Characteristic of anorexia nervosa. Is Anorexia Nervosa a Bad Habit or a Disease? Symptoms and treatment of the disease. Nutrition and supplementation

IN Lately Doctors are increasingly forced to diagnose anorexia nervosa" From the age of 13-14, teenage girls start dieting, deliberately exhausting themselves with hunger and exercise. All this leads not only to painful thinness, but also to disruption of almost all functions. internal organs. If left untreated, the disease can be fatal. As a preventive measure, parents should promptly explain to their children what it is and why it is dangerous. And for this they themselves need to know what this pathology is.

What it is?

Unlike symptomatic and drug-induced, anorexia nervosa is a mental disorder of eating, when a person deliberately refuses to eat for the purpose of losing weight or maintaining a low weight.

Some doctors believe that this disease is a type of self-harm. Patients have an unhealthy desire to achieve the minimum value on the scales and pathological fear. At the same time, they have a distorted perception of their body, considering it imperfect, even if there are no special problems with their figure.

On this moment Over time, anorexia nervosa syndrome has been carefully studied by scientists different countries, since in some cases its causes and mechanism of occurrence remain unclear. Various studies are being carried out, the main objective- to develop a unified therapeutic complex that would provide a 100% guarantee of recovery. The treatment methods that are currently available are not always effective.

Origin of name. The term “anorexia” goes back to two ancient Greek words: “ἀν” - a particle of negation, as in Russian - “not”, and “ὄρεξις”, which translates as “appetite”.

Causes

The reasons are conventionally divided into several large groups: biological (genetics), psychological (internal complexes, family relationships), social (influence of society: imposed stereotypes, imitation, diets).

Genetics

Studies were conducted in which not only patients with anorexia nervosa took part, but also their relatives (at least 2 people). It was found that the obsessive desire to lose weight and conscious refusal to eat is determined at the chromosomal level.

Scientific research was aimed primarily at studying the DNA responsible for eating behavior. In particular, a gene for susceptibility to this disease- brain-derived neurotrophic factor gene. This is a protein involved in regulating appetite at the level of the hypothalamus and in controlling the level of serotonin, which, when low, can cause a person to become depressed.

It was concluded that genetic vulnerability lies in the inheritance of a certain personality type, mental disorder or dysfunction of neurotransmitter systems. They may not manifest themselves in any way throughout a person’s life, but they may receive an impetus for development under unfavorable conditions, which in this situation are diet or emotional stress.

Biological factors

  1. Zinc deficiency.
  2. Dysfunction of neurotransmitters that regulate eating behavior - serotonin, dopamine, norepinephrine.
  3. Excess body weight.
  4. Early onset of menstruation.

Family factors

  1. Having relatives suffering from anorexia or obesity.
  2. Having family members suffering from depression, alcoholism, or drug addiction.
  3. Unfavorable atmosphere in the family.
  4. Lack of parental love.
  5. Parents' divorce.

Personal factors

  1. Inconsistency with the requirements and expectations of society.
  2. Low self-esteem.
  3. Perfectionist-obsessive personality type.
  4. Constant self-doubt.
  5. Feeling of own inferiority.

Age factor

Some scientists believe age is one of the main causes of anorexia nervosa. Adolescence and young adulthood are at risk. In the last 10 years, there has been a trend of lowering the age limit. If earlier girls aged 14-16 years old became hostages of thinness, today they begin to exhaust themselves with diets and become exhausted from the age of 12-13.

Anthropological factors

There is an opinion that anorexia nervosa is most directly related to search activity and determining one’s place in life. The main incentive to refuse food is the fight against obstacles in the form of your own appetite and everyone who wants to force you to eat. In this case, the process turns out to be more important final result. Anorexia is an everyday coping experience where every uneaten bite is perceived as a victory. Moreover, the more difficult it is to achieve, the more valuable it is for the patient.

Other factors

  1. Emphasis on thinness as the ideal of female beauty.
  2. Desire to become a model.
  3. Accommodation in big city industrialized country.
  4. Promotion of a slim body in the media.
  5. Stressful events: death loved one, any physical (including sexual) violence.
  6. Requirements of the profession (this applies to models, singers, TV presenters, actresses).

Based on the name, it most often develops on nervous soil, influenced stressful situations and emotional stress.

Statistics. It is common knowledge that anorexia nervosa primarily affects teenage girls and young women. On average, about 5% of the fair sex and about 0.5% of men suffered from it.

Clinical picture

Typical symptoms of anorexia nervosa:

  • body weight is 15% lower than expected, BMI is less than 17.5;
  • delay physical development V puberty: growth stops; Breasts do not enlarge, there is no menstruation in girls; the development of the genital organs in boys slows down;
  • distortion of perception own body, fear of obesity as an obsession;
  • weight loss is provoked by the person himself in the following ways: refusing to eat, artificially inducing vomiting after each meal, using drugs, diuretics or pills to reduce appetite, excessive exercise;
  • endocrine disorder, the symptoms of which are amenorrhea in women, decreased libido in men (more late stages diseases), increased level cortisol, growth hormone, problems with the production of thyroid hormone and insulin secretion.

There are also other signs that belong to the field of psychology:

  • depression;
  • looking at yourself in the mirror for a long time;
  • daily weigh-ins;
  • sleep disorders;
  • incorrect eating behavior: eating while standing, crushing foods into small pieces, consuming them only cold or not thermally processed;
  • incorrect attitudes: “With a height of 180 cm and a weight of 50 kg, I want to weigh 30 kg”;
  • low self-esteem;
  • denial of the problem;
  • absence from common meals;
  • panic fear of gaining weight;
  • constant feeling own completeness;
  • termination of communication;
  • irritability, unreasonable anger at everyone around; an unjustified feeling of resentment;
  • sudden mood changes;
  • passion for topics that are somehow related to food and weight: diets, the world of modeling fashion.

Physical disorders caused by anorexia are also diagnosed:

  • algodismenorrhea;
  • muscle spasms;
  • constant weakness;
  • failure menstrual cycle;
  • cardiac arrhythmia.

Relatives and friends should notice the first symptoms. Since the patient himself most often refuses to see them, it is often necessary to resort to compulsory treatment.

Stages

Prognosis for anorexia nervosa often depends on the stage at which treatment was started. If on initial stage- possible fast and full recovery without relapse and side effects. When diagnosing cachexia, unfortunately, doctors are often powerless.

Dysmorphomanic (initial) stage

  1. Looking at your reflection in the mirror for a long time (more than half an hour) (often naked), while locking yourself in the bathroom or your own room.
  2. Obsessive thoughts about imaginary completeness, one’s own defectiveness and inferiority.
  3. First food restrictions.
  4. Depressed mood.
  5. Search for a diet.
  6. Feeling of constant anxiety.

Anorectic

  1. Prolonged fasting.
  2. Loss of appetite.
  3. Inability to adequately assess the degree of weight loss.
  4. Cessation of the menstrual cycle, decreased libido.
  5. Weight reduction of 20% or more.
  6. Convincing yourself and others that you have no appetite.
  7. Tightening the diet.
  8. A decrease in the volume of fluid circulating in the body - the first health problems begin: hypotension and bradycardia, chilliness, dry skin, baldness, adrenal insufficiency.
  9. Excessive physical activity.
  10. Euphoria from achieving first results, inspiration.

Cachectic (advanced) stage

  1. Protein-free edema.
  2. Violation of water and electrolyte balance.
  3. Irreversible degeneration of internal organs.
  4. A sharp decrease in potassium levels.
  5. Weight reduction by 50% or more.
  6. Inhibition of the functions of systems and organs.
  7. Death.

In the absence of treatment, the patient goes through all these stages, the last one ending in death due to failure of vital organs or suicide. Suicide is also possible at the anorectic stage, but less common.

Diagnostics

For diagnosis, various instrumental and laboratory medical tests are prescribed:

  • blood test (general and ESR);
  • stool and urine tests to detect diuretic and laxative abuse;
  • gastroscopy;
  • stool test for fat content, occult blood, helminths;
  • CT or MRI of the head;
  • sigmoidoscopy;
  • X-ray;
  • X-ray contrast examination of the gastrointestinal tract;
  • esophagomanometry;

To put accurate diagnosis, the Eating Attitudes Test is also used.

Through the pages of history. The earliest medical reference to anorexia comes from Dr. Richard Morton (17th century), who described his 18-year-old patient as “a skeleton covered in skin.”

Treatment

Outpatient treatment of anorexia nervosa is carried out when the first two stages are diagnosed. With cachexia, the patient most likely needs to be hospitalized. Therapy before full recovery health can take from several months to 2-3 years.

Behavioral psychotherapy

Cognitive restructuring: patients themselves identify negative thoughts, make lists of evidence in their favor and against them, draw a reasonable conclusion, learn to manage their own behavior.

Monitoring: detailed daily records made by the patient himself: what he ate during the day, in what quantity, in what form, menu, time of eating, sensations caused by food, etc.

Training on how to correctly solve emerging problems: patients themselves must find a problem in their own behavior (unreasonable weight loss), develop several ways to solve it, make predictions about how each of them will end, and choose the best option, and then follow it with a clear plan of action.

Rejecting the wrong ones internal installations like “I’m ugly”, “I’m fat”. Increasing the patient's self-esteem. Creation of new cognitive formations of the type: “my usefulness and significance are not determined by my figure.” Formation of an adequate assessment of one’s own appearance.

Family psychotherapy

  1. Prescribed for the treatment of anorexia nervosa in adolescents.
  2. Identifies problems existing in the family.
  3. Works with all family members.
  4. Corrects the relationship between them.

Dietetics

The nutritionist individually develops a nutrition plan for the next month separately for each patient. It is distinguished by steps and consistency: a daily increase in calorie content by 50 kcal and portion size by 30-50 g until the desired indicators are achieved (at least 1,500 kcal per day and 300 g - the weight of one serving).

At first, the emphasis is on fruits and vegetables, then the diet (chicken, seafood, fish), some carbohydrates, and natural sweets (dried fruits, honey) are introduced into the diet.

The patient develops new eating habits: eating strictly according to the clock, introduction to fractional meals, an explanation of what the balance of food and drink is, refusal of harmful foods.

Medications

  1. Drugs that normalize metabolic processes in the body (water-salt, carbohydrate, electrolyte, protein): Polyamine, Berpamin.
  2. Antidepressants: Eglonil, Ludiomil, Paxil, Fevarin, Zoloft, Cipralex, Coaxin.
  3. To increase appetite: Frenolone, Elenium, Pernexin, Peritol, insulin, anabolic steroids (Primobolan).
  4. Vitamins: B9, B12, C, zinc, magnesium, iron, potassium.

Medications can only be taken as prescribed by a doctor. Self-administration of any medicines can lead to irreversible consequences and worsen the patient's condition.

Folk remedies

Since it is very difficult to persuade a patient to apply for medical care, family and friends can try to do something on their own. It is advisable to first consult with a doctor about the current situation and then follow his recommendations.

Working with an anorectic

  1. Identification and awareness of the problem by the patient himself.
  2. Calculating BMI and comparing it with normal values.
  3. View relevant readings on this topic.
  4. Creating a favorable atmosphere in the family and environment.
  5. Support from family and friends.
  6. Resuming regular eating.
  7. Necessity medical examination and following medical recommendations.

Normalization of nutrition

Gradual inclusion of main dishes in the diet:

  1. First week: broths, soups, porridges with water, purees.
  2. Second week: bananas, berries, carrot and apple puree.
  3. Third week: boiled or steamed lean fish, adding meat to soup, milk porridge, freshly squeezed juices diluted with water, excluding citrus fruits.
  4. Fourth week: bread, vegetable salads, boiled or steamed meat, some spices.

General strengthening agents

  1. Soothing decoctions and infusions of herbs: mint, valerian, lemon balm, dandelion, nettle.
  2. Herbs to increase appetite: St. John's wort, mint, calamus, centaury, wormwood.
  3. Products to increase appetite: apples, dill, White bread, nuts.

Treatment of anorexia nervosa at home is possible only at the initial stage and only under full medical supervision.

Complications

Depending on the stage of anorexia and the timeliness of treatment, prognosis may be different:

  • complete recovery;
  • relapses due to nervousness are possible in the future;
  • uncontrolled overeating, weight gain, psychological problems due to this;
  • death (according to statistics, occurs in 10% of cases).

As for health, the consequences of anorexia nervosa affect almost all organs and systems:

  • amenorrhea;
  • pain in the stomach, constant constipation, attacks of nausea;
  • slow metabolism;
  • lack of thyroid hormones;
  • inability to conceive.
  • inability to concentrate, lack of attention and concentration, prolonged depressive states, obsessive-compulsive disorder;
  • baldness, excessive dryness and unhealthy pallor skin, brittle nails;
  • osteoporosis;
  • cardiac arrhythmia (bradycardia), sudden cardiac death (SCD) due to potassium and magnesium deficiency, fainting, constant dizziness;
  • decrease in intelligence due to a decrease in the total mass of the brain;
  • suicide;
  • frequent bone fractures.

Recovery is quite possible, but the consequences of the disease can haunt the patient for the rest of his life. Therefore, it is so important to promptly identify its first signs and receive treatment at the initial stages. Since teenage girls are primarily at risk, all responsibility for their mental and physical state falls on the shoulders of the parents.

Anorexia nervosa is mental illness, which is characterized obsessive fear before obesity, the desire to get rid of extra pounds. As a result, in order to achieve normal body weight, people constantly refuse food and resort to diets. It leads to physical exhaustion, development of associated complications. Anorexia sufferers face muscle spasms, dysfunction of internal organs and other pathologies.

What is anorexia nervosa and its forms

Anorexia nervosa syndrome is caused by a psychological disorder associated with constant refusal of food, inhibition of the food center located in the brain. The course of the pathology is accompanied by a decrease in appetite.

The risk group for developing the disease includes people (usually women) with hypersensitivity or with certain personality characteristics (the presence of a desire for perfection, pride). It is also possible that there is a relationship between the appearance of this deviation and alcoholism and central nervous system pathologies identified in close relatives.

To understand what anorexia nervosa is, it is necessary to pay attention to the nature of the development of the pathology. On this basis, three forms of violation are distinguished:

  • neurotic;
  • neurodynamic;
  • neuropsychic.

The neurotic form develops due to strong experiences (stress), which activate certain centers of the brain. Moreover, negative emotions are considered the most dangerous.

The neurodynamic form has a similar development mechanism to the neurotic disorder. The difference lies in the causative factor. If the first variety is associated with nervous shocks, then the second - with the action of stimuli of a non-emotional nature (pain, etc.).

Anorexia nervosa occurs as a consequence of central nervous system disorders. The risk group for development includes people with manic-depressive syndrome, hypochondria, schizophrenia and other similar disorders. Appears also at the following borderline mental disorders X:

  • consequences severe stress;
  • temporary depression;
  • neurasthenia;
  • phobias;
  • anxious state.

The danger of anorexia is that patients are not aware of the presence mental disorder. Patients believe that they do not need the help of doctors; they control their own condition. At the same time, they continue to consider themselves fat, although they have normal body weight.

IN separate species distinguish atypical anorexia nervosa. It is characterized by the absence of one or more characteristic symptoms, for example, sudden weight loss.

If an attempt is made to reduce one's own weight by taking medications, one speaks of the presence of medicinal anorexia. With this form of mental disorder, patients, in an effort to “normalize” body weight, take medications that dull the feeling of hunger.

Depending on the features causative factor pathology is classified into:

  1. Primary (true). Develops due to organic damage brain (trauma, hypoxia, metabolic disorders, etc.) or against the background of mental disorders (schizophrenia, depression).
  2. Secondary (nervous). Occurs due to conscious refusal to eat.

IN medical practice it is customary to highlight next stages anorexia:

  1. Pre-anorexic. At this stage, a person has the first thoughts about the need to get rid of extra pounds, since the current state of the body does not satisfy him (he is disgusted with his own figure).
  2. Anorexic. Characterized by attempts to lose weight by fasting, taking medications, or going on strict diets.
  3. Cachectic. This degree of anorexia is characterized by a decrease in the fat layer to a minimum. At the cachectic stage, critical exhaustion of the body is observed, which leads to irreversible degeneration of internal organs. Occurs approximately one year after the onset of the disease.

Having reached the cachectic stage, most patients die.

This is explained by the fact that the development of dystrophy provokes the emergence of a complex of concomitant pathologies and an immunodeficiency state, so the body is not able to resist diseases.

Causes

True and nervous form diseases develop under the influence various factors. The causes of true anorexia are:


In addition to these reasons, anorexia develops under the influence of the following factors:

  • brain injuries;
  • necrosis of brain tissue;
  • toxic damage;
  • aneurysms of intracranial arteries;
  • brain irradiation;
  • neurosurgical operations.

The nervous type of the disease appears when:

  • hypersensitivity, pedantry, stubbornness and other personality traits;
  • frequent pathologies of the digestive system;
  • the desire to imitate fashion;
  • features anatomical structure bodies.

One of the main factors in the onset of the disease is considered to be improper upbringing in combination with personality traits. Moreover, the main role is given to the mother’s behavior towards her daughter in adolescence.

Overprotection and oppression of the individual provoke the child’s desire to stand out from others and to assert himself. One of the ways to achieve this goal is the desire to improve your appearance, to look slim. This behavior leads to the development of inferiority complexes, which is why teenagers begin to control and limit their food consumption.

Constant hunger acts as an obstacle that must be overcome in order to strengthen the will. Having passed such a “test”, the teenager feels like an adult, capable of solving other problems. In fact, such aspirations allow a person to feel like an accomplished person. But if a teenager experiences difficulties in other areas of life, then control over food increases.

Symptoms

With anorexia nervosa, symptoms vary. Moreover clinical manifestations not static. For example, some patients experience hair loss and crumbling nails during the first months after stopping food. In other patients, similar complications occur during a period of complete exhaustion of the body.

The initial stage of anorexia manifests itself in the same way in most people suffering from this disease and is associated with changes in eating behavior:

  • phobias, obsessions with food;
  • fear of gaining excess weight;
  • constant refusal to eat;
  • desire to lose excess weight;
  • narrowing the range of interests (attention is concentrated only on losing weight);
  • Constant calorie counting.

Anorexia nervosa provokes an increase in physical activity that help you lose weight. At the same time, patients change their wardrobe to loose clothing. Also symptoms mental anorexia accompanied aggressive behavior, the desire to retire, to avoid society.

These factors provoke mental disorders, which appears as:

  • depression;
  • feelings of apathy;
  • decreased performance;
  • depression;
  • constant dissatisfaction with oneself;
  • sleep disorders;
  • psychological lability.

An important feature is that the patient does not feel sick. Because of this, he refuses treatment, continuing to stubbornly limit his diet.

As a result, the disease causes the following complications:

  • reduction in body weight by 30% or more from normal levels;
  • constant weakness;
  • attacks of dizziness combined with fainting;
  • active growth of fine vellus hair;
  • decreased sexual activity;
  • absence of menstruation (more than three months);
  • poor blood circulation against the background of bradycardia, which causes a constant feeling of cold.

Restriction in food affects the performance of internal organs. Lack of nutrients causes tissue degeneration, which causes the following phenomena:


In advanced cases, swelling and internal hemorrhages appear. Without timely medical intervention, the water-salt balance, which leads to heart failure and death.

Peculiarities of manifestation in adolescents

Signs of anorexia nervosa in adolescents include similar phenomena characteristic of pathology in adults. The difference can mainly be seen in the patient's behavior.

Teenagers react more aggressively to people's comments about appearance or other issues affecting the individual. In adolescence, the desire to imitate and stand out from others is expressed, so their neurological anorexia is tied to self-affirmation.

An important sign of the disease can be called withdrawal. This is clearly manifested in children under parental overprotection.

The occurrence of pathological symptoms during adolescence requires mandatory medical intervention. Without help, the body experiences serious stress during the period of hormonal changes in adolescents, and severe and often irreversible changes develop. Therefore, it is important to pay attention to the child’s condition, comparing his behavior with the actions of healthy children.

Diagnostics

Sudden weight loss and refusal to eat are not always associated with psychological disorders. Both symptoms may indicate pathologies of the gastrointestinal tract. Therefore, when examining a patient, it is important to identify the causes of anorexia. To do this, information is collected about the condition and behavioral characteristics of the patient.

It is also important to take an anorexia nervosa test, which evaluates the patient's relationship with food. With the help of this examination, it is possible to make an accurate diagnosis and begin appropriate treatment. Carrying out the test is mandatory procedure if the patient is diagnosed a sharp decline body weight.

To exclude concomitant pathologies, as well as to identify the causes of development nervous disorder, apply:


If anorexia nervosa is suspected, body mass index (BMI) is assessed in comparison with normal indicators. If necessary, to make a diagnosis, they are prescribed additional research or consultations with specialized specialists (gastroenterologist, neurologist and others).

Treatment

Treatment for anorexia nervosa requires integrated approach, in which medications and psychotherapy methods are used. An important condition for the patient’s recovery is the support of the immediate environment.

If symptoms of primary anorexia are detected, treatment must be carried out for the pathology that caused this disorder.

Therapy for the disease begins with dietary correction in favor of protein and easily digestible foods.

This is done to restore body weight. The food is well ground and given to the patient in small portions at intervals of 2-3 hours.

Drug therapy

In the treatment of anorexia nervosa, a complex of drugs is used, which are selected taking into account the characteristics of each case. If the patient has problems with the absorption of protein products, a solution of Polyamine or another drug with a similar composition is administered intravenously before meals. If necessary, place a drip with a nutrient mixture.

Due to the fact that many people suffering from anorexia artificially induce vomiting, it is necessary to inject 0.5 ml of a 0.1% Atropine solution subcutaneously half an hour before meals. After consuming food, the patient must be supervised to prevent his stomach from emptying.

To eliminate the consequences caused by anorexia, drugs are used that restore water-salt balance, potassium levels and other useful microelements. Antidepressants for anorexia (Fluoxetine, Paxil, Zoloft and others) are prescribed if the disease is caused by mental disorders or provoked their occurrence. In some cases, treatment is limited to taking sedative medications. Hormonal medications are often recommended for teenagers.

Psychotherapy

Anorexia nervosa necessarily requires psychological assistance. This is explained by the fact that patients are not aware of the presence of the disease. Only voluntary therapy produces positive results.

Psychotherapeutic assistance involves the doctor changing a person’s attitude towards his own appearance, weight, and food. Close relatives are often involved in the treatment of adolescents.

One of the elements of psychotherapy is the restriction of the patient's freedom.

Patients are treated in a hospital setting, where they cannot take long walks and are required to follow doctor’s orders. If patients comply with the requirements, a reward is provided, selected individually in each case.

Folk remedies

For symptoms of anorexia nervosa, treatment with drugs traditional medicine is selected depending on the stage and causes of the disease. Infusions that improve appetite are shown:


The disease causes nutritional deficiencies. To eliminate their deficiency, recipes that contain fruits and vegetables are used. The rest of the pathology treatment is carried out through medications and psychocorrections.

Forecast and possible consequences

Psychogenic anorexia causes multiple complications. The degree of influence (consequences for the body) depends on the neglect of the case. If treatment for anorexia is started at the stage when the weight has decreased slightly, the patient will fully recover within 1-3 months, provided that the psychocorrection is successful. In advanced cases, due to exhaustion of the body, the following occur:

  • renal and heart failure;
  • metabolic disease;
  • immunodeficiency;
  • pathologies of the central nervous system.

Treatment for anorexia nervosa should begin when the first signs of the disease appear.

Prevention

Prevention is about following the principles proper nutrition and excluding the influence of factors influencing psychological condition the patient (especially on his self-esteem).

Since the disease occurs against the background of mental disorders, after severe stress, depression or other borderline conditions, it is recommended to seek help from a doctor.

Diagnostics is based on clinical picture. Treatment mainly consists of psychotherapy. Olanzapine helps increase body weight.

Anorexia nervosa mainly affects girls and women. young. The onset of the disorder usually occurs during adolescence.

The exact etiology is unknown. In addition to female gender, other risk factors for the development of this disorder have been identified. In Western countries, being overweight is considered highly undesirable. Many people, including children, are concerned with the desire to lose weight. More than 50% of girls go on diets or take other measures to control their weight during puberty. Excessive concern about weight or infatuation with all kinds of diets increases the risk of developing this disorder. It also cannot be ruled out genetic predisposition. Studies of identical twins have shown concordance of less than 50%. Perhaps family and social factors. Many patients are middle or upper socioeconomic class; they are meticulous, compulsive and intelligent; and also set very high standards for achievement and success.

There are two types of anorexia nervosa:

  • restrictive: patients persistently limit themselves in food intake;
  • bulimia: patients often overeat, then induce vomiting, use laxatives, diuretics, give enemas, etc.

Bulimia is defined as the consumption of much more food than most people eat in a similar period of time under similar circumstances with a loss of control, i.e. a perceived inability to resist or stop eating.

Pathophysiology of anorexia nervosa

Violations are often observed endocrine system: decreased luteinizing hormone levels, decreased thyroxine (T4) and triiodothyronine (T5) levels, increased cortisol levels. Menstruation usually stops against this background. Weight decreases bone tissue. Against the background of prolonged malnutrition, disorders of almost all organs and systems of the body occur.

Dehydration and metabolic alkalosis, decreased serum K+ levels often develop; these phenomena are aggravated by vomiting, taking laxatives and diuretics.

There is a decrease in myocardial mass, volume cardiac output. These patients often experience prolapse mitral valve. Some patients experience prolongation of the QT interval (even after adjustment for heart rate), which, in combination with electrolyte imbalance, increases the likelihood of developing tachyarrhythmias. Possible development sudden death, most often due to ventricular tachyarrhythmia.

Symptoms and signs of anorexia nervosa

Anorexia nervosa can be mild and short-term, but there are cases of severe, long-term course of the disease. Most patients with normal weight are concerned about their obesity and limit themselves in food. The patient's concern and anxiety about his weight continues to increase even as cachexia develops.

The term anorexia is not entirely appropriate in this situation, since patients retain their appetite up to a severe degree of cachexia. Patients show concern about their food:

  • They study different diets and count calories.
  • They tend to stockpile food for future use
  • They collect various recipes.
  • They cook complex dishes (not for themselves).

Patients are often cunning, cunning, and keep silent about their gluttony and various cleansing procedures. Bulimia occurs in 30-50% of patients. Other patients simply limit their food intake.

Many people with anorexia exercise to control their body weight. Even in a state of cachexia, patients, as a rule, remain active (playing sports, exercise), they rarely show symptoms of malnutrition and do not increase susceptibility to infections.

Patients often complain of bloating, abdominal discomfort, and constipation. Libido usually decreases sharply. The development of depression is often observed.

Patients experience bradycardia, decreased blood pressure, hypothermia, the appearance of vellus hair or mild hirsutism, and swelling. The mass of adipose tissue decreases sharply. In patients with frequent vomiting the integrity of tooth enamel may be compromised, and an increase in salivary glands and the development of esophagitis.

Diagnosis of anorexia nervosa

  • Clinical criteria

A distinctive feature of such patients is nihilism. Patients resist assessment and treatment. As a rule, they are brought to the doctor by relatives, family members, or they consult a doctor about another disease.

Clinical manifestations: a body weight<85% от нормального (ИМТ <17,5 кг/м 2);

  • fear of obesity;
  • denial of illness;
  • amenorrhea in women.

Patients may appear quite normal and healthy. Diagnosis should be based on identifying the cause of the fear of obesity, which does not decrease with weight loss. Differential diagnosis. This condition should be differentiated from mental disorders such as schizophrenia or true depression.

Severe mental disorder is extremely rarely accompanied by loss of body weight. It is necessary to exclude conditions such as malabsorption syndrome (impaired absorption in the intestine due to inflammatory diseases or celiac disease), type 1 diabetes mellitus, adrenal insufficiency, and central nervous system tumors. Similar symptoms can develop due to amphetamine abuse.

Prognosis of anorexia nervosa

Without treatment, the mortality rate is 10%. A mild form of the disease rarely leads to death. With adequate treatment, half of the patients manage to restore body weight and compensate for endocrine and metabolic complications. About a quarter of patients may experience relapses of the disease. Another quarter of patients develop persistent somatic and mental complications during relapses.

Treatment of anorexia nervosa

  • Enriched nutrition.
  • Psychotherapy (cognitive behavioral treatment).
  • For adolescents - psychotherapy with the involvement of family members of the patient.

With rapid, severe weight loss, when body weight decreases by more than 75% of normal, the patient must be hospitalized and decide on methods for restoring body weight. If any doubt arises, patients should be hospitalized. The very change of environment from home to hospital sometimes triggers the reverse process, but one should not abandon the methods of psychiatric treatment.

Dietary therapy that starts at 30-40 kcal/kg/day can provide weight gain of 1.5 kg/week during hospitalization and 0.5 kg/week during outpatient treatment. The most effective is enhanced feeding. However, in severe cases, if the patient resists, it is sometimes necessary to install a nasogastric tube and feed through a tube. To compensate for the loss of bone tissue, calcium supplements are prescribed at a dose of 1200-1500 mg/day, vitamin D 600-800 IU/day, and in severe cases bisphosphonates are added.

After stabilization of food, fluid and electrolyte balance, a long course of rehabilitation begins. The basis of treatment is outpatient psychotherapy. The method of choice is cognitive behavioral therapy, which is carried out for 1 year for patients with normal weight and for 2 years for patients with reduced weight. The best results are achieved in adolescents who have had this disorder for less than 6 months. For adolescents, a good effect is achieved against the background of family psychotherapy, in particular using the Model method. The Model method consists of 3 stages:

  • Family members are taught how to properly feed the teenager (for example, joint family dinners) and restore his body weight (unlike other methods, the Model method does not place personal responsibility for the results of treatment on family members or the teenager himself);
  • Gradually, control over the teenager’s nutrition decreases;
  • Once the teenager is able to independently maintain the restored weight, therapy is aimed at developing a healthy personality for the teenager.

It is quite difficult to treat patients who are afraid of excess weight, deny their illness and are characterized by manipulative behavior. The doctor should establish a calm, trusting, stable relationship with the patient, thereby encouraging normal calorie intake.

Despite the priority of psychotherapy, drug treatment is often prescribed. Second-generation antipsychotics (olanzapine 10 mg orally 1 time per day) help gain weight and reduce the morbid fear of obesity. Fluoxetine at a starting dose of 20 mg once a day helps prevent the development of relapse after restoration of normal body weight.

Anorexia (anorexia nervosa) is a serious mental illness characterized by an obsession with losing weight, refusal to eat, and a strong fear of gaining weight. Typically, anorexia nervosa progresses in girls and young women who have low self-esteem and at the same time place too high demands on their own appearance.

The following are distinguished: The main symptoms of anorexia nervosa are:

  • self-restraint in food intake or eating large amounts of food, after which the patient induces vomiting artificially
  • weight loss below normal levels
  • worry about your own weight
  • fanatical adherence to diet and exercise

    Causes of Anorexia Nervosa

    For anorexia nervosa syndrome 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 harm in the first years of life, personal characteristics, as well as microsocial factors, such as, for example, the importance of family. Depressive states, exhaustion, aversion to food, and stress are also important.

    Exist risk factors, increasing the likelihood of anorexia nervosa. These include:

  • In some cases, excessive concern about one’s own weight, increased interest in diets and other methods of losing weight can “help” the development of anorexia.
  • There is a certain type of personality that is more prone to the appearance of anorexia: usually these are meticulous, pedantic, people who make high demands on themselves and others, they have low self-esteem.
  • In the development of anorexia, a hereditary factor plays a role: if a parent has anorexia, this increases the risk of developing this disease in children.
  • Living in an environment where there is an obsession with ideals of beauty, maintaining a certain weight, and being thin is more conducive to the development of anorexia nervosa.
  • Anorexia nervosa can be caused by psychological trauma, such as the loss of a loved one or rape.

    Types of Anorexia

    First type- restrictive, which is characterized by the patient limiting himself in food intake, while the patient almost never eats until he feels full, and after eating he artificially provokes vomiting.

    Second type- cleansing. Its difference is that an anorexic person constantly eats until he feels full, after which he provokes vomiting, bowel movements (by taking laxatives), uses diuretics, etc. People with the purging type of anorexia nervosa tend to eat a lot (more than a healthy person of similar size) because they have no internal control over food intake.

    Signs and symptoms of anorexia

    Most people suffering from anorexia nervosa, even though they are quite thin, begin to worry about being overweight and try to limit themselves in the food they eat, until they become exhausted. It follows that a prerequisite for the appearance of anorexia nervosa may be distorted perception of your body.

    According to statistics:

    • The number of people with anorexia has increased significantly over the past 20 years in economically developed countries.
    • With a frequency of 1 in 90 cases, anorexia affects girls 16 years of age and older.
    • 10% of anorexia patients who do not seek treatment die
    There are several main symptoms and signs of the development of anorexia:
    1) People suffering from anorexia nervosa spend a lot of time on food: they study diets and caloric content of certain foods, collect collections of recipes, prepare delicious dishes to treat others, while they themselves refuse to eat food - they figure out what’s wrong have eaten for a long time, are not hungry, and can also feign eating (they do not swallow food, hide it, etc.).
    2) Usually an anorexic person hides his obsession with his weight and tries not to declassify the fact that after each meal he induces vomiting artificially.
    3) About 50 percent of people with anorexia nervosa develop a severe, constant feeling of hunger, which they satisfy with large amounts of food (so-called bulimia). The person then removes the eaten food from the body by inducing vomiting or using other methods.
    4) Patients with anorexia nervosa pay great attention to physical exercise, remain active and mobile.
    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 - absence of menstruation).
    7) Patients with anorexia nervosa have low body temperature and blood pressure. There may be a feeling of interruptions in the functioning of the heart muscle, this is due to a lack of necessary electrolytes in the body (during vomiting, a large amount of potassium is lost).
    8) Patients with anorexia nervosa often experience constipation, flatulence (bloating), and a feeling of discomfort in the abdominal area.

    Consequences of anorexia nervosa

    Anorexia nervosa that lasts for a long time, untreated, can have serious consequences, such as:
    • Cardiac muscle dysfunction- a common cause of death among patients with severe forms of anorexia nervosa. The following characteristic symptoms of cardiac dysfunction in anorexics are identified: a feeling of disruption of the heart (arrhythmia), palpitations, decreased blood pressure, the pulse becomes rare (less than 55-60 beats per minute), short-term loss of consciousness, dizziness, etc.
    Leads to a decrease in the production of thyroid hormones and female sex hormones endocrine system disorder. As a result of these disorders, menstruation ceases, sexual desire disappears, lethargy, infertility, etc.
    Lack of calcium causes thinning and increased fragility of bones. For those suffering from severe forms of anorexia, even minor impacts on a bone can cause 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: the mucous membrane of the esophagus becomes inflamed(esophagitis), tooth enamel is destroyed.
    Anorexia nervosa is often accompanied by feeling depressed, depressed, 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, including 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, you need to consult a 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 loved ones. During the conversation, the doctor asks those who come to the appointment questions that interest him. Typically, 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 complications of anorexia.
    2. Calculation of body mass index (BMI) helps diagnose anorexia. To calculate BMI, use the following formula: body weight in kilograms divided by height in square meters.
    For example, if your body weight is 65 kg and your height is 1.7 m, your body mass index will be 22.5.
    A normal body mass index can range from 18.5 to 24.99. A BMI below 17.5 may indicate anorexia.
    3. To identify the consequences of anorexia, such as decreased hemoglobin, electrolyte deficiency, lack of hormones, etc., the following tests are performed: biochemical blood test, general blood and urine test, determination of hormone levels in the blood. In addition, to diagnose the consequences of anorexia, they use radiography of skeletal bones (detect thinning of bones), fibroesophagogastroscopy (detect diseases of the esophagus and stomach), electrocardiography (detect cardiac disorders), etc.

    Treatment of anorexia nervosa

    Depending on the severity of the disease, the form of treatment for anorexia nervosa is chosen. In most cases, treatment of patients with severe anorexia is carried out in a specialized institution under the supervision of specialists. The main goals of treatment for anorexia are: gradual normalization of body weight, restoration of fluid and electrolyte balance in the body, and psychological assistance.

    In patients with severe anorexia normalization of body weight It is 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 drawing up an individual diet, the degree of exhaustion, body mass index, and the presence of symptoms of deficiency of any substances are taken into account (for example, if bone density is reduced, calcium-rich foods are needed, etc.). The best option is for a person to feed himself, 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).

    Drug treatment for anorexia involves all kinds of medications that eliminate the consequences of anorexia: for example, if there are no periods, hormonal drugs are prescribed; if bone density is reduced, calcium supplements and vitamin D are used, etc. Antidepressants and other medications that are used for mental illness are of great importance in the treatment of anorexia nervosa: for example, Prozac (Fluoxetine), Olanzapine, etc. The duration of use and dosage of these medications can only be determined by the attending physician, based on knowledge of the existing symptoms.

    Psychotherapy is an extremely important component of the treatment of anorexia nervosa. There are two main types of psychotherapy used for anorexia: family (used for adolescents) and behavioral (greatest effect in adults). Typically, the duration of psychotherapy courses depends on the patient. It may last one year for patients who have regained their normal weight, and two years for patients whose weight is still below normal.

    Treatment of a patient with anorexia also involves the participation of close relatives and friends, who must be patient, but be persistent in continuing treatment for this serious disease.

    Anorexia. Today a lot is written about this disease in the media and spoken on television. The sight of the emaciated bodies of the sick frightens ordinary people no less than the photographs of prisoners of Buchenwald and Auschwitz. Experts call scary figures: the proportion of deaths from anorexia in the world reaches 10-20%. Moreover, about 20% of patients have suicidal tendencies and attempt suicide. Anorexia chooses young people: the age limit of those affected is 12-25 years, 90% of them are girls. And another statistical paradox: the higher the standard of living in a country, the more people are susceptible to the disease.

    What kind of disease is this that forces physically healthy people to extinguish their natural feeling of hunger and bring the body to complete exhaustion? Why does the desire to eat food disappear when there is a need for it? Is it possible to somehow resist this pathological process? Let's talk about everything in order.

    Table of contents:

    The concept of "anorexia"

    Note: The term “anorexia” is used in the wider literature and means both a symptom of decreased appetite and a separate disease – anorexia nervosa.

    The name itself comes from Greek (ἀν- - “not-”, as well as ὄρεξις - “appetite, urge to eat”).

    This syndrome accompanies a large number of other diseases and is a component of them.

    Anorexia nervosa is a mental illness that manifests itself in the form of an eating disorder that is caused and maintained by the patient himself. At the same time, he has a pathological craving for weight loss, a strong fear of obesity and a distorted perception of his own physical form.

    Considering anorexia as only a problem of excessive desire for thinness and slimness, which is fashionable today, is fundamentally wrong. Attempts to present everything in the light of excessive enthusiasm for diets only aggravate the situation with the prevalence of the disease. This is a pathology with a complex etiology, the development of which involves many causes, both internal and external, related to the body of a particular person.

    In addition, social and cultural factors, as well as subtle connections between a person and society, also play a very serious role. That is why anorexia is considered a disease and medical measures are necessary to properly combat its development. After all, help not provided on time poses a serious threat to health and, unfortunately, often to human life.

    A popular documentary film is devoted to the problems of the social background of anorexia. The authors try to answer the question about the global causes of the spread of such a disease as anorexia:

    For quite a long time, it was believed that anorexia is a disease that affects exclusively representatives of the fair half of humanity, and many still adhere to such views. However, this is not entirely true.


    There is some evidence regarding the prevalence of anorexia:

    • On average, in women, anorexia occurs in 1.3-3% of cases among all diseases.
    • The incidence rate among men is 0.2%.
    • There are known cases of anorexia in childhood and adolescence
    • If untreated, the mortality rate is 20%.
    • Adequate therapy is prescribed only in 5-10% of cases.
    • Among psychiatric diseases, anorexia is in the top three in terms of the frequency of deaths.

    Anorexia, like any disease, has certain risk factors that increase the incidence of the disease.

    Proven ones are:


    Warning signs of anorexia

    To make a clinical diagnosis of anorexia, certain reliable signs are necessary, but there is a group of symptoms, the appearance and combination of which should alert the relatives of the patient, or the patient himself, about the possibility of the onset of the disease process.

    These include:

    • a person’s feeling of his own completeness;
    • expressed fear of weight gain;
    • changing the way you eat;
    • sleep disorders;
    • constant low mood;
    • unmotivated mood swings;
    • tendency to solitude;
    • passion for cooking with preparing luxurious meals without participating in meals;
    • close attention to diets and methods of losing weight;
    • a person’s obvious denial of the existing problem.

    If these symptoms are present, especially when several signs are combined with each other, or when some are added to existing ones, a mandatory consultation with a specialist is necessary!

    Note:A specially designed eating attitude test is used as an assessment of the risk of developing anorexia.

    Important!When seeking medical help, the ultimate goal is to visit a psychiatrist. No nutritionists, endocrinologists, nutritionists, therapists or doctors of other specialties can provide truly adequate care for patients with anorexia, although during the process of examination and treatment you will have to consult with many specialists.

    Currently, reliable signs of anorexia in a patient are a combination of ALL of the following symptoms:


    Important! All these symptoms of anorexia are diagnosed in seemingly healthy adolescents, whose thinness can easily be confused at first glance with the constitutional characteristics of the body itself.

    The verification of the diagnosis of anorexia does not consist of an examination by a psychiatrist alone. To confirm the diagnosis and exclude other causes that may also occur, consultation with other specialists is necessary.

    Stages of anorexia

    Anorexia is a progressive disease and in its course goes through a number of specific stages that are connected with each other. Each of the subsequent ones is not only more severe in terms of clinical symptoms, but also reflects the evolution of the disease, its aggravation and the formation of increasingly destructive consequences for the body.

    The main stages of anorexia nervosa include:

    • dysmorphomania;
    • anorexia;
    • cachexia

    Symptoms of the dysmorphomania stage

    It is mainly characterized by the dominance of mental and psychological symptoms. The patient is dissatisfied with his own weight, considering it excessive, and the assessment is subjective. Very often such patients are depressed or anxious. Gradually their style of behavior begins to change. Their activity is quite intense in terms of searching for ideal diets and the most effective ways to lose weight.

    It is believed that the full completion of this stage is noted with the beginning of the first attempts to change one’s own eating behavior (fasting, vomiting, exhausting training against the background of insufficient food intake).

    Symptoms of the anorexia stage

    It is considered the peak of the clinical picture and is observed against the background of persistent starvation. Each record of weight loss is considered an achievement and at the same time is a stimulant for even more tightening of the diet or the use of several methods of changing eating behavior.

    Patients with anorexia, due to reduced food intake, can deliberately induce vomiting by taking pharmacological laxatives and intense physical activity. At this stage of anorexia nervosa, any praise for their thinness is perceived as a compliment and at the same time as “hidden mockery.”

    Critical remarks can cause significant affective reactions with auto-aggression, or a maximum, unreasonable, repeated tightening of the “achieving ideal weight” regime. All the results achieved are never sufficient due to a persistent change in the perception of one’s own body. It is at this stage of anorexia nervosa that symptoms of changes in the functioning of all organs and systems begin to be observed.

    Cachexia stage

    In essence, it is the final stage. There is exhaustion of the body with irreversible changes in all organs and tissues. At this stage, treatment is ineffective due to multiple irreversible multisystem damage to the entire body. The average time for the onset of this stage is 1-2 years.

    Important!With anorexia, absolutely all organs of the human body suffer, and damage to particularly important systems leads to an increase in the rate of progression of the disease and an early onset of death..

    Treatment of anorexia

    Curing anorexia is possible, but it is a rather complex, multicomponent and lengthy process that has many points of application.

    The following are used in the treatment of anorexia nervosa:

    • psychotherapeutic techniques;
    • nutrition correction;
    • emotional support;
    • medicinal methods

    Psychotherapeutic methods for treating anorexia

    Various types of psychotherapy aim to normalize the patient’s mental background. Many experts consider them as a basis for recovery.

    When implementing various mental correction programs, correction of previously distorted ideas about one’s own inferiority and excess weight is achieved.

    Psychological methods for treating anorexia help normalize the perception of one’s own body. A separate area is the normalization of relationships in the family and immediate environment of an anorexic patient.

    Creating a background of emotional support and assistance for anorexia.

    In fact, this is one of the types of psychological help in the treatment of anorexia. Only it comes not from the doctor, but from the closest people, thanks to whom a positive emotional background is created, allowing patients to receive a positive response in response to difficult or unusual decisions for them. This helps resolve crises and relieve constant stress.

    Nutritional therapy for anorexia

    An extremely important point in the treatment of anorexia is the normalization of body weight, which requires a gradual increase in food intake. For this purpose, appropriate programs have been developed that allow you to restore weight without negative effects for the “practically atrophied” digestive system.

    Pharmacotherapy in this situation is an additional factor and consists of correcting mental disorders with appropriate medications. Taking medications to increase appetite is also indicated. Some regimens also include medications to reduce the likelihood of possible relapses.

    Disease prognosis


    Anorexia is characterized by the following development options:

    • Full recovery.
    • Recovery from existing organic consequences of organs and systems.
    • Recurrent course with varying frequency and duration of exacerbations.
    • Death for various reasons - ranging from suicide to cachexia.
    • In rare cases, the disease transforms into bulimia - uncontrolled overeating.

    Remember! Therapy for cachexia is a long process and largely depends on its correctness and the time of initiation of adequate treatment for anorexia. Ignoring the problem, as well as self-medication, is detrimental not only to health, but often to the life of patients.

    General practitioner, Sovinskaya Elena Nikolaevna

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