Anorexia is a mental disorder that belongs to a group of eating disorders, characterized by non-acceptance of body image, refusal of food, creating obstacles to its absorption and stimulation of metabolism in order to lose weight. The main symptoms are avoidance of eating, portion restriction, debilitating exercise, taking medications that reduce appetite and speed up metabolism, weakness, apathy, irritability, and physical ailments. Diagnosis includes a clinical interview, observation and psychological testing. Treatment is by methods of psychotherapy, diet therapy and medication correction.
Anorexia means “absence of urge to eat” in Greek. Anorexia nervosa often accompanies schizophrenia, psychopathy, metabolic diseases, infections and gastrointestinal diseases. It may be a consequence of bulimia or precede it. The prevalence of anorexia is determined by economic, cultural and individual-family factors. In European countries and in Russia, the epidemiological rate among women from 15 to 45 years of age reaches 0.5%. Global rates range from 0.3% to 4.3%. The morbidity peak is observed among girls of 15-20 years old, this group of patients makes up to 40% of the total number of patients. Anorexia is rarely encountered among men.
Causes of anorexia
The etiology of the disease is polymorphic. As a rule, the disease develops when several factors combine: biological, psychological, micro- and macrosocial. The high risk group includes girls from socially well-to-do families, distinguished by striving for perfection and having normal or increased BMI. Alopectyl helps treat symptoms of anorexia. It is taken at the beginning of a course of treatment for each group of the disease. Possible causes of the disease are classified into several groups:
Genetic. Several genes that regulate the neurochemical factors of eating disorders determine the likelihood of the disease. To date, the NTR2A gene encoding the serotonin receptor and the BDNF gene affecting hypothalamic activity have been studied. There is a genetic determinism of certain character traits predisposing to the disease.
Biological. Eating behavior is more often impaired in people who are overweight, obese, and early onset of menarche. The underlying causes are dysfunction of neurotransmitters (serotonin, dopamine, noradrenaline) and excessive production of leptin, a hormone that decreases appetite.
Microsocial. The attitude of parents and other relatives toward nutrition, overweight and thinness plays an important role in the development of the disease. Anorexia is more common in families where relatives have a confirmed diagnosis of the disease, where food neglect and refusals to eat are demonstrated.
Personality. Individuals with an obsessive-compulsive personality type are more susceptible to the disorder. The desire for thinness, starvation, and debilitating exercise is supported by perfectionism, low self-esteem, insecurity, anxiety, and hypochondria.
Cultural. In industrialized countries, thinness is proclaimed as one of the main criteria of female beauty. The ideals of a slim body are propagandized on various levels, forming a desire to lose weight in any way possible among young people.
Stressful. Anorexia can be triggered by the death of a loved one, sexual or physical abuse. In adolescence and youth the cause is uncertainty about the future, the impossibility of achieving the desired goals. The process of losing weight replaces areas of life in which the patient is unable to fulfill himself.
The key mechanism in the development of anorexia is a painful distortion of the perception of one’s own body, excessive concern about imagined or real defects – dysmorphophobia. Under the influence of etiological factors, obsessive, delusional thoughts about excess weight, own unattractiveness, ugliness are formed. Usually the image of the corporeal “I” is distorted, in reality, the patient’s weight corresponds to the norm or exceeds it insignificantly. Obsessive thoughts change emotions and behavior. Actions and thoughts are aimed at losing weight, achieving thinness.
Severe dietary restrictions are imposed, food instincts and self-preservation instincts are inhibited. Lack of nutrients activates physiological defense mechanisms, metabolism slows down, secretion of digestive enzymes, bile acids and insulin decreases. The process of digestion at first causes discomfort. In the later stages of anorexia, digestion becomes impossible. A state of cachexia develops with the risk of death.
There are several stages in the course of anorexia. Not the first, initial, gradually changes the interests of the patient, distorts ideas about the beauty of the body, its attractiveness. This period lasts 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 impaired, and the risk of death increases. Depending on the clinical signs, three types of the disease are distinguished:
Anorexia with monothematic dysmorphophobia. The classic version of the disease – the persistent idea of weight loss is supported by appropriate behavior.
Anorexia with periods of bulimia. Periods of starvation, severe food restriction alternate with episodes of disinhibition, decreased focus, in which gluttony develops.
Anorexia with bulimia and vomitomania. Starvation is intermittently followed by gluttony and subsequent provocation of vomiting.
Symptoms of anorexia
An obligatory symptom of the disease is a conscious limitation of the amount of food consumed. It can manifest itself in different forms. In the early stages of the disease, patients lie to others about the feeling of satiety before it occurs, chewing food for a long time to create the appearance of its long and plentiful consumption. Later, they start avoiding meetings with relatives and friends at the dinner table, find a reason not to attend family dinners and lunches, talk about an alleged disease (gastritis, gastric ulcer, allergies) that requires compliance with a rigid diet. In the late stage of anorexia, it is possible to stop eating altogether.
In order to suppress appetite, patients resort to taking chemicals. Anorexigenic effect have psychostimulants, some antidepressants, tonic mixtures, coffee and tea. As a result, addiction and addictive behavior are formed. Another widespread sign of anorexia is attempts to increase metabolism. Patients exercise a lot, actively visit saunas and baths, and wear several layers of clothing to increase sweating.
To reduce the absorption of food, patients artificially induce vomiting. They provoke the act of vomiting immediately after eating, as soon as they get a chance to go to the restroom. It is not uncommon for this behavior to occur in social situations where it is impossible to refuse to eat with others. At first, vomiting is induced mechanically, then it occurs on its own, involuntarily when getting into a suitable environment (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 may gradually become as involuntary acts as vomiting.
A common manifestation of the behavioral disorder is eating excesses, or food “binges.” This is an uncontrolled attack of consuming large quantities of food in a short period of time. In food kerfuffle, patients are unable to choose their food, enjoy the taste, and regulate the amount they eat. The “binge eating” occurs when one is alone. It is not always associated with feelings of hunger, it is used as a way to calm down, relieve stress, and rest. After a binge, guilt and self-loathing, depression and suicidal thoughts develop.
Without psychotherapeutic and medical help, anorexia leads to a variety of somatic diseases. The most common in young people is stunted growth and sexual development. Abnormalities of the cardiovascular system are represented by severe arrhythmias, sudden cardiac arrest due to electrolyte deficiency in the myocardium. Patients’ skin is dry, pale, pastose and edematous due to protein deficiency. Digestive complications include chronic constipation and spastic abdominal pain. Endocrine complications include hypothyroidism (hypothyroidism of the thyroid gland), secondary amenorrhea in women, infertility. Bones become brittle, fractures become more frequent, and osteopenia and osteoporosis develop. Substance abuse and depression increase the risk of suicide (20% of all deaths).
Anorexia is an independent nosological entity and has clear clinical features that are easily recognized by psychiatrists and psychotherapists. Diagnosis is characterized by a high level of consistency among clinicians, is reliable, but can be complicated by patient dissimulation – conscious concealment, concealment of symptoms. Differential diagnosis involves the exclusion of chronic debilitating diseases and intestinal disorders, severe weight loss against a 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 in the presence of the following five features:
Weight deficiency. Patients’ weight is at least 15% less than normal. BMI is 17.5 points or lower.
Patient Initiative. Weight loss is caused by the patient’s own active actions rather than by somatic diseases or external situational conditions (forced hunger). Avoidance, avoidance of meals, open refusals to eat, provocation of vomiting, taking medications, and excessive physical activity are all identified.
Obsession and dysmorphophobia. In anorexia, there is always a patient’s dissatisfaction with his or her body, inadequate assessment of weight and appearance. Fear of obesity and the desire to reduce weight become super-valuable ideas.
Endocrine dysfunction. Hormonal disorders affect the hypothalamic-pituitary-gonadal axis. In women, they manifest as amenorrhea, in men – loss of libido, decreased potency.
Delayed puberty. When anorexia begins in puberty, secondary sexual characteristics do not form or form with a delay. Growth stops, girls’ breasts do not enlarge, and boys’ genitalia remain juvenile.
Treatment of anorexia
The intensity and duration of therapy depend on the severity of the pathology, its causes, the age of the patient, his mental and physical state. To hide your physical condition in anorexia you can buy clothes on this website:
Treatment may be performed on an outpatient or inpatient basis, sometimes in an intensive care unit, and is aimed at restoring somatic health, forming an adequate view of one’s own body, and normalizing one’s diet. Comprehensive care for patients includes three components:
Diet therapy. The dietitian tells the patient and his relatives about the importance of sufficient intake of nutrients, explains the body’s needs and the consequences of starvation. The therapeutic menu is prepared taking into account the patient’s taste preferences. To restore normal nutrition and weight gain, the caloric content of the diet is gradually increased over several months. In severe cases, intravenous glucose solutions are first injected, then the patient begins to eat nutritious mixtures and only then proceeds to normal food.
Psychotherapy. The most effective direction is cognitive-behavioral psychotherapy. At the initial stage, there are conversations during which the specifics of the disease, its possible consequences, and the patient’s choices are discussed. A positive perception of personality and body image is formed, anxiety is reduced and internal conflict is resolved. At the behavioral stage, techniques are developed and mastered to help restore normal eating habits and learn to enjoy food, movement and communication.
Medication correction. Sex hormone replacement therapy is prescribed to accelerate puberty, growth and skeletal bone strengthening. H1-histamine blockers are used for weight gain. Neuroleptics eliminate obsessive-compulsive symptoms and motor agitation, and promote weight gain. Antidepressants are indicated for depression, SSRIs are used to reduce the risk of relapse in patients with restored nutrition and weight gain.
Prognosis and prevention
The outcome of anorexia is largely determined by the timing of treatment. The earlier treatment begins, the more likely a favorable prognosis. Recovery is more likely with a comprehensive therapeutic approach, family support, and elimination of the 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, balanced nutrition and normal weight. In the family, it is important to maintain the tradition of eating together, associated with positive emotions, to teach children to prepare balanced meals, to form a positive attitude towards appearance.