion. It should be noted that artificially induced vomiting does not cause severity similar to female vomiting. As for refusing food, it is either motivated in a formal way, or in a completely absurd way (cleansing the soul and body; food is a hindrance in activity and in life in general, etc.).
The development of anorexia in men determines for them the subsequent addition of another type of signs of schizophrenia. Signs of schizophrenia in this case are manifested in impaired thinking, self-absorption, and a narrowing of the usual range of interests.
In addition, of course, anorexia in men can also manifest itself as an independent disease, which determines the generally recognized symptoms of this condition.
Anorexia during pregnancy
For women who have previously experienced anorexia, including bulimia, as a form of eating disorder, trying to get pregnant is comparable to serious difficulties. The basis for this statement is the fact that these patients are twice as likely to resort to artificial insemination, which, accordingly, indicates the negative impact of eating disorders in the future on reproductive function.
Based on the results of one study, it is known that out of 11,000 cases with a history of eating disorders, 39.5% of women require about 6 months to conceive successfully, while a similar problem occurs in only a quarter of women without eating disorders . 6.2% of those with a history of eating disorder problems are patients of in vitro fertilization clinics, while 2.7% of the total number in this case did not have problems in the form of anorexia and bulimia in the past. What is noteworthy is that most often pregnancy with anorexia is unplanned; therefore, not in all cases this disease is comparable to infertility.
If there is a malnutrition during pregnancy, a miscarriage may occur, and the possibility of developing gestational diabetes is not excluded - a disease that goes away after childbirth, unlike other types of diabetes, which are chronic, characterized by an increased level of glucose in the blood.
During pregnancy, women gain about 10-13 kg, which is necessary to ensure the normal development of the child. In most cases, pregnant women consume about 2000 kcal per day, and by the last trimester - about 2200 kcal. If you have anorexia, it is quite difficult to come to terms with such facts.
If your body mass index (BMI) is abnormal during pregnancy, there is a risk of having a low birth weight baby, which is especially likely with concomitant smoking. Also against this background there is a risk of premature birth.
Diagnosis
In general, the diagnosis of anorexia is based on a comparison of general symptoms within the framework of the following criteria:
- changes accompanying the condition that occurred before the age of 25 (derogations are possible, including based on gender);
- weight loss of 25% or more of the indicator serving as the starting point for diagnosis;
- the absence of any organic disease acting as the main cause of weight loss;
- a perverted approach to eating and one’s own weight;
- absence/presence of mental illness concomitant with the condition;
- the presence of at least two manifestations from the following list:
- lanugo (appearance of very fine body hair);
- amenorrhea;
- episodes of bulimia;
- bradycardia (a condition in which the heart rate at rest is 60 beats per minute or less);
- vomiting (possibly intentionally induced).
Treatment
Treatment of anorexia in some cases is possible without reaching the stage of development of severe forms of complications, which only accompanies a rapid recovery, often at a spontaneous level. Meanwhile, in most cases, patients do not recognize the disease, and accordingly, they do not seek help. Severe forms imply the need for complex therapy, this includes inpatient treatment, drug therapy, and psychotherapy (including for members of the patient’s family). In addition, a normal diet is subject to restoration, in which an increase in the calorie content of the food consumed by the patient is gradually achieved.
As part of the first stage of treatment, the somatic condition is subject to improvement, in which the process of weight loss is suspended and the threat to life is eliminated, and the patient is brought out of cachexia. As part of the next, second stage, they focus on treatment using medications in combination with psychotherapy methods while simultaneously distracting the patient from the existing fixation on appearance and weight, in particular, on the development of self-confidence, acceptance of the surrounding reality and oneself. Anorexia, a video and photo of which is available in our article, also determines the possibility of achieving some effect in “reaching out” to the patient, in particular, to his perception of the situation and possible results with further progression of the disease.
Relapse of anorexia is a frequent stage in this disease, due to which several courses of treatment are often required. It is extremely rare that excess weight or obesity becomes a side effect of therapy.
Anorexia requires an integrated approach to diagnosis and treatment, which is why consultation with a number of specialists may be required at the same time: psychologist (psychotherapist), neurologist, endocrinologist, oncologist and gastroenterologist.
Anorexia nervosa is an eating disorder characterized by dietary restriction, atypical eating habits or rituals, an obsession with being thin, and an irrational fear of gaining weight. Accompanied by impaired body image and typically involves excessive weight loss. Due to fear of weight gain, patients with this disorder limit the amount of food they eat. Outside the medical literature, the terms "anorexia nervosa" and "anorexia" are often used interchangeably, however "anorexia" is simply the medical term for the symptom of lack of appetite, and in anorexia nervosa a dysregulation or alteration in the sense of fullness of taste is suspected. Anorexia nervosa is often accompanied by a disturbed self-image, which may be supported by a variety of cognitive distortions that alter the patient's assessment and opinion of their own body, food, and nutrition. Patients with anorexia nervosa often see themselves as overweight or underweight even though they are underweight. Anorexia nervosa is predominantly diagnosed in women. It caused approximately 600 deaths in 2013, compared to 400 in 1990. It is a serious health disorder with high comorbidity rates and mortality rates comparable to serious mental disorders.
Classification
Anorexia nervosa is classified as an Axis I disorder in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), published by the American Psychiatric Association.
Signs and symptoms
Anorexia nervosa is an eating disorder characterized by attempts to lose weight to the point of self-depletion. Individuals with anorexia nervosa may have a variety of signs and symptoms, the type and severity of which may vary in each case and which may be present but not obvious. Anorexia nervosa and associated malnutrition, which is caused by voluntary wasting, can lead to serious complications in each of the body's major organ systems. Hypokalemia, a decrease in potassium levels in the blood, is a sign of anorexia nervosa. Significant decreases in potassium levels can cause irregular heart rhythms, constipation, fatigue, muscle damage, and paralysis. Symptoms of anorexia nervosa may include:
Diagnostics
The diagnostic evaluation includes an assessment of the patient's current circumstances, biographical information, current symptoms, and family history. The assessment also includes a mental status examination, which is an assessment of the patient's current mood and thinking, focusing on weight and eating behavior patterns.
Diagnostic and Statistical Manual of Mental Disorders criteria, 5th edition
Compared to the previous edition of the Diagnostic and Statistical Manual of Mental Disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised), the 2013 edition (5th edition) reflects changes in the criteria for anorexia nervosa, specifically noting the removal of the criterion for amenorrhea. Amenorrhea was removed for several reasons: this criterion does not apply to men and women who are pre- or post-menstrual or taking contraceptives, and for some women who meet other criteria for anorexia nervosa who are still menstrually active.
Subtypes
There are two subtypes of anorexia nervosa:
Purging type (binge eating/purging): Patients use binge eating or purging behavior as a means of losing weight. It differs from bulimia nervosa by the weight of the patients. Patients with purging anorexia do not maintain a healthy or normal weight but are significantly underweight. Patients with bulimia nervosa, on the other hand, may be somewhat overweight.
Restrictive type: Patients restrict food intake, fast, take diet pills, or use exercise as a means of weight loss; they may engage in excessive exercise to lose weight or prevent weight gain, and some patients eat only to survive.
Severity
Analyzes and research
Medical tests to check for signs of physical decline in anorexia nervosa:
CBC: counting white blood cells, red blood cells and platelets, is used to evaluate the presence of various disorders such as leukocytosis, leukopenia, thrombocytosis and anemia, which may be caused by malnutrition.
Urinalysis: Various urine tests are used in the diagnosis of medical disorders to determine chemical dependency and as an indicator of general health.
Blood Chemistry Test (20 Tests): Chem-20, also known as SMA-20/Sequential Multiplex Test, is a panel of twenty separate blood serum tests. Tests will include cholesterol levels, proteins and electrolytes such as potassium, chloride and sodium, and tests specific to liver and kidney function.
Glucose tolerance test: An oral glucose tolerance test is used to evaluate the body's ability to metabolize glucose. May be useful in identifying various diseases and conditions such as diabetes, insulinoma, Cushing's syndrome, hypoglycemia, and polycystic ovary syndrome.
Serum cholinesterase test: A test for liver enzyme levels (acetylcholinesterase and pseudocholinesterase) is useful as a test of liver function and for assessing malnutrition.
Liver test: A series of tests to evaluate liver function, some tests are also used to evaluate malnutrition, protein deficiency, kidney function, coagulopathies, etc.
Luteinizing hormone response to gonadotropin-releasing hormone: Luteinizing hormone (LH) response to gonadotropin-releasing hormone (GnRH): Testing the pituitary gland's response to GnRH, a hormone produced in the hypothalamus. Hypogenitalism is often observed in anorexia nervosa.
Creatine kinase test: measures blood levels of creatine kinase, an enzyme found in the heart (cardiac fraction of creatine kinase), brain (creatine kinase-brain fraction), and skeletal muscle (creatine kinase-muscle subunit).
Blood urea nitrogen test: Urea nitrogen is a byproduct of protein metabolism, first formed in the liver, then excreted from the blood by the kidneys. Blood urea nitrogen testing is primarily used to evaluate kidney function. Low blood urea nitrogen levels may indicate the effects of malnutrition.
Blood urea nitrogen to creatinine ratio: Used to predict various conditions. A high blood urea nitrogen/creatinine ratio may occur with severe hydration, acute renal failure, congestive heart failure, and intestinal bleeding. A low blood urea nitrogen/creatinine ratio may indicate a low protein diet, celiac disease, rhabdomyolysis, or cirrhosis.
Electrocardiogram (ECG): measures the electrical activity of the heart. Can be used to detect various disorders such as hyperkalemia.
Electroencephalogram (EEG): measures the electrical activity of the heart. May be used to identify disorders such as those associated with pituitary tumors.
Thyroid Screening TSH, T4, T3: A test used to evaluate thyroid function by assessing the levels of thyroid stimulating hormone (TSH), thyroxine (T4), and.
Differential diagnosis
Many diseases and psychological conditions can be misdiagnosed as anorexia nervosa, in some cases the correct diagnosis may not be made for more than ten years. Distinguishing between the diagnoses of anorexia nervosa, bulimia nervosa, and other eating disorders is often difficult because there is significant overlap between patients at diagnosis. It appears that even minimal changes in the patient's general behavior or attitudes can change the diagnosis of purging anorexia to bulimia nervosa. The main factor differentiating purging anorexia from bulimia is the difference in physical weight. Patients with bulimia nervosa are usually of normal or slightly overweight. Patients with purging anorexia are usually underweight. Patients with this type of anorexia may be significantly underweight and usually do not eat much food, although they purse the small amount of food they eat. In contrast, patients with bulimia nervosa tend to be normal to overweight and eat large amounts of food. It is common for patients with eating disorders to “go through” multiple diagnoses as their behaviors and beliefs change over time.
Accompanying illnesses
Various other psychological problems may contribute to the development of anorexia nervosa, some meeting the criteria for a separate diagnosis of Axis I or personality disorders that fall under Axis II and are thus considered comorbid with the diagnosed eating disorder. Some patients have pre-existing disorders that may increase their susceptibility to developing eating disorders, and some subsequently develop them. The presence of Axis I or II psychiatric comorbidities has been noted to influence the severity and type of symptoms of anorexia nervosa in adolescent and adult patients. (OCD) and obsessive-compulsive personality disorders are highly comorbid with anorexia nervosa, in particular the restrictive type. Obsessive-compulsive personality disorders are associated with more severe symptomatology and worse prognosis. The cause-and-effect relationship between personality disorders and eating disorders is still not fully understood. Other associated conditions include depression, alcoholism, borderline and other personality disorders, anxiety disorders, attention deficit hyperactivity disorder, and body dysmorphic disorder. Depression and anxiety are the most common comorbid conditions, with depression associated with the worst prognosis. Autism spectrum disorders are more prevalent among people with eating disorders than in the general population. Zucker et al. (2007) proposed that conditions in autism spectrum disorder constitute a cognitive endophenotype underlying anorexia nervosa.
Causes
There is evidence of biological, psychological, developmental, and sociocultural risk factors, but the exact causes of eating disorders are not known.
Biological reasons
Research hypothesizes that long-term eating disorders may be an associated symptom of burnout. Results from the Minnesota Wasting Experiment showed that the normal control group reflected many of the behavior patterns of anorexia nervosa in the wasting pattern. This can be caused by numerous changes in the neuroendocrine system, resulting in an endless cycle. Another hypothesis is that anorexia nervosa is more likely in populations in which obesity is prevalent and as a result of the sexually selected evolutionary drive to look young in populations in which figure becomes the primary indicator of age. Anorexia nervosa most often occurs in people of puberty. Some hypotheses to explain the increasing prevalence of eating disorders in adolescents are "increased body fat in girls, hormonal changes during puberty, social expectations of increased levels of independence and freedom that are particularly difficult for adolescents to achieve [and] increased influence from peers and their values."
Psychological reasons
Early theories about the causes of anorexia linked it to childhood sexual abuse or living in dysfunctional families; The evidence is inconsistent and a well-designed study is required.
Sociological reasons
The number of diagnoses of anorexia nervosa has increased since the 1950s; the increase was associated with receptivity and internationalization of the ideal figure. People in occupations where there is social pressure to be thin (such as models and dancers) are most likely to develop anorexia, and these anorexics also have greater exposure to cultural sources that promote weight loss. This trend can also be tested for people who participate in certain sports, such as jockeys and wrestlers. There is a high incidence and prevalence of anorexia nervosa in sports, especially in aesthetic sports where lower body fat is an advantage, and sports in which being lighter is a competitive advantage.
Media influence
Treatment
There is no clear evidence that any specific treatment for anorexia nervosa is better than others; however, there is sufficient evidence that earlier intervention and treatment are more effective. Treatment for anorexia nervosa focuses on three main aspects:
Although restoring the patient's weight is the primary goal, optimal treatment also includes and monitors changes in the patient's behavior. Some agents have little value in the treatment of anorexia; hospitalization is a worse option compared to voluntary treatment. Psychotherapy for patients with anorexia nervosa is challenging because they may assert thinness as a value in life and seek means to maintain control and resist change.
Diet
Diet is the most significant factor when working with patients with anorexia nervosa and must be tailored to the needs of each patient. When developing a diet, a variety of foods is important, as is the consumption of foods with higher energy value. Patients should consume the optimal number of calories, start their food intake slowly and increase it at a moderate pace.
Medicines
Medications have limited benefit in treating anorexia itself.
Therapy
Family therapy has been shown to be more successful than individual therapy. Various forms of family therapy have been shown to work in treating adolescents with anorexia nervosa, including conjoint family therapy, in which parents and children are seen by the same therapist, and separated family therapy, in which parents and children attend therapy separately from different professionals. Proponents of family therapy for adolescents with anorexia nervosa argue that it is important to involve parents in the adolescent's treatment. A long-term 4-5 year study of Maudsley Family Therapy, an empirical practice model, showed complete recovery rates of up to 90%. Although this model is recommended by the National Institute of Mental Health, critics say it has the potential to create power struggles in intimate relationships and can undermine equal partnerships. Cognitive behavioral therapy is appropriate for adolescent and adult patients with anorexia nervosa; Acceptance and Commitment Therapy is part of cognitive behavioral therapy and appears to be useful in the treatment of anorexia nervosa. Cognitive restoration therapy is also used in the treatment of anorexia nervosa.
Forecast
Anorexia nervosa has the highest mortality rate of any mental disorder, being 11–12 times higher than expected, and the risk of suicide is 56 times higher; Half of women with anorexia nervosa achieve full recovery, while another 20-30% may have partial recovery. Not all patients with anorexia nervosa recover completely: approximately 20% develop chronic anorexia nervosa. If anorexia nervosa is left untreated, severe complications can develop, such as heart and kidney disease, which ultimately lead to death. The average period from onset to remission of anorexia nervosa is seven years for women and three years for men. After 10-15 years, 70% of patients no longer meet diagnostic criteria, but many still continue to experience problems associated with eating behavior. According to the Morgan Russell criteria, patients can have a favorable, intermediate or unfavorable outcome. Even when patients are classified as having a “favorable” outcome, only the weight must be within 15% of the average weight and the women must have normal menstruation. A favorable outcome also excludes mental illness. Recovery for patients with anorexia nervosa is undoubtedly positive, but recovery does not mean a return to normal.
Complications
Anorexia nervosa can have serious complications if its severity and duration are significant and if the disease begins before the patient has completed growth, reached puberty, or reached peak bone mass. Complications specific to adolescents and children with anorexia nervosa may include the following conditions:
Relapses
Relapses occur in about a third of hospitalized patients, with the highest rate occurring in the first six months and up to one and a half years after the patient is discharged from the hospital.
Epidemiology
Although anorexia is widespread among many patient groups in the United States, the disease is more limited to Western countries. Anorexia has an average prevalence of 0.9% in women and 0.3% in men in developed countries. Women get sick three times more often than men. The lifetime prevalence of atypical anorexia nervosa, a form of other eating disorders in which all diagnostic criteria for anorexia nervosa are not met, is much higher, ranging from 5-12%. Whether the prevalence of anorexia nervosa is increasing is controversial. Most studies show that the prevalence of anorexia nervosa in adult women has been fairly constant since at least 1970, while there is some indication that the prevalence may have increased among girls and young women aged 14 to 20 years. It is difficult to compare increases in incidence at different times and perhaps in different locations due to changes in diagnostic methods, reporting, and population sizes reported after 1970.
Insufficient representation
Eating disorders are less common in pre-industrial, non-Westernized countries than in Western countries. In Africa, not including South Africa, data on eating disorders are provided only in case reports and isolated studies, rather than in prevalence studies. Research data shows that in Europeanized cultures, ethnic minorities have very similar rates of eating disorders, compared with the belief that eating disorders occur predominantly in Caucasian patients. Due to different beauty standards for men and women, men are less likely to be diagnosed with anorexia. Typically, men who change their body shape do so to become leaner and more muscular, not skinny. Additionally, men who may otherwise be diagnosed with anorexia may meet the Diagnostic and Statistical Manual of Mental Disorders, 4th Revision criteria for body mass index because they have increased muscle mass but very little body fat. Anorexia in athletes is often overlooked. Research highlights the importance of looking at athletes' diet, weight and symptoms when diagnosing anorexia, rather than simply measuring weight and body mass index. For athletes who turn training into a ritual, such as focusing on weighing before competition, this may contribute to the development of eating disorders. While women use diet pills, which are indicators of unhealthy behavior and eating disorders, men use steroids, which contextualize gender ideals of beauty. It is also noted that men are preoccupied with their body image, which is an indicator of eating disorders. In a Canadian study, 4% of ninth grade boys used anabolic steroids. Men with anorexia are sometimes called manorexics.
Story
The term anorexia nervosa was coined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: an- (ἀν-, a prefix expressing negation) and orexis (ὄρεξις, “appetite”), which literally translates as nervous loss of appetite. The history of anorexia nervosa begins with descriptions of religious fasts of the Hellenistic era and continues into the Middle Ages. The medieval practice of self-exhaustion by women, including some very young women, in the name of religion and purity is also associated with anorexia nervosa, sometimes called anorexia miraculous. Early medical descriptions of anorexic diseases are generally attributed to the English physician Richard Morton in 1689. Case reports of anorexic illness continued into the 17th, 18th and 19th centuries. At the end of the 19th century, anorexia nervosa became widely recognized among doctors. In 1873, Sir William Gull, one of Queen Victoria's personal physicians, published the original article using the term anorexia nervosa and presented several detailed case reports and treatment regimens. In the same year, the French physician Ernest Charles Lasegue published similar data on several cases in a work entitled De l "Anorexie Histerique. Awareness of this disease was greatly limited to the medical field until the second half of the 20th century, when the German and American psychoanalyst Hild Bruch published the article Golden The Cage: The Mystery of Anorexia Nervosa in 1978. Despite major advances in neuroscience, Bruch's theory tends to predominate as popular teaching.The next major event was the death of popular singer and drummer Karen Carpenter in 1983, which attracted widespread, ongoing media interest in the disorder eating behavior.
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Nowadays, there are very high demands on the appearance of boys and girls. Women, of course, pay particular attention to their appearance. They are very demanding of their appearance, sometimes they want the almost impossible. The standard of modern beauty is an ideal, slim, fit, sexy figure. This idea is imposed on us by television programs, videos on the Internet, and photographs in magazines.
Images of thin models impose on many women the idea that thinness and beauty are equivalent concepts. Women who are unhappy with their figure are willing to go to great lengths to achieve the desired result. But some of them get too carried away with this idea and go too far. Therefore, when losing weight, you need to understand that there is such a disease as, which in its symptoms is practically no different from the behavior of an ordinary woman who is simply losing weight.
Very few women are naturally deprived of an ideal body, such is nature. For this reason, many representatives of the fairer sex are trying to get rid of extra pounds, folds, and centimeters. They are ready to use various tools in this fight, which are not always harmless. Teas and diet pills, fasting, exhausting physical activity can be used, all this can have a very disastrous result. In this article we will tell you in detail how to distinguish normal weight loss from anorexia, as well as the reasons for which this disease occurs and what symptoms it manifests.
What is anorexia?
Anorexia is a disease in which normal eating behavior is disrupted, which is expressed in too much attention to one’s weight and in the desire to almost completely limit oneself from eating food. Women who suffer from anorexia are so afraid of gaining excess weight that they are ready to drive themselves to the point of exhaustion.
Alas, this disease mainly occurs in young girls, and sometimes in teenagers. This is explained by the fact that they are the ones who are most susceptible to environmental influences. Girls with anorexia so deplete their body with various diets, or even refusing food, that their weight drops fifteen to twenty percent below what it should be. In some cases, weight may decrease even more. But even under such circumstances that the girl’s weight is greatly reduced and her general well-being suffers, the girl, looking at herself in the mirror, sees herself still very fat. She continues to make every effort to get rid of the “extra weight” that she needs, on the contrary.
This disease is very, very dangerous for young girls, as their body is not yet fully formed and continues to grow and develop. As a result of trying to lose weight, others see not a healthy, beautiful girl, but a ghost with bruises under her eyes, pale skin and many concomitant diseases. When the body intensively grows and develops, various functional systems of the body are formed - endocrine, nervous, musculoskeletal, cardiovascular; it needs many nutrients, vitamins, and minerals. A teenager, instead of giving all this to the body in the right quantities, torments it with starvation, this brings irreparable harm to the young, developing body.
Anorexic symptoms
Most often, girls and women who develop anorexia refuse to admit that they have this disease. It is very important for close friends to detect the signs of anorexia in a timely manner. If this does not happen, then the obsession with getting rid of excess weight will bring very disastrous results - the girl’s health is under great threat, and in some cases, her life. The most important and first sign of anorexia in a woman is a significant obvious weight loss, sometimes in a very short period of time. But, unfortunately, this symptom becomes visible only when the exhaustion of the body approaches a dangerously critical point. It may simply seem to many that the girl decided to get rid of excess weight in a very harmless way.
Another manifestation of anorexia is a significant reduction in the portion of food that a woman eats and loss of appetite. These signs should never be ignored. Some girls may refuse to eat at all, while finding many different excuses, which sometimes look very plausible - she’s tired, her stomach hurts, she’s eaten recently. But despite this, a person who suffers from anorexia can happily talk about different diets, food, weight loss methods, and calories. In addition, women with anorexia can spend a long time in the kitchen, while preparing a wide variety of dishes. They themselves do not want to use them.
It may seem to many that anorexics are not interested in food at all. But this is not really true - they think about food almost all the time. But as soon as it comes to putting these thoughts into practice, this desire instantly disappears somewhere. The patient's general condition worsens as the disease progresses. This manifests itself in various symptoms of disrupted functioning of many systems in the body.
- The condition of nails and hair is deteriorating. Hair becomes dull, loses its shine, and splits severely. And no hair balms, even the best ones, help improve the condition of your hair. This process is due to the fact that the body does not have enough minerals and vitamins that are needed to maintain hair in excellent condition. The same applies to nails, they become brittle and thin, sometimes peeling.
- Very high fatigue. The patient develops severe weakness and gets tired quickly. The girl is just waking up and is already starting to feel tired. This happens not because of strong physical activity, but because the body does not receive the necessary energy, and it begins to take it from its internal resources, which are limited. If the cases of the disease are severe, the girl may become very drowsy, she may begin to faint regularly.
- Disappearance of menstruation or. The mechanism by which this symptom occurs is not entirely clear; it is most likely influenced by the lack of nutrients that the body needs. For this reason, hormonal levels fail. Amenorrhea is a serious disorder, which indicates that the girl needs urgent medical attention.
- The condition of the skin changes. In patients with anorexia, the face becomes pale and blue circles appear under the eyes. The reason for this is iron deficiency anemia, which is mandatory for this disorder. Anorexia very often causes kidney problems. The skin of the sick girl's legs and arms acquires a characteristic bluish tint. It occurs due to poor microcirculation of the skin. For this reason, a woman is often cold; her body can often be covered with a layer of short and thin hair. The body thus tries to maintain heat and protect itself from hyperemia.
- Various diseases develop. The body lacks essential minerals, vitamins, proteins, carbohydrates, fats, and nutrients. This is a kind of stress for the body, and it is very difficult to predict exactly how it will react to this. Many women experience problems with the gastrointestinal tract, develop osteoporosis, and disrupt the functioning of the endocrine and nervous systems.
Causes of anorexia
Many people are interested in the reasons for this disease. An important fact is that there are several types of anorexia: mental, nervous and primary. Primary anorexia in women occurs due to various physiological and organic pathologies. This may be neurological disorders, malignant tumors, hormonal dysfunction and other diseases. Mental anorexia occurs due to various psychiatric pathologies. These could be delusions, depression, schizophrenia, catatonic stupor. But when most people use the term “anorexia,” they still mean anorexia nervosa. There are many reasons why anorexia nervosa occurs. These include family characteristics, problems communicating with others, and personal difficulties. Basically, the wide range of problems that cause anorexia include:
- Dysfunctional family. Such a family has an unhealthy mental climate. All family members become irritated with each other or hide their emotions greatly. One family member or several of its members most often have various types of addiction - drug addiction, alcoholism, gambling addiction, and so on. Everyone thinks exclusively for themselves and does not take into account each other's needs. A child in such a family is left to his own devices, or is under the authoritarian control of his parents. In such conditions, most often one of the family members, usually a teenage girl, suffers from anorexia.
- Too low self-esteem and impaired perception of one's own body. All girls with anorexia consider themselves fat and ugly. Even if a girl has very little weight, and her bones stick out, it still seems to her that she is very fat and has a lot of extra pounds. But, most likely, this opinion is not the result of anorexia; the real reason is that in life such girls consider themselves passive, uninteresting, weak, stupid and ugly. They want to achieve at least something in life, that is, to have a beautiful figure, in their opinion.
- Negative atmosphere around eating. The source of such a reason lies, as a rule, in early childhood. Many parents consider it necessary to feed their baby, despite his reluctance to eat. They forcefully begin to push food into the child, and the child, in turn, develops a gag reflex and develops a negative attitude towards eating food. For this reason, anorexia can occur already in early childhood, and sometimes it can hide and make itself felt in adolescence or adulthood, if there is the influence of additional factors.
- Unmet need for acceptance and love. In this case, the disease occurs because the girl strives to please other people. Very often this can happen to those girls who suffered from excess weight. When they begin to lose weight, they begin to notice how other people begin to show sympathy and be drawn to them. This fact reinforces the positive result of losing weight in a person, and they quickly continue in the same spirit. Very soon the disease begins to become pathological.
- Perfectionism. Obsessiveness and fixation in behavior. With long-term weight loss, this trait has very serious consequences. Even if it begins as a completely normal and healthy process, then a very high desire for perfection can provoke a girl to become fixated on this idea, on the idea of losing weight. She will constantly seem not beautiful enough for herself. And in order to appear beautiful to yourself and others, you need to eat less and less (according to people with anorexia).
- Fighting some obstacles. Some doctors believe that the basis of the disease anorexia is the girl’s desire to overcome some difficulties; the difficulties are their own constant appetite. By refusing to eat, the girl believes that she has overcome this difficulty and it brings her pleasure. This process brings the girl victory over herself and has an important meaning in her life. This is why it is so difficult for girls suffering from anorexia to give up such pathological behavior.
Girls, if your figure does not suit you in some way, and you are planning to get rid of extra pounds with the help of some effective diet, then before that, think carefully about whether it is worth it? Are you ready to risk your own health for the sake of invented beauty?
If you still decide to improve and correct your body and overcome extra pounds, then do it wisely, do not forget about the limits in such a struggle. Assess the current situation soberly, because the line between anorexia and ordinary harmless weight loss is very, very thin. It is very easy to cross, so if your friends or relatives have any doubts about your health, it is better to once again seek advice from a specialist. If nature has not blessed you with an ideal figure, then this is not a reason to fall into despair.
You need to know that you can be attractive, charming, beautiful and attract attention without an ideal appearance. Much more important than a flat stomach is charisma and self-confidence! Be healthy and love yourself for who you are!
Health
It is generally accepted that anorexia is a psychological disorder consisting of voluntary refusal of food. However, this disease, which is far from clear, in some cases is characterized not only by loss of appetite, but also by an overly active addiction to physical exercise. In general, to everything that leads to weight loss. Since anorexia nervosa manifests itself in a conscious, often mentally unfounded desire to lose weight, it is no wonder that this disorder has a strong impact on the physical body of a person, leading to the development of many diseases and, sometimes, death.
DESCRIPTION
So, anorexia nervosa usually begins with the desire to maintain a strict diet and lose weight by all means. This phenomenon may be caused by some event in your personal life, for example, a break in a relationship with a loved one. In this case, the emerging desire to control your diet and follow some kind of healthy diet is displaced by the desire to completely control your partner’s feelings. Anorexia can also be caused by the death of a loved one, illness, or some other significant event. As a rule, this disease mainly affects girls and young women, but there are also known cases of male anorexia. It is also known that 60 percent of people suffering from anorexia have been sexually assaulted. In this case, anorexia can be considered a certain post-traumatic syndrome.
People suffering from anorexia are overcome by an obsession associated with refusing to eat, and most often associated with thoughts of losing weight. Such people may eventually stop eating enough to maintain a normal body weight. In addition to all, People suffering from anorexia may worry about their appearance, considering themselves too fat. However, as a rule, there are no reasons to think so. Moreover, some of these people simply look extremely thin and emaciated.
Refusal to eat by a person suffering from anorexia can take quite bizarre forms. For example, a person may refuse to eat in the presence of other people, or simply hide food in cabinets. There are even cases where people showed increased interest in preparing various dishes, but did not eat them themselves. There are also cases when a person completely refuses foods from certain groups, especially those that contain too much (in the opinion of the anorexic) fats and carbohydrates. Anorexics can also devote a lot of time to exhausting physical exercise, sometimes showing signs of so-called compulsive overeating (impulsive gluttony), which is then accompanied by vomiting. Some people specifically take emetics and even laxatives. Also many people take so-called diuretics, that is, diuretics. To cope with hunger pangs (those who have them!), anorexics can often take so-called suppressants, which include appetite suppressants.
People suffering from anorexia nervosa usually do not recognize or acknowledge that there is anything wrong with their eating habits. This phenomenon is especially common at the initial stage, when an anorexic person does not want to admit that he has any psychological disorder. Anorexia is in many ways similar to bad habits, such as drunkenness and drug addiction - it is extremely difficult to convince a person that he is an alcoholic or drug addict. A person suffering from anorexia has a dulled emotional perception of what is happening, and if such a person decides to lose weight and starts following a debilitating diet, it can be very difficult to stop. But we need to stop, because this psychological disorder is almost always associated with a deterioration in the physical condition of the body. Anorexia is a potentially extremely dangerous condition, and if not dealt with promptly, it could very well end in death.
CAUSES
The reasons that lead to anorexia are very complex and not always clear. However, experts around the world admit that a wide range of factors play a role in the development of this disorder, among which we can distinguish psychological, social, biological, cultural and even hereditary factors. Some scientists have suggested that even genetic factors may underlie the disorder, but this version has not received support among other specialists due to the lack of clear evidence in its favor. However, research is still ongoing. So, all of the above factors, according to experts, can make a serious contribution to the emergence and development of anorexia nervosa in people susceptible to this disorder.
According to many researchers, a significant contribution to the spread of anorexia was made by the media, which actively advertised a certain image of a woman with an “ideal” figure. Young women all over the world are literally bombarded with a huge number of advertising images, the main characters of which are extremely thin girls who look more like concentration camp prisoners. This image put a lot of pressure on social stereotypes regarding beauty standards. However, some researchers believe that such an advertising image, nurtured by the media, is only a reflection of trends and moods in society.
As mentioned above, anorexia nervosa is more likely to manifest itself in those young people who have been influenced by any difficult life circumstances at a certain age level. The age group most susceptible to developing anorexia includes young people aged 16 to 24 years. It is assumed that such young people have experienced some kind of emotional or physical shock, manifested in a syndrome of increased anxiety. People suffering from anorexia often also suffer from extremely low self-esteem; many of them believe, for example, that they do not deserve love. These thoughts are reinforced by the desire to look beautiful and have a slim body, since, according to anorexics, this is what will help them feel like full members of society. An important factor that spurs the desire to lose weight in such people is the approval that they receive from relatives, friends and other people around them at the early stage of losing weight.
In some people, family members unwittingly influence the development of anorexia. It is known that people suffering from anorexia very often come from families in which high demands and expectations are placed on each family member. Such people are often characterized as perfectionists, ambitious careerists who strive to achieve the highest level of success in all aspects of their lives. In such families, people depend on the opinions of other family members, so there can be no talk of any independent development. Moreover, the child gets used to it and is afraid of growing up. Thus, refusal to eat and the desire to maintain the development of one’s body within the framework of the existing body may be the anorexic's subconscious desire to remain a teenager (or child) for as long as possible. Ideally - always. Basically, this is a problem for teenage girls who are terrified of the changes in their body that occur in connection with the development of sexuality. They try to stop the onset of these changes by trying to keep their body in a thin state. It is noteworthy that this phenomenon is typical both for families in which parents are overly protective of their child, and for families in which parents do not pay attention to him. For example, this phenomenon is often found in families in which parents devote all their free time to their careers and earning money. Or the other extreme: this phenomenon can be found in families in which parents are prone to drunkenness or drug addiction. And even in a family in which the cult of food is nurtured, and the parents are real gluttons, a child may refuse food so as not to associate his image with the image of his parents.
SYMPTOMS
If we talk about documented cases of anorexia, then This psychological disorder was accompanied by the following symptoms:
-- Unwillingness to maintain a body weight that is at least 85 percent of the normal weight typical for a person of a particular age and height.
-- Panic fear of gaining excess weight and looking fat, whereas in reality the person looks extremely thin and emaciated.
-- A distorted perception of the image of one’s own body, which seems normal, but in fact, is more like a skeleton.
-- Simply too little body weight, unnatural thinness and an exhausted body.
-- Menstrual irregularities in girls (absence of at least three cycles in a row) against the background of extreme thinness. It is necessary to take into account, however, that taking contraceptives can lead to such a violation.
As a rule, all of the above symptoms are mandatory accompaniments of anorexia nervosa. In addition, the following manifestations are possible:
-- Vomiting, laxative abuse in an attempt to control your weight.
-- Use of suppressive drugs to suppress appetite. The most active and most addictive drug is pseudoephedrine.
-- Strict restrictions in terms of food - including quantity.
-- Obsessive-compulsive manifestations (impulsive gluttony, etc.).
-- Torture by excessively intense physical exercise.
-- Inappropriate reaction to everything related to food.
-- Decreased sexual desire.
-- Denial of the presence of an obvious problem with excessive thinness and so on.
-- Refusal from normal daily activities.
-- Attempts to hide or disguise their condition by such actions as, for example, wearing large clothing, trying to hide food, artificially inducing vomiting, and so on.
-- Decline of conscious activity. Manifestation of drug and alcohol addiction.
Anorexia, among other things, is dangerous because it has a negative impact on all areas of a person’s life. Fasting can have the same effect as severe depression. A person feels extremely tired, suffers from absent-minded attention and loss of ability to concentrate, loses interest in everything that once interested him in life. All these manifestations lead to social and interpersonal conflict, from which not only the anorexic person himself suffers, but also his close circle.
The health consequences for a person suffering from anorexia can be, as mentioned above, extremely severe. Changes in health status are characterized by the following symptoms:
-- Abnormally decreased heart rate.
-- Dry skin that takes on a yellowish tint.
-- The appearance of hair in the form of a small fluff on the face and hands (a phenomenon called "lanugo", which is explained by the fact that the body thus tries to retain body heat).
-- Lack of energy and fatigue when doing even a little activity.
-- Intolerance to cold - especially in the arms and legs.
-- Low blood pressure and dizziness.
-- Problems with the gastrointestinal tract, manifested in constipation and abdominal pain.
-- Hormonal disorders.
-- Swelling of the joints.
-- Increased fragility of hair and nails.
In particularly severe cases serious complications are possible, which manifest themselves in the following symptoms:
-- Heart rhythm disturbances.
-- Weakening of kidney function.
-- Anemia.
-- Extremely low blood pressure.
-- The appearance of erosion of tooth enamel due to constant vomiting.
-- Decreased bone strength (osteoporosis).
These complications pose the greatest threat not only to the general health of the anorexic, but also to his life.
DISEASE DEVELOPMENT
As mentioned above, anorexia is most common in women (90 percent of cases), and usually appears during adolescence or very young adulthood. According to various information sources, the number of Russian girls suffering from anorexia is at least one percent, and a maximum of ten percent. But most experts agree on an average of five percent. For comparison, in the same United States of America, 0.5 percent of girls aged 13 to 19 suffer from anorexia nervosa.
Experts consider anorexia a chronic disease that has a very ambiguous course. Some researchers have noted numerous cases of self-healing without any treatment. Most often, relief occurs after using some combination of measures to treat anorexia. Repeated relapse is often observed, consisting of weight fluctuations. Unfortunately, there are cases when severely manifested complications of the disease end in death.
As is the case with many other diseases, doctors report more favorably on the progress of treatment in cases where the disorder is noticed early in its development and adequate treatment for anorexia is offered before it becomes advanced. People with mild cases of anorexia who do not require hospitalization generally have the best chance of coping with the condition. Approximately 70 to 80 percent of people with this disorder recover quite successfully, thanks to generally accepted treatment methods.
However, anorexia very often demonstrates resistance to many types of treatment, and also tends to reappear some time after the first small successes in treatment. Approximately 50 percent of people with anorexia return to their normal weight, but nearly half continue to suffer from other symptoms and problems such as depression, increased levels of anxiety, problems with social adjustment and communication with loved ones. Some of the unfortunate people fall into extreme states. For example, there have been cases of bulimia, a mental disorder manifested in increased appetite associated with a feeling of extreme hunger. Usually such manifestations end in overeating and even attempts to artificially induce vomiting.
RISK FACTORS
Anorexia nervosa very often begins with a normal diet, gradually manifesting itself in a manic desire to control one’s own body weight. For example, if a person initially denied himself dessert for dinner for some time, then he may begin to deny himself the whole dinner. Of course, this sign cannot be used to determine which women on a diet belong to the risk group for anorexia. However, there are observations demonstrating that, for example, sudden weight loss (from one to one and a half kilograms per week) is more likely to lead to the development of anorexia nervosa. Smoother weight loss associated with the consumption of a certain amount of calories per day (more than 1400 calories), to a lesser extent threatens with serious eating disorders and even more so with anorexia.
As mentioned above, anorexia can begin unexpectedly after some event has occurred in a person’s life, which turned into severe stress for him. But in some cases, even seemingly harmless events can cause particularly susceptible people to refuse to eat. Such changes in the behavior of adolescents or a young girl (less often a guy) can be considered signs that the individual may belong to a risk group. That is why special attention should be paid to how the behavior of such young people will change in the future and whether such changes will lead to a psychological disorder such as anorexia.
WHEN DO YOU NEED A DOCTOR'S HELP?
As mentioned above, some cases of anorexia may go away, as it were, on their own. However, it is necessary to seek medical help without delaying this decision, if you see a friend or loved one exhibiting the following symptoms:
-- If there is significant weight loss in a short period of time.
-- If there are constant refusals to eat.
-- If there is an excessive craving for various debilitating diets.
-- Despite the pronounced thinness a person complains of being overweight.
-- Constantly cuts back on her diet, worrying about extra calories.
-- Every time after meals he takes laxatives, diuretics, diet pills and emetics.
-- Feels dizzy, faints, and expresses extreme feelings of apathy.
-- Constantly complains of changing heart rhythm.
-- Observed unhealthy hyperactivity and sleep problems.
-- If he denies the existence of a problem, despite its obviousness.
-- If there are mental complications, manifested, for example, in depression.
DIAGNOSIS
Unfortunately, it can be very difficult to diagnose the presence of this disorder in a person suffering from anorexia for the simple reason that anorexic person does not want to admit the presence of the disease (or is unable to do so) and goes to all sorts of tricks to hide the problem. Leaving aside the group of girls who clearly suffer from problems associated with anorexia, a huge group of adolescents and young women show signs of the disorder, which, according to experts, can easily result in full-blown anorexia. That is why you should pay special attention to these warning signs. Anorexia nervosa should be identified at a stage when a girl just starts to lose weight and continues to actively complain about being overweight. It doesn’t matter how much weight this person has lost. Sometimes simple blood and urine tests are enough to determine other possible causes of sudden weight loss.
Diagnosing anorexia is also complicated by the fact that there is some analogy between this disease and another mental disorder - bulimia nervosa. As mentioned above, bulimia nervosa is a condition characterized by actual binge eating followed by an inadequate strategy to prevent excess weight gain. In other words, a person takes emetics and laxatives, and can also exhaust himself with excessively intense physical training. Many girls suffering from anorexia exhibit the same symptoms as with bulimia at different periods in the development of the disease, that is, the person begins to eat a lot, while taking emetics and laxatives. Usually, the reason why an anorexic can lose control of himself and indulge in gluttony is extremely simple– a person begins to feel intense hunger. After this, as a rule, awareness of what happened occurs, followed by the use of emetics and laxatives.
TREATMENT
The main goal that a specialist should set for himself when trying to cure a person with anorexia is detection of psychological personal and interpersonal factors underlying this disease. The weight lost by a sick person should be restored in an extremely careful and humane manner. It is very important that weight restoration be the primary point of recovery that doctors will observe; only then, as weight is restored, the girl suffering from anorexia should be returned to a normal diet. Understanding the underlying problems early on can help stop the disorder from progressing further. In general, Anorexia treatment is most effective when it consists of multifunctional activities, including psychotherapy, nutritional advice and constant medical supervision.
Many experts consider a very important point in the fight against anorexia to be the development of individual programs for the treatment of this disorder, which would take into account all the needs of the individual suffering from this disease. Correct treatment must also take into account the stage of the disease and the patient’s personal desire to participate in treatment. If the anorexic person is severely malnourished, hospitalization may be recommended. Typically, this occurs when the anorexic has lost approximately 25 percent of healthy body weight, or when fasting has led to some physical complications in the body. Hospitalization may also be prescribed in cases where outpatient treatment has not brought any positive results. Also, admission to the hospital is carried out if a person suffering from anorexia tried to commit suicide, or has demonstrated any other obvious mental health complications. In this case, as a rule, stricter control and monitoring of the patient is prescribed.
Undoubtedly, the first step in curing anorexia should be individual psychotherapy - methods of influencing the psyche of an anorexic with words for therapeutic purposes. An additional and very important measure is the development of a special diet. If a person receives treatment at home, then a very important point in treatment is the support of family and friends. To do this, specialists must develop methods of psychotherapy with the involvement of family members of the patient. Collective psychotherapy can be very useful when treatment takes place in a group of people suffering from a similar problem. This treatment is also less expensive.
Dietary control and regular medical care are essential to complement all of the above forms of psychotherapy. Returning to a normal diet will bring the desired results faster if it is carried out with the active participation of the patient. The anorexic is gradually taught to consume an adequate amount of calories. Since we are talking about changing a behavioral response related to nutrition, the carrot method, so to speak, can be very effective, that is, a certain reward system that plays a major role in the mechanisms for reinforcing behavior. However, specialists should be extremely careful when developing such a reward system. Although it is very important to praise and reward a sick person for his achievements on the road to recovery, such rewards can lead to relapse of the disease, since it is not always possible to successfully and quickly cope with the task of restoring healthy body weight. Many experts advise in special cases the use of certain antidepressants and relaxants, which can also lead to a positive effect.
PREVENTION MEASURES
As you know, the most effective measures to treat any disease are measures to prevent its occurrence. Unfortunately, There are no clearly approved measures to prevent anorexia, but there are some recommendations from specialists that can reduce a person's risk of developing this mental disorder.
-- Parents, teachers and educators can help the child focus on an adequate self-image and on creating a positive image of his personality.
-- Parents need to focus their attention on carrying out certain educational work, which will help the child not to take any flaws in his own appearance and extra pounds too seriously.
-- Parents should under no circumstances judge their child for having extra pounds, or in any way focus attention on the disadvantages of excess weight, if the child has one.
-- Parents should conduct preventive conversations with their children, which will focus on the disadvantages of intensive fasting. Instead, you should pay attention to improving the child’s diet.
-- Parents should take an interest in the child’s life in order to notice in time suspicious changes in his eating habits, or the emergence of a desire to adhere to a strict diet.
-- Ideally, of course, a child should be protected from the information flow advertising the anorexic image of a modern teenager, which falls on him from TV screens, computers and from the pages of modern fashion magazines.
is a mental disorder that belongs to the group of eating disorders, characterized by non-acceptance of body image, refusal of food, creation of obstacles to its absorption and stimulation of metabolism in order to lose weight. The main symptoms are avoiding food intake, limiting portions, exhausting exercise, taking medications that reduce appetite and speed up metabolism, weakness, apathy, irritability, and physical ailments. Diagnosis includes clinical interview, observation and psychological testing. Treatment is carried out using psychotherapy, diet therapy and medication correction.
ICD-10
F50.0 F50.1
General information
Translated from ancient Greek, the word “anorexia” means “absence of the urge to eat.” Anorexia nervosa often accompanies schizophrenia, psychopathy, metabolic diseases, infections and gastrointestinal diseases. It may be a consequence of bulimia or precede it. The prevalence of anorexia is determined by economic, cultural and individual-family factors. In European countries and Russia, the epidemiological indicator among women from 15 to 45 years old reaches 0.5%. Worldwide rates range from 0.3 to 4.3%. The peak incidence is observed among girls 15-20 years old; this group of patients accounts for up to 40% of the total number of patients. Anorexia is rare among men.
Causes of anorexia
The etiology of the disease is polymorphic. As a rule, the disease develops due to a combination of several factors: biological, psychological, micro- and macrosocial. The high-risk group includes girls from socially prosperous families, characterized by a desire for excellence and having a normal or increased BMI. Possible causes of the disease are divided into several groups:
- Genetic. The likelihood of illness is determined by several genes that regulate the neurochemical factors of eating disorders. To date, the HTR2A gene, encoding the serotonin receptor, and the BDNF gene, which affects the activity of the hypothalamus, have been studied. There is genetic determination of certain character traits that predispose to the disease.
- Biological. Eating behavior is more often disturbed in people with overweight, obesity and early menarche. It is based on dysfunction of neurotransmitters (serotonin, dopamine, norepinephrine) and excessive production of leptin, a hormone that reduces appetite.
- Microsocial. An important role in the development of the disease is played by the attitude of parents and other relatives to nutrition, excess weight and thinness. Anorexia is more common in families where relatives have a confirmed diagnosis of the disease, where neglect of food and refusal to eat are demonstrated.
- Personal. Individuals with an obsessive-compulsive personality type are more susceptible to the disorder. The desire for thinness, starvation, and exhausting stress are supported by perfectionism, low self-esteem, uncertainty, anxiety and suspiciousness.
- Cultural. In industrialized countries, thinness is proclaimed one of the main criteria for a woman’s beauty. The ideals of a slim body are promoted at different levels, creating in young people the desire to lose weight in any way.
- Stressful. The triggering factor for anorexia can be the death of a loved one, sexual or physical violence. In adolescence and young adulthood, the cause is uncertainty about the future and the inability to achieve desired goals. The process of losing weight replaces areas of life in which the patient fails to realize himself.
Pathogenesis
The key mechanism for the development of anorexia is a painful distortion of the perception of one’s own body, excessive concern about an imaginary or real defect - dysmorphophobia. Under the influence of etiological factors, obsessive, delusional thoughts about excess weight, one’s own unattractiveness, and ugliness are formed. Usually the image of the bodily “I” is distorted; in reality, the patient’s weight corresponds to the norm or slightly exceeds it. Under the influence of obsessive thoughts, emotions and behavior change. Actions and thoughts are aimed at losing weight and achieving thinness.
Strict dietary restrictions are introduced, the food instinct and the instinct of self-preservation are inhibited. Lack of nutrients activates physiological protective mechanisms, metabolism slows down, and the secretion of digestive enzymes, bile acids and insulin is reduced. The process of digesting food initially causes discomfort. In the later stages of anorexia, food absorption becomes impossible. A state of cachexia occurs with a risk of death.
Classification
There are several stages during the course of anorexia. Not the first, the initial one, the patient’s interests gradually change, ideas about the beauty of the body and its attractiveness are distorted. This period lasts for several years. Then comes the stage of active anorexia, characterized by a pronounced desire to lose weight and the formation of appropriate behavior. At the final, cachectic stage, the body is exhausted, the patient’s critical thinking is impaired, and the risk of death increases. Depending on the clinical signs, three types of the disease are distinguished:
- Anorexia with monothematic dysmorphophobia. The classic version of the disease is that a persistent idea of losing weight is supported by appropriate behavior.
- Anorexia with periods of bulimia. Periods of fasting and severe food restriction alternate with episodes of disinhibition and decreased focus, during which gluttony develops.
- Anorexia with bulimia and vomitomania. Fasting periodically gives way to gluttony and subsequent provocation of vomiting.
Symptoms of anorexia
A mandatory symptom of the disease is a conscious limitation of the amount of food consumed. It can appear in different forms. In the early stages of the disease, patients lie to others about feeling full before it occurs, and chew food for a long time to create the appearance of prolonged and plentiful consumption. Later, they begin to avoid meeting with relatives and friends at the dinner table, find a reason not to attend family dinners and lunches, talk about an allegedly existing disease (gastritis, stomach ulcers, allergies) that requires adherence to a strict diet. At the late stage of anorexia, complete cessation of eating is possible.
To suppress appetite, patients resort to taking chemicals. Psychostimulants, some antidepressants, tonic mixtures, coffee and tea have anorexigenic effects. As a result, dependence and addictive behavior are formed. Another common symptom of anorexia is attempts to increase metabolism. Patients exercise a lot, actively visit saunas and steam baths, and wear several layers of clothing to increase sweating.
To reduce the absorption of food, patients artificially induce vomiting. They provoke vomiting immediately after eating, as soon as it becomes possible to get into the toilet. Often this behavior occurs in social situations when it is impossible to refuse to eat with other people. At first, vomiting is induced mechanically, then it occurs independently, involuntarily when entering a suitable environment (toilet, private room). Sometimes, to quickly get rid of fluids and food, patients take diuretics and laxatives. Diarrhea and diuresis can gradually become the same involuntary acts as vomiting.
A common manifestation of a behavioral disorder is food excess, or food binge. This is an uncontrollable bout of eating large amounts of food in a short period of time. With eating excess, patients cannot choose foods, enjoy the taste and regulate the amount of food eaten. “Binge drinking” occurs in solitude. It is not always associated with a feeling of hunger; it is used as a way to calm down, relieve stress, and relax. After overeating, feelings of guilt and self-loathing, depression and suicidal thoughts develop.
Complications
Without psychotherapeutic and drug help, anorexia leads to a variety of somatic diseases. Most often, young people experience delayed growth and sexual development. Pathologies of the cardiovascular system are represented by severe arrhythmias, sudden cardiac arrest due to a deficiency of electrolytes in the myocardium. The patients' skin is dry, pale, pasty and swollen due to a lack of proteins. Complications from the digestive system include chronic constipation and cramping abdominal pain. Endocrine complications include hypothyroidism (hypothyroidism), secondary amenorrhea in women, and infertility. Bones become fragile, fractures become more frequent, and osteopenia and osteoporosis develop. Substance abuse and depression increase the risk of suicide (20% of all deaths).
Diagnostics
Anorexia is an independent nosological entity and has clear clinical signs that are easily recognized by psychiatrists and psychotherapists. Diagnosis has a high level of agreement between clinicians and is reliable, but can be complicated by patient dissimulation - deliberate concealment, concealment of symptoms. Differential diagnosis involves the exclusion of chronic debilitating diseases and intestinal disorders, sudden weight loss against the background of severe depression.
The diagnosis is established on the basis of the clinical picture; in some cases, psychodiagnostic questionnaires are used (Cognitive-behavioral patterns for anorexia nervosa). Anorexia is confirmed if the following five signs are present:
- Body weight deficiency. The patient's weight is at least 15% less than normal. BMI is 17.5 or lower.
- Patient initiative. Weight loss is caused by the active actions of the patient himself, and not by somatic diseases or external situational conditions (forced hunger). Avoidance, evasion of meals, open refusal to eat, provocation of vomiting, taking medications and excessive physical activity are revealed.
- Obsession and body dysmorphic disorder. With anorexia, there is always a patient's dissatisfaction with his body, an inadequate assessment of weight and appearance. The fear of obesity and the desire to lose weight become overvalued ideas.
- Endocrine dysfunction. Hormonal imbalances affect the hypothalamic-pituitary-gonadal axis. In women they manifest themselves as amenorrhea, in men – loss of libido, decreased potency.
- Delayed puberty. At the onset of anorexia in puberty, secondary sexual characteristics are not formed or are formed with a delay. Growth stops, in girls the mammary glands do not enlarge, in boys the genitals remain juvenile.
Treatment of anorexia
The intensity and duration of therapy depends on the severity of the pathology, its causes, the patient’s age, his mental and physical condition. Treatment can be carried out on an outpatient or inpatient basis, sometimes in an intensive care unit, and is aimed at restoring physical health, forming an adequate opinion about one’s own body, and normalizing the diet. Comprehensive patient care includes three components:
- Diet therapy. The nutritionist tells the patient and his relatives about the importance of sufficient intake of nutrients, explains the body's needs and the consequences of fasting. The treatment menu is compiled taking into account the patient’s taste preferences. To restore normal nutrition and gain weight, the caloric content of the diet increases gradually over several months. In severe cases, glucose solutions are first administered intravenously, then the patient begins to consume nutritional mixtures and only then proceeds to regular food.
- Psychotherapy. The most effective direction is cognitive behavioral psychotherapy. At the initial stage, conversations are held during which the characteristics of the disease, its possible consequences, and whether the patient has a choice are discussed. A positive perception of personality and body image is formed, anxiety is reduced, and internal conflict is resolved. At the behavioral stage, techniques are developed and mastered to help restore a normal diet, learn to enjoy food, movement and communication.
- Medication correction. To accelerate puberty, growth and strengthening of skeletal bones, sex hormone replacement therapy is prescribed. H1-histamine blockers are used for weight gain. Neuroleptics eliminate obsessive-compulsive symptoms and motor agitation, and promote weight gain. Antidepressants are indicated for depression, SSRIs are used to reduce the risk of relapse in patients with restored nutrition and weight gain.
Prognosis and prevention
The outcome of anorexia is largely determined by the time of initiation of therapy. The earlier treatment is started, the more likely the prognosis is favorable. Recovery often occurs with an integrated therapeutic approach, family support and elimination of factors that provoke the disease. Prevention should be carried out at the level of the state, society and family. It is necessary to promote a healthy lifestyle, sports, a balanced diet and normal weight. In the family, it is important to maintain the tradition of sharing food, which is associated with positive emotions, teach children how to prepare balanced meals, and develop a positive attitude towards appearance.