Anorexia nervosa is a potentially life-threatening eating disorder. This is a severe mental disorder, which is characterized by either a significantly reduced appetite or a complete aversion to food.
A patient with anorexia nervosa, often referred to simply as "anorexia" (although the meaning is different), has a distorted body image and an exaggerated fear of being overweight and obese, and therefore makes a deliberate effort to reduce his weight.
Anorexia should not be confused with anorexia nervosa.
- Anorexia is a general loss of appetite or interest in food.
- Anorexia nervosa is a severe mental illness. The patients did not "lose" interest in food, they intentionally limited their food intake due to their irrational fear of becoming fat.
However, common people often use the term "anorexia" when referring to a serious mental disorder.
Anorexia nervosa is defined by the National Library of Medicine as an eating disorder that causes a patient to lose more weight than is considered normal for his or her height and age.
A person with anorexia may be underweight but still have a strong fear of gaining it. Such people may exercise too much, eat too strict a diet, use laxatives, and use other methods to become thinner.
Anorexia nervosa usually begins in adolescence or early adulthood. It is the third most common chronic disease among adolescents.
The National Association of Anorexia Nervosa and Related Disorders (USA) says that 85-90% of all patients with this disease or bulimia nervosa are women.
Many studies have found that patients with anorexia nervosa have an increased risk of suicide. A study published in the journal PLoS ONE found that of eating disorders, anorexia nervosa had the highest rates of completed suicides, but not of attempted ones.
However, scientists in the American Journal of Public Health write that "the results suggest that the suicide rate among people currently suffering from anorexia nervosa is not elevated."
James Locke, MD, professor of psychiatry and behavioral sciences at Stanford University School of Medicine, says anorexia nervosa kills about one in ten patients with it (all causes, not just suicide).
Causes of Anorexia Nervosa
Anorexia nervosa does not have a single cause. The National Health Service (UK) says that most experts believe that mental illness is caused by a combination of biological, environmental and psychological factors.
It is believed that some people have personality traits that make them more likely to develop the disease.
Being underweight and not eating a healthy diet can have an effect on the brain, reinforcing the behaviors and intrusive thoughts associated with anorexia nervosa. In other words, malnutrition and underweight can start a cycle of further weight loss and malnutrition.
The following risk factors are associated with anorexia nervosa:
- Over-obsession with rules.
- Tendency to depression.
- Excessive concern about your weight and shape.
- Excessive worry, doubt and/or fear about your future.
- Perfectionism.
- Having a negative self-image.
- Eating problems in early childhood or infancy.
- The presence of anxiety disorders in childhood.
- Adherence to specific cultural/social ideas regarding beauty and health.
- Suppression - a person restrains or controls their behavior and expression.
environmental factors
Environmental factors may include hormonal changes during puberty, feelings of anxiety, stress, and low self-esteem.
Many experts believe that some young women in Western culture who are exposed to numerous media reports that being thin is beautiful are more likely to develop anorexia nervosa.
However, a study conducted at the University of Granada (Spain) found that the frequency of eating disorders was significantly higher among Muslim teenagers than among their Christian peers.
Other environmental factors that some experts believe may contribute to the development of the disease include physical and sexual abuse, family relationship problems, bullying, stress at school (such as exams), bereavement, stressful life events (such as a breakup). relationship or dismissal).
Biological factors
According to the National Eating Disorders Association, research has found that some people with eating disorders may have imbalances in certain chemicals that control digestion, appetite, and hunger. No one knows what the consequences of this may be - further research is underway to find out about this.
Experts believe that the tendency to develop eating disorders may be due in part to a person's genes. In many cases, anorexia nervosa, bulimia nervosa and other eating disorders have run in families.
A symptom is something that the patient feels and describes (such as pain), while a sign can be detected by others (such as a rash).
According to the University of Maryland Medical Center, severe weight loss is the main symptom of anorexia nervosa. Patients typically try to reduce their weight by severely restricting their food intake.
In order to speed up weight loss, people may take laxatives and induce vomiting after eating, and exercise excessively.
In all cases, the patient insists that she or he is overweight.
Physical signs and symptoms of anorexia nervosa
- severe weight loss
- Lethargy, fatigue, exhaustion
- Hypotension - blood pressure below normal
- Hypothermia - reduced body temperature
- Stomach upset
- Bloating
- Dry skin
- Cold hands and feet
- Swelling of hands and feet
- Alopecia - hair loss
- Absence of menstruation (or it is much less common)
- Infertility
- Insomnia
- Osteoporosis - decreased bone density
- Brittle nails
- Arrhythmia – irregular/irregular heart rhythm
- Bad breath and tooth decay - caused by acid in vomit
- Lanugo - thin fluffy hair growing all over the body
- More facial hair
- Constipation
- Dizziness
Psychological symptoms and signs of anorexia nervosa
- Underweight patients insist they are overweight.
- Vomiting after eating.
- Patients are often weighed, look at themselves in the mirror and measure their size.
- Obsessive thoughts about food - a person can spend a lot of time reading recipes and cookbooks.
- Patients lie about what they ate.
- Do not eat, refuse to eat.
- Lack of emotion.
- Depressed mood.
- Decreased libido (sex drive).
- Memory deterioration.
- Self-denial - Patients refuse to admit that they have a problem or a serious illness.
- obsessive-compulsive behavior.
- Irritability.
- Excessive exercise.
Examination and diagnostics
Patients who are diagnosed with eating disorders early and treated appropriately have better outcomes.
Diagnosing eating disorders can be difficult. If a doctor finds a low BMI (body mass index), heart rhythm disturbances, skin changes, gastrointestinal disturbances, and other signs that indicate anorexia nervosa, they may order additional testing to rule out other conditions.
The following medical problems may have similar signs and symptoms associated with eating disorders: diabetes mellitus, Addison's disease, chronic infections, malabsorption syndrome, immunodeficiency, inflammatory bowel disease, cancer, and hyperthyroidism.
Diagnostic tests may include:
- Blood tests – complete blood count, electrolyte and protein levels. Blood tests can show if the kidneys, liver, and thyroid are functioning normally.
- Imaging examination - to detect heart problems, bone fractures and pneumonia.
- Electrocardiogram - to detect cardiac abnormalities.
Diagnostic criteria for anorexia nervosa ( DSM-5)
- The patient does not want to maintain a body weight that is at least the minimum normal weight for his or her height and age.
- Even if the patient is underweight, he has a strong fear of becoming fat or gaining weight.
- The patient refuses to admit that he has a serious problem with low body weight, or that he has a distorted idea of his shape or appearance.
Many physicians feel that these criteria are too strict because they do not include patients who clearly have an eating disorder and are in need of medical attention.
Ideally, treatment should consist of a combination of medication, psychotherapy, family therapy, and nutritional counseling.
Although involving the anorexic patient in the treatment process is sometimes difficult, his or her participation is important. Cooperation and recognition of the existence of a medical and psychological problem can be unsustainable. Treatment is often long-term and patients may experience relapses, especially when they experience periods of stress.
Patients need a comprehensive treatment plan specifically designed to meet their needs. Treatment has the following goals:
- Restoring the patient's weight to normal levels.
- Treatment of emotional problems, including low self-esteem.
- Correction of distorted thinking.
- Helping the patient develop behavioral changes that will last for a long time.
Psychotherapy
Individual counseling is aimed at changing the thinking (cognitive therapy) and behavior (behavioral therapy) of the patient.
The patient is taught how to develop a healthy attitude towards nutrition and body weight, how to respond effectively to stressful or difficult situations.
Support from family and friends is an important component of a successful and sustainable treatment outcome. Family members need to understand what anorexia is and quickly identify its symptoms and signs. Family therapy has been proven to help patients significantly.
Medical therapy
There is no specific treatment for anorexia nervosa. A doctor may prescribe medications to control anxiety and obsessive-compulsive disorder, or antidepressants.
Selective serotonin reuptake inhibitors (SSRIs) - a type of antidepressant - may be prescribed when the patient's weight is at least 95% of the normal weight for his or her height and age.
Olanzapine is a drug used to treat psychosis. It can be useful in cases where the patient is very concerned about their diet and weight.
Nutrition Counseling
The goal of counseling is to help the patient regain a healthy approach to body weight, nutrition, and food intake. Sometimes this requires comprehensive education about the role of a balanced diet in maintaining good health.
Hospitalization
In severe cases of weight loss, with persistent refusal to eat, psychiatric emergencies, hospitalization of the patient, up to compulsory treatment, may be necessary.
Complications of anorexia nervosa
Patients who are diagnosed with anorexia at an early stage and who have received the correct treatment, complications are much less common.
- Death – Eating disorders have the highest mortality rates of any mental illness. Between 5% and 10% of patients with anorexia die within 10 years of the onset of the disease (18-20% within 20 years).
- Cardiovascular problems - up to 95% of hospitalized patients have a low heart rate. These changes increase the risk of myocardial damage.
- Hematological problems - there is a high risk of developing leukopenia (low white blood cell count) and anemia (low red blood cell count).
- Gastrointestinal problems - peristalsis in the intestines slows down significantly if a person is severely malnourished and eats too little. This goes away when they start eating normally.
- Kidney problems - People with anorexia nervosa often suffer from dehydration, which in turn leads to high concentrations of urine. Patients have polyuria because the kidneys cannot concentrate urine. When the patient's weight returns to normal, the kidneys usually recover.
- Hormonal problems – Some patients with anorexia have low levels of growth hormones, which can lead to stunted adolescent growth. When the patient begins to eat healthy food, normal growth is restored.
Dear visitors of the site Farmamir. This article is not medical advice and should not be used as a substitute for consultation with a physician.
Anorexia nervosa is a psychological disorder that is characterized by a violation of the correct perception of one's body, fear of being overweight, limiting oneself in food and a further change in eating behavior, that is, a complete refusal to eat.
The risk group includes mainly young women, girls and boys who are in their transitional age.
Stages of development of the disease
There are several stages in the course of anorexia nervosa:
What is the root of evil?
There can be a lot of reasons for anorexia, and in each case, one of the unfavorable factors can play a decisive role in starting the disease. These include:
- Physiological features- completeness, early physical development, shortcomings in appearance.
- Traits- low self-esteem, lack of self-confidence, the desire to be better, a sense of inferiority, a tendency to idealize.
- Psychological trauma.
- Socio-cultural factors. Such motives are due to the desire to comply with the norms and trends dictated by modern fashion.
- Heredity. A lot of studies have shown that there is a certain gene that can form a tendency to this pathology, that is, in the presence of other unfavorable factors, anorexia may develop in individuals predisposed to the disease.
Of great importance is the presence in the patient's family of relatives who suffered from mental disorders and alcoholism.
What does it look like in real life?
All manifestations of the disease can be divided into several groups. External symptoms of anorexia nervosa include:
Psychological signs:
- irritability and depression;
- emotional instability;
- memory impairment;
- inability to concentrate for a long time;
- appetite suppression;
- constant fear of gaining weight;
- low self-esteem, obvious dissatisfaction with oneself;
- obsession with sports;
- striving to be perfect;
- feelings of guilt and anxiety.
Behavioral signs:
Anorexia Nervosa Tests and Diagnosis
If symptoms of the disease appear, you should immediately consult a specialist. To make an accurate diagnosis, the following methods are used:
- Personal conversation with the patient or his relatives. The conversation is carried out in order to determine the risk factors for the development of the disease, identify symptoms and existing complications.
- Body mass index calculation. To do this, use a special formula: weight in kilograms divided by height in square meters. For example, if the body weight is 65 kg with a height of 1 meter 75 centimeters, then the BMI will be 22.5. The optimal indicator is considered to be from 18.5 to 24.99. Indicators below this may indicate pathology.
- Analysis of blood, urine, hormones- is carried out to determine the decrease in hemoglobin levels, hormone deficiency and violations of water and electrolyte balance.
- X-ray of the skeleton- Shows thinning of the bones.
- Ultrasound of the stomach and intestines- detects diseases.
- Electrocardiography- detects heart disease.
Comprehensive Therapy Approach
The treatment of a patient with anorexia nervosa has three main goals:
- return to normal physical condition;
- return to the correct diet;
- self-image correction.
Primary Therapy
The form of therapy will be selected taking into account the degree of the disease. Basically, treatment is carried out in a hospital under the strict supervision of doctors.
In patients with severe anorexia, normalization of body weight is carried out gradually - starting from 0.5 kg to 1.5 kg per week. An individual diet is prescribed, which ensures that the body receives the required amount of nutrients.
The diet will be based on the degree of malnutrition, BMI and symptoms of any micronutrient deficiencies. For example, with a decrease in bone density, food should contain a large amount of calcium.
It is very good if the anorexic does not reject food and eats on his own. Otherwise, force-feeding is carried out using a probe.
Medical therapy
Treatment with drugs involves the relief of complications of the disease. In this case, the following will be assigned: 
- hormonal agents- in violation of the menstrual cycle;
- calcium preparations, vitamin D- with a decrease in bone density;
- antidepressants: Prozac, Olanzapine - to eliminate mental disorders.
The duration of the course of treatment and dosage can be determined solely by the attending physician.
Psychotherapy
Psychological assistance in this case plays a huge and sometimes decisive role. The main task of the specialist is to identify the negative thoughts and feelings that are defining for an eating disorder and replace them with healthy adequate beliefs.
It is also very important to teach the patient to independently cope with negative emotions, problems in interpersonal relationships and direct their feelings in a positive direction.
In the treatment of anorexia, two areas of psychotherapy are used:
- family- for adolescent patients;
- behavioral- for adult patients.
The duration of the course will depend on the patient himself. In some cases, it may take several years.
Consequences of the disease
Nervous-psychic anorexia is fraught with very serious consequences. Here are some of them:
- Violation of the cardiovascular system.
- Pathological disorders in the endocrine system against the background of a decrease in the production of triiodothyronine and thyroxine (thyroid hormones) and sex hormones. As a result of this, not only menstruation stops, but reproductive function also decreases, that is, the girl may subsequently not have children.
- Fragility of bones due to calcium deficiency in the body. Such people systematically suffer from various fractures.
- Inflammation of the esophagus and deterioration of tooth enamel due to the action of stomach acid, which is released during the constant provocation of vomiting.
- Disorder of the psycho-emotional sphere- such people are constantly depressed, irritable, emotionally unstable.
- The most terrible consequence of anorexia is fatal outcome, which can happen if you do not pay attention to this problem at the wrong time and let the situation take its course.
What to do relatives
The role of relatives in the rehabilitation of anorexic is simply enormous. If such a problem has appeared in the family, you need to understand exactly how to behave. Here are some useful rules that will help you choose the right course of action:
- first of all, you should go for a consultation with a psychologist;
- be a role model - healthy eating, good physical shape, sports;
- in no case do not criticize the appearance of others;
- avoid threatening and intimidating tactics;
- protect the patient from the influence of any negative emotions and stress;
- provide full psychological support.
Only if you follow these instructions and with the right timely treatment, you can achieve good results and return a loved one to a normal state.
The danger of the disease lies in the fact that the anorexic does not really understand that he is sick and wants to lose weight more and more. He does not perceive the words of others that he has lost weight, it seems to him that this is not true.
Little depends on the patient himself in such a situation, he is obsessed with his fixed idea, therefore it is the family that should take part in the process of his return to normal life.
Anorexia nervosa is a disease that is more common in adolescents and young adults, more often in women. This pathological process is characterized by a deliberate refusal of food, which ultimately leads to a critical decrease in body weight and complete exhaustion. In some cases, an irreversible pathological process takes place, which leads to death.
It should be understood that this disease is psychological in nature. In this case, a person does not adequately and loyally evaluate his body, even with a critically low weight, he believes that he has excess weight, and against this background he refuses food completely or adheres to a strict diet. Based on this, we can say that anorexia nervosa in adolescents and adults requires an integrated approach to treatment. According to the international classification of diseases of the tenth revision (ICD-10), this disease is assigned the code F 50.0.
Etiology
Anorexia on a nervous basis can be due to the following etiological factors:
- psychological impact on a person - insults, negative statements regarding his figure, weight;
- psychological illnesses;
- pathological fear of gaining excess weight;
- the impact of the environment;
- disharmonic teenage crisis.
Separately, it is necessary to highlight the risk factors in the development of this pathological process:
- genetic - the 1p34 gene, which is activated during strong and excessive nervous strain, can provoke the development of this disease;
- family - at risk are people who have relatives with this disease in the family;
- personal - low self-esteem, increased susceptibility to inadequate criticism from outside, moral pressure;
- anthropological - overcoming desire is also a fear of normal nutrition;
- social - imitation of someone, a fashion for excessive thinness.
Most often, the development of such a violation is due precisely to the psychological influence from the outside and the desire to follow fashion trends.
Classification
There are four degrees of development of this pathological process:
- preorexic - thoughts about the "fullness", the ugliness of one's figure appear, a person begins to look for ways to get rid of "extra" kilograms as quickly as possible;
- anorexic - almost complete starvation, weight is reduced to a critical minimum, but the person does not stop, but, on the contrary, tightens the diet;
- cachectic - almost complete absence of adipose tissue and exhaustion. An irreversible process of dystrophy of internal organs begins. In most cases, this stage is observed a year after the onset of the development of this pathological process.
At the last stage of the development of the disease, there is a high risk of death, since against the background of extreme exhaustion of the body and dystrophy of internal organs, concomitant diseases occur. At the same time, it should be noted that the protective functions of the body are almost completely absent, which leads to complications.
Symptoms
Signs of anorexia nervosa, as a rule, appear at the first or second stage in the form of such a clinical picture:
- categorical refusal of food, which manifests itself gradually - from the exclusion of nutritious food from the diet to the use of only mineral water;
- pale skin, hair loss, brittle nails;
- frequent dizziness;
- fainting states;
- violation of the heart rhythm;
- sensation of coldness in the whole body;
- exacerbation of existing chronic diseases;
- violation of the menstrual cycle, and as the pathological process worsens, the complete absence of menstruation;
- excessive sensitivity to physical influences;
- psychological disorders - sudden mood swings, apathy towards everything around, depression, suicidal tendencies;
- weakness, drowsiness.
Since the syndrome of anorexia nervosa is quite often observed in adolescents, some specific symptoms of the development of this disease should be highlighted separately:
- dissatisfaction with their figure, fear of obesity;
- constant calorie counting;
- radical diets;
- taking laxatives and diuretics, special preparations for weight loss;
- change in behavior - a teenager may abandon their usual pastime;
- can be observed to everything around;
- sudden mood swings, aggression, irritability;
- complaints of a constant feeling of coldness in the hands and feet;
- a teenager sharply denies his pathological thinness;
- aversion to food, inducing vomiting even with a minimal amount of food eaten.
Diagnostics
Initially, the psychotherapist conducts a conversation with the patient on the subject of complaints and his attitude to his illness, then the anamnesis of the disease and life is clarified with relatives. This is followed by a physical examination of the patient. To confirm the diagnosis are carried out:
- general and detailed biochemical blood test;
- general urine analysis;
- analysis for thyroid hormones;
- CT scan of the brain;
- Ultrasound of the abdominal organs.
The exact diagnostic program will depend on the current clinical picture. Based on the results of the examination, the doctor will determine the stage of development of the disease and prescribe the most effective course of treatment.
Treatment
The indication for hospitalization in anorexia nervosa is the 3-4 degree of development of the pathological process. Therapy for such a disease should be comprehensive, with drug treatment and a mandatory diet.
Medical treatment may include taking the following drugs:
- hormonal;
- antidepressants;
- sedatives;
- antiemetics;
- solutions for restoring water and electrolyte balance.
As for the diet, at the initial stage of treatment, only light, moderately high-calorie meals should be included in the diet. As the patient's condition improves, you can increase the calorie content of meals and the volume of servings. You should also consider the following nutritional recommendations for the patient:
- in especially severe cases, parenteral nutrition is carried out;
- food should be only liquid, in extreme cases, puree;
- meals should be frequent (5-6 times a day), but in small portions. Otherwise, the stomach will not be able to digest such a large amount of food;
- optimal drinking regime;
- it is recommended to include nutritional supplements that contain trace elements in the diet;
- if the patient's condition is not critical, then dietary table No. 11 according to Pevzner is prescribed.
In general, the diet is prescribed individually, depending on the stage of development of the disease, clinical indicators and the general condition of the patient.
Prognosis and possible complications
If treatment is started in a timely manner, then the development of serious complications can be avoided. Otherwise, the following dangerous changes are likely to develop:
- violation of the functioning of the central nervous system, which is due to insufficient nutrition of the brain;
- a decrease in the protective functions of the body, against which a person often gets sick;
- violation of mineral metabolism;
- acute;
In general, against the background of an exhausted organism, almost any pathological process can develop.
Prevention
- proper, balanced nutrition;
- exclusion of negative psychological impact;
- in the event of the appearance of severe emotional states, contact a neuropsychiatrist.
If you feel unwell, both physically and psychologically, you should consult a doctor, and not self-medicate.
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Diseases with similar symptoms:
Avitaminosis is a painful human condition that occurs as a result of an acute shortage of vitamins in the human body. Distinguish between spring and winter beriberi. There are no restrictions regarding gender and age group in this case.
- This is a mental disorder that belongs to the group of eating disorders, characterized by the rejection of the body image, the refusal of food, the creation of obstacles to its absorption and the stimulation of metabolism in order to reduce weight. The main symptoms are avoidance of food intake, restriction of portions, exhausting physical exercises, taking drugs that reduce appetite and speed up metabolism, weakness, apathy, irritability, physical ailments. Diagnosis includes clinical interview, observation and psychological testing. Treatment is carried out by methods of psychotherapy, diet therapy and drug 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. 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 in Russia, the epidemiological rate among women aged 15 to 45 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 is up to 40% of the total number of patients. Anorexia is rare in men.
Causes of anorexia
The etiology of the disease is polymorphic. As a rule, the disease develops with a combination of several factors: biological, psychological, micro- and macrosocial. The high-risk group includes girls from socially prosperous families who are distinguished by their striving for excellence and have a normal or increased BMI. Possible causes of the disease are divided into several groups:
- Genetic. The probability of disease 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 a genetic determinism of certain character traits that predispose to the disease.
- Biological. Eating behavior is more often disturbed in people with overweight, obesity and early onset of 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, overweight and thinness. Anorexia is more common in families where relatives have a confirmed diagnosis of the disease, which demonstrates the neglect of food, refusal to eat.
- Personal. The disorder is more prone to persons with an obsessive-compulsive personality type. The desire for thinness, starvation, exhausting loads are supported by perfectionism, low self-esteem, insecurity, anxiety and suspiciousness.
- Cultural. In industrialized countries, thinness is proclaimed one of the main criteria for the beauty of a woman. The ideals of a slim body are promoted at different levels, shaping the desire of young people to lose weight in any way.
- Stressful. Anorexia can be triggered by the death of a loved one, sexual or physical abuse. In adolescence and young age, the cause is uncertainty about the future, 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, own unattractiveness, and ugliness are formed. Usually the image of the bodily "I" is distorted, in reality the weight of the patient corresponds to the norm or slightly exceeds it. Under the influence of obsessive thoughts, emotions and behavior change. Actions and thoughts are aimed at weight loss, achieving thinness.
Strict dietary restrictions are introduced, the food instinct and the instinct of self-preservation are inhibited. The lack of nutrients activates physiological defense mechanisms, metabolism slows down, the secretion of digestive enzymes, bile acids and insulin decreases. The process of digesting food at first causes discomfort. In the later stages of anorexia, digestion becomes impossible. There is a state of cachexia with the risk of death.
Classification
During anorexia, several stages are distinguished. Not the first, initial, the patient's interests gradually change, the ideas about the beauty of the body, its attractiveness are distorted. This period continues for several years. Then comes the stage of active anorexia, characterized by a pronounced desire to reduce weight and the formation of appropriate behavior. At the final, cachectic stage, the body is exhausted, the critical thinking of the patient is disturbed, 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 - a persistent idea of losing weight is supported by appropriate behavior.
- Anorexia with periods of bulimia. Periods of fasting, severe restriction of food alternate with episodes of disinhibition, a decrease in focus, during which gluttony develops.
- Anorexia with bulimia and vomitomania. Starvation is periodically replaced by gluttony and subsequent provocation of vomiting.
Symptoms of anorexia
A mandatory symptom of the disease is a conscious restriction 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 sets in, chewing food for a long time to create the appearance of its long and plentiful consumption. Later, they begin to avoid meetings with relatives and friends at the dinner table, find a reason not to attend family dinners and dinners, talk about an allegedly existing disease (gastritis, stomach ulcer, allergies) that requires a strict diet. In the late stage of anorexia, a complete cessation of nutrition is possible.
To suppress appetite, patients resort to taking chemicals. Psychostimulants, some antidepressants, tonic mixtures, coffee and tea have an anorexigenic effect. 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 baths, put on several layers of clothing to increase sweating.
To reduce the absorption of food, patients artificially induce vomiting. They provoke a vomiting act immediately after eating, as soon as it becomes possible to get into the toilet room. Often this behavior occurs in social situations where it is impossible to refuse to eat with other people. First, vomiting is induced mechanically, then it occurs on its own, involuntarily when it enters a suitable environment (to a toilet, a secluded room). Sometimes patients take diuretics and laxatives to get rid of fluids and food as soon as possible. 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 food excess, patients cannot choose products, enjoy the taste and regulate the amount of food eaten. "Drinking" occurs in loneliness. It is not always associated with a feeling of hunger, it is used as a way to calm down, relieve tension, and relax. After gluttony, feelings of guilt and self-hatred develop, depression and suicidal thoughts develop.
Complications
Without psychotherapeutic and medical assistance, anorexia leads to a variety of somatic diseases. Most often in young people there is a delay in growth and sexual development. Pathologies of the cardiovascular system are represented by severe arrhythmias, sudden cardiac arrest due to electrolyte deficiency in the myocardium. The skin of patients is dry, pale, pasty and edematous due to lack of proteins. Complications from the digestive system are chronic constipation and spastic abdominal pain. Endocrine complications include hypothyroidism (hypothyroidism), secondary amenorrhea in women, and infertility. Bones become brittle, fractures become more frequent, osteopenia and osteoporosis develop. Substance abuse and depression increase the risk of suicide (20% of all deaths).
Diagnostics
Anorexia is an independent nosological unit and has clear clinical signs that are easily recognized by psychiatrists and psychotherapists. Diagnosis is characterized by a high level of agreement between clinicians, is reliable, but can be complicated by dissimulation of patients - conscious concealment, concealment of symptoms. Differential diagnosis involves the exclusion of chronic debilitating diseases and intestinal disorders, a sharp 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 in anorexia nervosa). Anorexia is confirmed when the following five signs are present:
- Deficiency in body weight. The weight of patients is less than normal by at least 15%. BMI is 17.5 or below.
- 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, avoidance of meals, open refusals of food, provocation of vomiting, medication and excessive exercise 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 reduce weight become overvalued ideas.
- endocrine dysfunction. Hormonal disorders affect the hypothalamic-pituitary-gonadal axis. In women, they are manifested by amenorrhea, in men - by loss of libido, a decrease in potency.
- Delayed puberty. At the onset of anorexia in puberty, secondary sexual characteristics are not formed or are formed late. Growth stops, the mammary glands do not increase in girls, the juvenile genitalia remain in boys.
Treatment of anorexia
The intensity and duration of therapy depends on the severity of the pathology, its causes, the age of the patient, his mental and physical condition. Treatment can be carried out on an outpatient or inpatient basis, sometimes in an intensive care unit, aimed at restoring somatic 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 needs of the body and the consequences of starvation. The treatment menu is compiled taking into account the taste preferences of the patient. To restore normal nutrition and weight gain, the caloric content of the diet is increased gradually over several months. In severe cases, intravenous glucose solutions are first administered, then the patient begins to consume nutrient mixtures, and only after that does he switch to regular food.
- Psychotherapy. The most effective direction is cognitive-behavioral psychotherapy. At the initial stage, conversations are held, during which the features of the disease, its possible consequences, and the choice of the patient are discussed. A positive perception of personality and body image is formed, anxiety is reduced, 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.
- Medical correction. To accelerate puberty, growth and strengthening of the bones of the skeleton, sex hormone replacement therapy is prescribed. H1-histamine blockers are used for weight gain. Antipsychotics eliminate obsessive-compulsive symptoms and motor arousal, promote weight gain. Antidepressants are indicated for depression, and SSRIs are used to reduce the risk of relapse in patients with refeeding and weight gain.
Forecast 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. Recovery often occurs with a comprehensive therapeutic approach, family support and the 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 traditions of sharing food associated with positive emotions, to teach children how to cook balanced meals, and to form a positive attitude towards appearance.
Anorexia (anorexia nervosa) is a serious mental illness characterized by an obsession to lose weight, refusal to eat, and a marked fear of gaining weight. Usually, anorexia nervosa progresses in girls and young women who have low self-esteem and at the same time make too high demands on their own appearance.
There are the following The main symptoms of anorexia nervosa are:
Causes of Anorexia Nervosa
For the syndrome of anorexia nervosa to form, a number of social and biological prerequisites are necessary. A significant role in the occurrence of anorexia nervosa is played by the hereditary factor, exogenous hazards in the first years of life, personal characteristics, as well as microsocial factors, such as, for example, the importance of the family. Depressive states, exhaustion, aversion to food, and stress are also important.Exist risk factors that increase the risk of anorexia nervosa. These include:
Types of anorexia
First type- restrictive, which is characterized by limiting the patient himself in eating, while the patient almost never eats up to a feeling of fullness, after eating artificially provokes vomiting.Second type- cleansing. Its difference is that the anorexic constantly eats up to a feeling of fullness, after which he provokes vomiting, bowel movements (by taking laxatives), uses diuretics, and so on. People with the purgatory type of anorexia nervosa tend to eat a lot (more than a healthy person of similar build) because they have no internal control over food intake.
Signs and symptoms of anorexia
Most people with anorexia nervosa, even though they are quite thin, begin to worry about being overweight and try to limit themselves in the food they take, until the appearance of malnutrition. It follows that the prerequisite for the appearance of anorexia nervosa may be distorted perception of your body.According to statistics:
- The number of patients with anorexia over the past 20 years in economically developed countries has increased significantly
- With a frequency of 1 in 90 cases, girls aged 16 years and older suffer from anorexia.
- 10% of anorexics who do not seek treatment die
1) People suffering from anorexia nervosa devote a lot of time to food: they study diets and the calorie content of certain foods, collect collections of recipes, prepare gourmet dishes to treat others, while they themselves refuse to eat - come up with what is wrong have eaten for a long time, are not hungry, can also simulate eating (they do not swallow food, hide it, etc.).
2) Usually an anorexic hides obsession with their weight and tries not to declassify the fact that after each meal causes vomiting artificially.
3) Approximately 50 percent of people with anorexia nervosa develop a pronounced constant feeling of hunger, which they satisfy with large amounts of food (so-called bulimia). The eaten food is then removed from the body by inducing vomiting or using other methods.
4) Patients with anorexia nervosa pay great attention to physical exercises, maintain activity, mobility.
5) Usually, patients with anorexia nervosa lose interest in sex.
6) Due to a lack of nutrients, hormonal imbalance occurs, which often leads to the cessation of the menstrual cycle (amenorrhea appears - the absence of menstruation).
7) Patients with anorexia nervosa have low body temperature and blood pressure. There may be a feeling of interruptions in the work of the heart muscle, this is due to the lack of necessary electrolytes in the body (during vomiting, a large amount of potassium is lost).
8) Patients with anorexia nervosa often have constipation, flatulence (bloating), a feeling of discomfort in the abdomen.
Consequences of anorexia nervosa
Long-term, untreated anorexia nervosa can lead to serious consequences, such as:It leads to a decrease in the production of thyroid hormones and female sex hormones disruption of the endocrine system. As a result of these violations, there is a cessation of menstruation, the disappearance of sexual desire, lethargy, infertility, etc.
calcium deficiency causes thinning and increased fragility of bones. In those suffering from severe anorexia, even a slight impact on the bone can lead to a fracture.
Frequent artificial provocation of vomiting in anorexics leads to the fact that the acidic contents of the stomach damage the esophagus and teeth: inflammation of the lining of the esophagus(esophagitis), tooth enamel is destroyed.
Anorexia nervosa is often accompanied by feelings of despondency, depression, inability to concentrate. In some cases, it can end in suicide.
Often patients with anorexia nervosa do not perceive themselves as sick and do not pay attention to their condition. However, anorexia nervosa is a serious disease that can lead to serious consequences, even death. That is why relatives and friends of people with symptoms of anorexia need to recognize this disease in time and persuade the patient to see a doctor.
Diagnosis of anorexia
When the main symptoms and signs of anorexia nervosa appear, it is necessary to consult a specialist psychiatrist. He will make the correct diagnosis and determine the course of treatment.The main methods for diagnosing anorexia are as follows:
1.
Conversation with the patient or his relatives and close people. During the conversation, the doctor asks those who come to the reception questions of interest to him. Usually, during such a conversation, the specialist determines the existing risk factors for the development of anorexia, the presence of certain signs and symptoms of the disease, as well as the complications of anorexia.
2.
Calculation of body mass index (BMI) helps to diagnose anorexia. To calculate BMI, use the following formula: body weight in kilograms divided by height in square meters.
For example, if the body weight is 65 kg and the height is 1.7 m, then the body mass index will be 22.5.
A normal body mass index can be between 18.5 and 24.99. If the BMI is below 17.5, this may indicate the presence of anorexia.
3.
To identify the consequences of anorexia, such as a decrease in hemoglobin, electrolyte deficiency, lack of hormones, etc., the following tests are performed: a biochemical blood test, a general blood and urine test, and determining the level of hormones in the blood. In addition, to diagnose the consequences of anorexia, the method of X-ray of the bones of the skeleton is used (thinning of the bones is detected), fibroesophagogastroscopy (diseases of the esophagus and stomach are shown), electrocardiography (cardiac disorders are determined), etc.
Treatment of anorexia nervosa
Depending on the severity of the disease, the form of treatment for anorexia nervosa is chosen. In most cases, the treatment of patients with severe anorexia is carried out in a specialized institution under the supervision of specialists. The main goals of the treatment of anorexia: the gradual reduction of body weight, restoration of the balance of fluid and electrolytes in the body and psychological assistance.In patients with severe anorexia normalization of body weight carried out gradually: from half a kilogram to one and a half kilograms per week. Patients are prescribed an individual diet that contains the required nutrients in sufficient quantities. When compiling an individual diet, the degree of malnutrition, body mass index, the presence of symptoms of a lack of any substances (for example, if bone density is reduced, calcium-rich foods are needed, etc.) are taken into account. The best option is self-feeding of a person, but if the patient refuses to eat, it is possible to feed through a special tube that is inserted through the nose into the stomach (the so-called nasogastric tube).
Medical treatment for anorexia involves all sorts of medications that eliminate the effects of anorexia: for example, if there are no periods, hormonal drugs are prescribed; if bone density is reduced, calcium preparations and vitamin D are used, and so on. Of great importance in the treatment of anorexia nervosa are antidepressants and other drugs that are used for mental illness: for example, Prozac (Fluoxetine), Olanzapine, etc. Only the attending physician can determine the duration and dosage of these drugs, based on knowledge of the symptoms.
Psychotherapy is an essential component of the treatment of anorexia nervosa. There are two main options for psychotherapy used for anorexia: family (applied to adolescents) and behavioral (greatest effect in adults). Usually the duration of psychotherapy courses depends on the patient. It can last one year in patients who have regained their normal weight, and two years in patients whose weight is still below normal.
Treatment of an anorexic patient also involves the participation of close relatives and friends, who must be patient, but persevere in continuing the treatment of this serious disease.
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