What is anorexia, signs and causes. Anorexia nervosa: symptoms

Anorexia today, unfortunately, is not uncommon: if previously emaciated girls with literally protruding bones were a unique phenomenon, now thinness is no longer surprising. Preoccupation with appearance and body weight often develops into a manic desire to become even better, in which even the most slender girl believes that she is overweight. To get rid of it, they resort to radical methods, up to complete starvation. This causes anorexia - a condition in which the work of the food center of the brain is disrupted, which entails a lack of appetite and refusal to eat.

The essence of the disorder

Anorexia nervosa is a disease characterized by deliberate and excessive weight loss. Most often, this disorder occurs between the ages of 14 and 18, and it is much more common in girls than in boys.

This disease is very dangerous, as it is characterized by specific features. Anorexia nervosa is a condition that often leads to death: approximately 20% of patients die. The reason for this is the general depletion of the body and which has developed against this background. Diets and an obsessive desire to lose weight - this is what leads to a lack of appetite and intolerance to food.

The main number of anorexics are teenagers, since it is during puberty that girls and boys are most concerned about their appearance and subject to other people's opinions. It is quite easy to impose stereotypes on them, including those related to how a person should look.

Note! People who suffer from anorexia do not recognize the fact that they really suffer from a serious disease that can have the most severe consequences.

There are 3 stages of anorexia:

• preorexic. At this stage, a person has not yet observed severe symptoms anorexia nervosa: he believes that his appearance is not good enough, and that this can cause ridicule over him. That is why girls and boys are looking for the best way lose weight. Most often, this way is a rigid diet that can turn into starvation;
• anorexic. Signs of the disease begin to appear: a person is starving, refusing food. Initially, after receiving the first results, he follows the principles of a strict diet even more enthusiastically, but subsequently ceases to feel satisfaction with the way his body looks and feels fat. This creates a vicious circle: the patient tightens his diet even more, depleting the body;
• cachectic, the most severe stage. Patients are emaciated, they develop dystrophy internal organs associated with persistent deficiency nutrients. This is observed approximately 1.5-2 years after a person begins to follow a strict diet and reduce weight extremely quickly. Weight loss is about 50% of your ideal body weight.

Important! Individuals who become ill with anorexia may behave in two different scenarios: either severely restrict themselves in food, or alternate periods of fasting with bouts of uncontrolled overeating. This is called bulimia, which, like anorexia, is a deviation.

Anorexia in adolescents is often accompanied by exhausting physical exercises that patients perform in the hope of further weight loss. This continues until the development of muscle weakness.

Anorexia Development Factors and Deviation Symptoms

A disease that makes girls and men consciously refuse food for weight loss can occur due to predisposing factors, which include:

• thinness fashion;
• conscious use of diuretics and laxatives in order to reduce weight;
• poor heredity, a tendency to develop anorexia;
• mental disorders - severe stress, obsessions;
• endocrine chronic disorders;
• reception medicines that affect the central nervous system;
• disease digestive system;
• dental diseases.

Important! Anorexia in children is a very likely phenomenon that occurs as a result of a violation of the feeding regimen or overfeeding.

Many boys and girls have an idea of ​​how to bring themselves to anorexia: there is a large number of movies, books, television programs dedicated to this topic. Unfortunately, they do not always perceive this information correctly and, instead of abandoning the idea of ​​fasting once and for all, they set themselves the goal of being like an anorexic.

Not the last role in the spread of anorexia is the desire of teenagers to be like celebrities.

A significant role in the prevalence of this deviation is played by the appearance of famous people - actors, pop performers. One of the most famous examples- the appearance of Angelina Jolie, who, despite excessive thinness, is considered the standard of beauty. The teenager who is her idol is unlikely to be visited by the idea that thin arms and legs are ugly. On the contrary, young girls will try with all their might to resemble Angelina, choosing a cruel method for this - starvation.

Recently it became known that Maria Kokhno, a participant in the famous television project Dom-2, suffered from anorexia even before filming. The girl admitted that the cause of the disorder was the separation from her husband. Her weight reached 34 kg. Ill, malnourished, Maria was sent on a journey to have a change of scenery. Only her a strong character helped the treatment: she independently learned to love food again. The symptoms of anorexia disappeared, and Masha's weight began to gradually increase.

What is anorexia?

According to psychologists, the patient's desire to return to normal life is of decisive importance in the treatment of anorexia.

To suffer from anorexia means to undergo a number of symptoms that are difficult to get rid of without the help of specialists, primarily a psychologist and (or) psychotherapist.

Conscious refusal to eat is also accompanied by the following symptoms:

• lack of appetite;
• a sharp weight loss to critical levels;
• weakness;
• constant feeling of coldness in the extremities;
• violation of the heart rhythm;
• insomnia;
• depression;
• lack of menstruation;
• misperception of one's own body;
• increased interest in cooking, active cooking, while the person himself, who suffers from anorexia, does not take part in meals;
• propensity to solitary pastime;
• narrowing the circle of interests, which is limited only by the search for ways to reduce weight;
• frequent fainting.

Note! Anorexia in men, as in women, is accompanied by a decrease in libido.

Consequences of anorexia

It is very important to treat anorexia in order to avoid dangerous consequences.

The treatment of anorexia is very importance, since this deviation has dangerous consequences. They should include:

• pronounced depletion of the body;
• slow heart rate;
• lowering arterial;
• pallor of the skin;
• dry skin, its sagging;
• atrophy of muscle tissue;
• heart failure.

Note! If appropriate treatment is not started in time, the patient dies from total exhaustion of the body.

How to treat anorexia

Psychologists say that in the treatment of anorexia, the patient's desire to return to normal life is of decisive importance. If there is no his will, then it is unlikely that he will be able to help.

Treatment of anorexia is complex and includes the following methods:

• correction of the patient's condition associated with exhaustion. Prescribe the intake of vitamin complexes, organize a diet that includes foods high in protein. When you refuse to eat, nutrients are injected through a needle into the blood;
• psychological help, which consists in distracting the patient from obsession with the idea of ​​losing weight;
• family therapy. Psychological work is also carried out with the patient's family members, during which they are explained the features of the patient's condition and ways to distract him from obsessive ideas. It is important that relatives and relatives of an anorexic follow his diet, spend more time with him, try to protect him from any information related to weight loss methods.

It is difficult to treat anorexia, because the patient does not admit to others, and even to himself, that he really suffers from a serious deviation. The unwillingness of the patient to return to meals, which further aggravates the state of health, is the main reason that causes his death.

The most common victims of anorexia are young girls. Unfortunately, they do not think about the consequences of fasting: even if they manage to get rid of the manic desire to lose weight, there is no guarantee that in the future they will be able to endure and give birth to a child. The strongest depletion of the body is reflected in the functioning of internal organs and provokes serious hormonal changes. It is important for parents to pay special attention to their child during adolescence: it is at the age of 13-16 that they are able to make a mistake that in the future may cost their lives.

According to medical observations, about 20% of people with anorexia die. More than half of the deaths are due to suicide. As for natural death, its cause is heart failure and changes in internal organs incompatible with life, resulting from the exhaustion of the body.

Approximately 15% of women who are addicted to diets bring themselves to the development of an obsessive state, which is close to anorexia. The vast majority of anorexics are teenagers and young girls (especially girls working in the fashion industry).

Anorexia: causes and development factors

The cause of anorexia can be anemia, diabetes mellitus, drug addiction, anxiety phobias, various infections, immunological and hormonal disorders. Recently, anorexia nervosa has spread, which, as a rule, accompanies anxiety disorders of the psyche. With anorexia nervosa, it seems to a person that he is overweight, shows dissatisfaction with his body. Patients with mental anorexia refuse food, expose themselves to excessive physical exertion.

Anorexia can occur due to insufficiency of the hypothalamus in children and autism.

The presence of chronic pathology of organs and systems can contribute to the development of the disease. Among them are endocrine disorders (pituitary, hypothalamic insufficiency, hypothyroidism), diseases of the digestive tract (pancreatitis, gastritis, hepatitis and cirrhosis of the liver, appendicitis), chronic kidney failure, malignant neoplasms, chronic pain of any etiology, prolonged hyperthermia (due to infections or metabolic disorders ), dental diseases.

Iatrogenic forms of anorexia can develop against the background of taking some medicines which negatively affect the central nervous system. As a rule, these are antidepressants, tranquilizers, as well as narcotic drugs, sedatives, caffeine, amphetamines and others.

In young children, anorexia can develop due to a violation of the feeding regimen (in particular, with persistent overfeeding of the child).

Psychological food aversion develops as a result of a strong fear of being overweight against the background of a markedly reduced self-esteem. Psychologists say that subconsciously anorexia is an obvious way to get rid of the fear of being overweight and losing attractiveness. The unstable teenage psyche very clearly fixes the idea of ​​losing weight as the most valuable thing for life. In other words, a person simply loses a sense of reality, ceases to adequately perceive himself and his state of health. Often, women and men suffering from anorexia, with an obvious lack of body weight, continue to consider themselves fat. Often, patients are aware that they are suffering from exhaustion, but at the same time they experience a subconscious fear of eating, and are unable to overcome it.

Types of disease: classification of anorexia

• Mental anorexia: appears with mental disorders that are accompanied by a loss of hunger (schizophrenia, paranoia, depression). It can also appear after taking psychotropic substances.
• Symptomatic anorexia: is a symptom of a somatic disease (diseases of the lungs, stomach and intestines, endocrine system, gynecological disorders).
• Nervous (psychological) anorexia: a person deliberately restricts himself in food.
• drug anorexia: occurs as a result of exceeding the dose of antidepressants, psychostimulants and other medicines.

Symptoms of anorexia: how the disease manifests itself

The main symptoms are significant weight loss, marked loss of appetite. In patients, sleep is disturbed, general weakness, muscle spasms occur. Flabby or atrophied muscles, thin subcutaneous fat, flat stomach and sunken eyes, looseness or loss of teeth, brittle nails, age spots on the skin, hemorrhages on the body, dryness and hair loss, low blood pressure, decreased sexual desire, unstable mood are characteristic. , pallor. In women, the menstrual cycle is disrupted. With anorexia, due to the lack of magnesium, potassium and other minerals and vitamins, cardiac arrhythmia occurs, which can manifest itself as dizziness, fainting, and in some cases, sudden cardiac arrest. When the digestive system is affected, stomach pain, constipation, and sometimes nausea and vomiting occur. Anorexia can lead to depression.

Side symptoms eating behavior:

• an obsessive desire to lose weight, despite a clear lack of body weight;
• fatphobia - fear excess weight;
• constant refusal to eat. Obsessive calorie counting, devoting all the time only to the problem of losing weight;
• turning the process of eating into a complex ritual (serving, carefully weighing food, cutting into small pieces, etc.);
• fanatical avoidance of events that are associated with eating (birthdays, holidays, meetings with friends);
• the appearance of psychological discomfort after eating.

Mental health symptoms:

• depressed mental state, apathy and depression;
• constant dissatisfaction with oneself, one's appearance;
• sleep disturbance and severe mental lability;
• Feelings of loss of control over their own lives
• refusal of the need for treatment, since patients with anorexia often do not realize their problem, considering themselves healthy people.

Physiological manifestations of anorexia:

• significant weight loss;
• tendency to faint, weakness and dizziness;
• body hair growth;
• decreased sexual activity, menstrual disorders;
• poor circulation and feeling cold.

Other behavioral changes in anorexia:

• pathological desire for physical activity. Patients with anorexia become very irritated if they fail to perform overload exercises;
• fanatical thinking and aggressive upholding of one's beliefs and lifestyle;
• choosing loose clothing that hides "overweight";
• inclination to solitude and avoidance of society.

Actions of the patient with anorexia

If you have symptoms of anorexia in yourself or loved ones, you should immediately seek help from a doctor.

Diagnosis of anorexia

In order to diagnose anorexia, body mass index (BMI) is determined. To calculate BMI, a person's weight in kilograms is divided by their height in meters squared. Normally, this indicator is equal to a value in the range from 18.5 to 25. An index value of less than 16 indicates a pronounced underweight.

Also important in the diagnosis of the disease are general analysis blood, urine, detection of hormone levels, biochemical analysis of blood. Gastroscopy, radiography, electrocardiography show the severity of anorexia, possible consequences.

With secondary anorexia, the underlying disease is treated. Nutrition is gradually restored to prevent possible complications in the form of edema, lesions of the digestive system, metabolic disorders. Initially, they take low-calorie foods in small doses, gradually moving to more nutritious foods, increasing the dose. In the treatment of severe cases, intravenous administration of nutrients is used.

In case of damage to the endocrine system, hormone therapy is prescribed. With anorexia nervosa, psychotherapy, the use of antidepressants are indicated. It is recommended to take multivitamin complexes (Elkar and others) and dietary supplements (L-carnitine).

Complications of anorexia

Among the possible complications are hormonal changes (deficiency of thyroid hormones, sex hormones, cortisol, somatotropin), diseases of the cardiovascular system (hypotension, arrhythmia, a decrease in the size of the heart muscle, lack of blood circulation), sexual dysfunction, changes in the musculoskeletal system (osteopenia , ), blood diseases (anemia), diseases of the gastrointestinal tract (organ dystrophy).

Prevention of anorexia

To prevent the disease, you should adhere to the optimal diet, avoid excessive physical activity, stressful situations.

Anorexia nervosa is a severe mental disorder that is accompanied by an eating disorder motivated by the goals of losing weight or preventing excess weight. As a result, such a pathological desire to lose weight, accompanied by an all-consuming fear, leads to a loss of 30 to 60% of body weight. In many patients, criticality to their condition disappears, they do not notice obvious dystrophy, their metabolism is disturbed, diseases occur various systems and organs, but it can be extremely difficult to convince them of the need for treatment by a specialist. Some of the patients are aware of their exhaustion, but their fear of eating is so deep that they cannot restore their appetite on their own.

In this article, we will introduce you to the causes, risk factors, manifestations, consequences, ways to identify and treat anorexia nervosa. This information will help you notice the alarming symptoms of the disease in yourself or your loved ones, and you will make the right decision about the need to contact a specialist.

Without treatment, anorexia nervosa leads to death in about 10-20% of patients. This condition is rightly called the disease of stereotypes, and more often it develops among wealthy segments of the population. According to statistics in recent years, the number of such patients has been increasing, almost 95% of patients are women. Approximately 80% of all anorexics are girls and young women aged 12-26, and only 20% are men and women of more mature age (up to the period).

Causes and risk factors

Anorexia nervosa is more prone to self-doubt, suffering from low self-esteem girls.

The causes of anorexia nervosa are conditionally divided into biological, psychological and social. The following factors can lead to the occurrence of such an ailment:

• genetic - the disease manifests itself when adverse conditions in carriers of certain genes (HTR2A, BDNF), which form a certain type of personality and contribute to the development of mental disorders;
• biological - obesity and early onset, dysfunctions of neurotransmitters regulating eating behavior (serotonin, norepinephrine and dopamine) can deepen pathological disorders in anorexia;
• personal - the likelihood of developing a mental disorder increases among persons belonging to the perfectionist-obsessive type of personality, suffering from feelings of inferiority and the need to comply with some standards and requirements, low self-esteem and insecurity;
• family - the risk of anorexia increases among people in whose family someone suffers from the same disease, obesity, bulimia nervosa, depression, alcoholism and drug addiction;
• age - persons of adolescence and youth are most susceptible to aspirations to please the opposite sex or to imitate idols and stereotypes;
• cultural - living in industrialized cities strengthens the desire to comply with the canons of beauty and success, expressed in the harmony of the figure;
• stressful - physical, psychological, sexual abuse or traumatic events (death of a close friend or relative, divorce, etc.) can contribute to the development of eating disorders;
• mental - a number of mental illnesses (for example, schizophrenia) can be accompanied by eating disorders.

Symptoms

Usually the disease begins with the fact that the patient develops delusional and obsessive thought that excess weight is the cause of all his troubles (unattractiveness, separation from a loved one, lack of demand in the profession, etc.). Further, the patient develops depression, which leads to a strong and constantly progressive restriction of oneself in food. As a rule, patients try to carefully hide this from others (throw away food secretly, give it to a pet, transfer part of their portion back to the pan, etc.).

Constant malnutrition and starvation leads to the appearance of another pathological deviation - at times it “breaks down” and begins to absorb a large amount of food. At the same time, he reproaches himself and comes up with ways to limit its assimilation. To do this, the patient can artificially provoke vomiting, take laxatives and conduct enemas.

Against the background of changes occurring in the body due to malnutrition and metabolic disorders, patients with anorexia nervosa lose their criticality to their condition. Even after they achieve the desired result in losing weight, it begins to seem unsatisfactory to them, and they set themselves new “tasks”.

As a rule, after about 1.5-2 years, the patient loses 20% or more of body weight and he has the physical consequences of anorexia nervosa - physiological abnormalities in the work of various systems and organs.

Psychiatric disorders

Prolonged malnutrition leads to a number of changes in the behavior and mental state of the patient:

• denial by the patient of mental disorders and lack of criticality to signs of exhaustion;
• a constant feeling of fullness and a desire to lose weight more and more;
• changes in eating habits (eating in small portions, eating standing up);
• sudden preoccupation with topics about food: collecting recipes, reading books on cookery, organizing gourmet meals for relatives without the participation of the patient himself, excessive enthusiasm for diets;
• panic fear of extra pounds;
• the emergence of unreasonable resentment and anger;
• sleep disorders;
• depressive state: sadness, irritability, periods of euphoria, followed by reduced activity;
• change in activity in the social environment and family: excessive sports training outside the home, unwillingness to attend events that include meals (birthdays, corporate parties, etc.), limiting communication with relatives and friends.

One of characteristic features Anorexia nervosa is the following reasoning of the patient: "My height is 168, and now my weight is 45 kilograms, but I want to weigh 35 kilograms." Subsequently, the numbers become smaller.

Any results in weight loss are regarded by the patient as a desired achievement, and gaining even a few kilograms is perceived as insufficient self-control and dissatisfaction with oneself. Even patients who are aware of their dystrophy often wear baggy clothes that hide thinness from others. In this way, they try to avoid the need to explain themselves and engage in discussion with those who do not support their aspirations for far-fetched "ideal" standards.

One of the most dangerous manifestations of anorexia nervosa is the self-prescription of various hormonal drugs for weight loss. Such cases are very difficult to treat, and even compulsory treatment may be ineffective.

Mental disorders that occur with anorexia nervosa can cause suicide.

Physical Disorders

Over time, prolonged malnutrition and starvation leads to severe metabolic disorders and the development of diseases of various systems and organs.

Initially, the patient experiences hormonal changes caused by reduced production of thyroid hormones, estrogen, and increased cortisol levels. They show the following symptoms:

• constant weakness (up to hungry fainting);
• menstrual disorders (scanty periods, pain, delay and absence of menstruation, inability to conceive);
• decreased libido;
• muscle spasms;
• bradycardia;
• propensity for.

Subsequently, the following disturbances in the functioning of body systems occur:

• cardiovascular system - fainting, a feeling of cold, the occurrence of arrhythmias, which can cause;
• blood - signs, a decrease in the level of leukocytes, leading to increased susceptibility to infections;
• digestive system - functional dyspepsia, convulsive pain in the stomach, peptic ulcer, chronic constipation, nausea, edema (bloating) of the abdominal cavity;
• skin and hair - dryness and swelling, yellow skin tone, dullness and hair loss, the appearance of vellus hair on the face and body, brittleness and delamination of nails;
• skeletal system and muscles - susceptibility to fractures and their long healing, tooth decay, swelling of the joints, muscle atrophy;
• urinary system - a tendency to,.

Some of the physical disorders described above can be corrected with treatment of anorexia nervosa and restoration of normal weight and nutrition, but some of them are irreversible.

Excessive enthusiasm for attempts to induce artificial vomiting and cleansing enemas can cause the following disorders:

• trouble swallowing food and liquids;
• rupture of the esophagus;
• weakening of the rectal wall;
• rectal prolapse.

Pregnancy and anorexia nervosa

Pregnancy with anorexia is often difficult, but after treatment and weight gain, estrogen levels can be restored and conception occurs. Even after therapy in the future, a woman may experience the following problems associated with hormonal imbalance:

• difficulty with the onset of conception;
• increased risk of fetal malnutrition and the appearance of congenital malformations in the unborn child;
• increased risk of complications during pregnancy and childbirth;
• an increased risk of anorexia recurrence against the background of a stressful state that occurs in response to the news of pregnancy.

In severe forms of anorexia nervosa, even after treatment, the menstrual cycle does not restore, and the woman cannot become pregnant on her own.

Stages of the disease

The initial stage of anorexia nervosa is characterized by the constant bad mood of the patient, her tendency to frequent weighing and measuring body volumes, and the desire to follow a strict diet.

During anorexia nervosa, the following stages are distinguished:

1. dysmorphomaniac. The patient often has painful thoughts about his own inferiority, associated with imaginary fullness. The mood becomes depressed, anxious. The patient can look at his reflection in the mirror for a long time, often weigh himself, measure the waist, hips, etc. At this stage, he begins to make the first attempts to limit himself in food or seeks and follows an “ideal” diet.
2. Anorexic. The patient is already attempting persistent starvation and has lost about 20-30% of body weight. Such “successes” are perceived with euphoria and are accompanied by the desire to lose weight even more. The patient begins to exhaust himself with excessive physical exertion, eats even less and tries in every possible way to convince himself and those around him that he has no appetite. At this stage, he can no longer be critical of his exhaustion and underestimates its excessive degree. Starvation and lack of nutrients lead to the appearance of the first signs of changes in physical condition: hypotension, bradycardia, fainting and weakness, menstrual and libido disorders, dry skin, hair loss. Disturbances in metabolism and the physiological functioning of organs are accompanied by active decay of tissues and lead to even greater suppression of appetite.
3. cachectic. At this stage, there is an occurrence of irreversible disorders caused by dystrophy of organs. As a rule, this period begins 1.5-2 years after the first manifestations of anorexia nervosa, when the patient loses approximately 50% of body weight. If left untreated, dystrophic processes lead to the extinction of the functions of all organs and the death of the patient.

Diagnostics

Many people with anorexia nervosa think they are not sick or are able to control their condition on their own. That is why they rarely go to the doctor on their own. In such cases, the task of their relatives is to help the loved one understand the problem and resort to the services of a specialist.

Usually, to make a diagnosis, the doctor asks the patient several questions of the test, developed in the UK:

• do you consider yourself complete;
• whether you keep your weight under control and what you eat;
• Have you lost more than 5 kilograms recently?
• whether thoughts about food are dominant;
• do you believe that you are fat (th), if others say that you are thin (th).

Even two “yes” answers indicate the presence of eating disorders.

To confirm the diagnosis and determine the severity of anorexia nervosa, the patient is assigned the following types of studies:

• body mass index calculation (for example, the norm for women over 20 years old is 19-25, the risk threshold is 17.5);
• blood tests to detect anemia and electrolyte disorders;
• blood tests to determine kidney and liver function;
• and sex hormones.

If necessary, examination of a patient with anorexia nervosa can be supplemented (to detect osteoporosis), ultrasound of various organs and (to detect diseases of internal organs).

Treatment

Treatment of anorexia nervosa is carried out by doctors of several specializations and can be carried out on an outpatient basis or in a hospital setting. The need for hospitalization of the patient is determined by the severity of the clinical picture. It is shown in the following cases:

• a decrease in body mass index by 30% below normal;
• progressive weight loss on the background of outpatient therapy;
• heart rhythm disturbances;
• hypotension;
• hypokalemia;
• severe forms of depression;
• suicidal tendencies.

The main goal of treatment for anorexia nervosa is to restore weight and eating habits. An increase in body weight of 0.4-1 kg per week is desirable. In addition, therapy is aimed at eliminating mental and physical complications.

The most successful tactic for treating such a disease is a combination of psychotherapy, family and conservative therapy. It is extremely important that the patient himself participate in this process and realize its necessity.

Even after treatment, some patients remain prone to relapses of the disease and need constant psychological support (especially during stressful periods of life). The following factors can complicate the recovery process and increase the risk of relapse:

• communication with friends, sports coaches and relatives who admire thinness and promote weight loss;
• lack of psychological support from close friends and family;
• the impossibility of overcoming the patient's conviction that excessive thinness is the only way to combat obesity.

The treatment plan for anorexia nervosa is made depending on the characteristics of the disease and the personality of the patient. The composition of complex therapy includes several methods.

Lifestyle change

A patient with anorexia nervosa needs the following changes:

• regular and healthy eating;
• proper formation of the diet and menu planning with the help of a nutritionist;
• getting rid of the habit of constant weighing;
• exclusion of exhausting physical activity for weight loss (only after the patient's condition is normalized, the doctor can include exercises in physiotherapy exercises in the treatment plan);
• increasing social activity;
• psychological support from friends and relatives.

Restoration of normal nutrition and weight gain

This part of the treatment plan for anorexia nervosa is fundamental, as the normalization of nutrition and weight contributes to the restoration of both physical and mental health. In addition, these factors increase the effectiveness of psychotherapy.

To increase weight, the patient is prescribed a diet, the principle of which is aimed at gradually increasing the calorie content of the daily diet. Initially, it is recommended to consume 1000-1600 calories per day, and then the diet gradually expands to 2000-3500. Food should be taken 6-7 times a day in small portions.

In the early stages, the patient may experience anxiety, depression, and signs of fluid retention in the body in response to weight gain. Over time, as you gain weight, these symptoms decrease and disappear.

Parenteral and intravenous nutrition is not usually used for the treatment of anorexia nervosa, since in the future such methods may lead to difficulty in restoring normal nutrition, and many patients perceive such methods as punishment and compulsory treatment. However, in some difficult cases (categorical and prolonged refusal to eat, heart rhythm disturbances, bleeding from the mouth, etc.), such methods can be used temporarily to initially improve the patient's condition.

Nutrition and supplementation

Patients with anorexia nervosa suffer from a lack of vitamins, minerals and nutrients. Their replenishment significantly improves the mental and physical condition of patients, and therefore food should be nutritious and fortified.

If necessary, diet therapy is often supplemented by taking nutritional supplements. For this, the following dietary supplements can be used:

• multivitamin products (A, C, E) and supplements based on magnesium, zinc, calcium, copper, phosphorus and selenium;
• Omega-3, fish oil, eating fish (especially halibut and salmon);
• coenzyme Q10;
• 5-hydroxytryptophan;
• probiotics based on lactobacilli and acidophilus;
• creatine.

Improve absorption useful substances and general condition can comply with the following recommendations:

• sufficient reception drinking water(up to 6-8 glasses per day);
• inclusion in the diet of high-quality protein sources: eggs, meat, dairy products, protein and vegetable shakes;
• quitting smoking and drinking alcohol;
• eliminating or significantly reducing the number of caffeinated products;
• restriction of refined sugars: sweets, sweet water, etc.

Cognitive Behavioral Therapy

This method of treatment of patients with anorexia nervosa is the most effective. With this technique, the patient learns to replace distorted thoughts and negative judgments with real and positive ways of solving problems.

Cognitive behavioral therapy consists in the fact that for several months or six months the patient himself draws up his own menu and includes in it products that he previously refused in every possible way. He monitors his diet and records unhealthy thoughts and reactions associated with food. In addition, he notes that he has relapses in the form of vomiting, taking laxatives and excessive physical exertion.

The patient periodically discusses these notes with a cognitive therapist and, as a result, may become aware of false and negative judgments about their weight. After such acceptance, the list of products in the diet expands, and the awareness of the problems present earlier allows him to get rid of ingrained false judgments. Subsequently, they are replaced by correct and realistic ones.

Family Therapy

An important role in the complex treatment of anorexia nervosa belongs to family psychotherapy. The patient needs to feel the support and understanding of friends and relatives.

The involvement of parents, relatives and friends helps the patient cope with the difficulties that arise. The doctor teaches them to develop the right tactics of behavior with him. In addition, family therapy is aimed at eliminating feelings of guilt and anxiety that arise in the relatives themselves and the patient's relatives.

Maudsley method

This tactic is a type of family therapy and can be used in the early stages of anorexia nervosa. The Maudsley method consists in the fact that in the first stages the patient's parents take over the planning of the menu and control the use of prepared dishes. Gradually, as correct judgments about nutrition are restored, the patient begins to make his own decisions about when and how much to eat. Weekly, the results of treatment are discussed with a psychotherapist, who gives additional recommendations and evaluates the effectiveness of this technique.

Hypnotherapy

The use of hypnosis can become part of the complex treatment of anorexia nervosa. Such sessions allow the patient to regain self-confidence, increase resistance to stressful situations, restore the correct perception of their appearance and weight. As a result, hypnotherapy can help return to normal eating habits.

Medical therapy

Taking medications for the treatment of anorexia nervosa is recommended only if it is impossible to eliminate existing problems with the help of psychotherapeutic techniques and diet therapy. For this, the patient may be prescribed:

• antidepressants (Fluoxetine, Cyproheptadine, Chlorpromazine, etc.) - for the treatment of severe forms of depression, anxiety and obsessive-compulsive disorders;
• atypical antipsychotics (Azenapine, Ziprasidone, Clozapine, Sertindole, etc.) are used to reduce advanced level anxiety.

In addition, drug treatment is supplemented by symptomatic therapy of emerging complications of anorexia nervosa (gastritis, peptic ulcer, arrhythmias, etc.). If mental illnesses that cause eating disorders are identified, their treatment is prescribed.

Forecasts

The recovery process of a patient with anorexia nervosa can take about 4-7 years. Even after recovery, there is a possibility of recurrence of the disease.

According to various statistics, approximately 50-70% of patients fully recover from the disease, but 25% of patients fail to achieve such results. Sometimes after treatment, uncontrolled overeating occurs, leading to weight gain and a number of other psychological problems.

The probability of a fatal outcome in anorexia nervosa depends on the stage of the disease, the mental and physiological characteristics of the patient's body. Death can be caused natural causes(i.e., arising complications and diseases) or occurs due to suicide.

Which doctor to contact

If there is an extreme concern about your weight, an open or hidden from others refusal to eat and sudden weight loss, you should contact a psychotherapist. When anorexia nervosa is detected, a nutritionist and a general practitioner are involved in the patient's treatment process.

Anorexia(lat. anorexia nervosa) is a disorder associated with a conscious refusal to eat in order to optimize one's own body weight. Anorexia, the symptoms of which are considered significant weight loss, is typical for girls during puberty. Most of the patients are girls. The causes of the disease are not fully understood.

HISTORICAL INFORMATION

The first mention of anorexia is found in the writings of French psychiatrists at the end of the distant XVIII century, when the first symptoms of anorexia in girls were described. The main feature of the disease was a persistent unwillingness to eat. In the future, this condition was given the name of anorexia nervosa or mental anorexia. Described by various scientists, they had the same type of clinical picture, which is characterized by three successive stages:

• Gastric - patients reduce the amount of food they take due to subjective complaints of discomfort in the digestive tract.
• The struggle stage, the essence of which lies in the false conclusion of the patient that the restriction of food intake helps to get rid of discomfort in the abdominal cavity.
• The stage of cachexia is the final stage of anorexia, in which the patient is bedridden due to a critical decrease in body weight.

Subsequently, the interpretation of the components of the clinical picture changed, which is evidenced in the works of domestic psychiatrists who began to actively study the symptoms and signs of anorexia in the middle of the last century.

In Europe, it is customary to classify anorexia nervosa as a psychosomatic illness. According to statistics, the disease occurs in 1.2% of girls, among which eight out of ten are under the age of 25 years.

ETIOLOGY OF ANOREXIA

Despite the constantly updated data on the disease, it is still not possible to accurately answer the question of what causes anorexia. In the development of pathology, there are several groups of factors that can have a predisposing effect on the onset of the disease.

Predisposing factors:

• Genetic. Recent information on the human genome has made it possible to identify loci in chromosomes that increase susceptibility to anorexia nervosa. The disease manifests itself after the action of a significant emotional load, constant errors in nutrition. In the absence of provoking factors, a person with such genetic material remains clinically healthy.
• Biological. In this group of factors, scientists include abdominal obesity, early onset of menstruation, endocrine pathology. The key point is to increase the concentration of certain lipid fractions in the general circulation.
• Family. The risk of developing anorexia nervosa is significantly higher in families with mental disorders. The presence of relatives who abuse alcohol or drugs also increases the likelihood of the disease.
• Personal. Anorexia nervosa affects certain personality types. The desire to meet the standards of society, self-doubt contribute to the development of psychosomatic illness.
• Age and gender. The most significant for the development of anorexia nervosa is the pubertal period of life. Very rarely, the disease develops after 25 years. In terms of gender, there is a significant predominance of female patients.
• Culture. Living in a region where harmony is the criterion for female beauty affects the diet of the population. At the same time, teenagers try to meet such standards, refusing normal nutrition.

SYMPTOMS OF THE DISEASE

In the clinical picture of anorexia nervosa, the initial manifestation and the actual clinical symptoms of the disease are distinguished.

Initial manifestations

Initial symptoms of anorexia appear in patients long before the main clinical manifestations. Patients may be concerned about:

• emotional lability. Change of mood occurs very quickly, sometimes even without apparent external causes.
• Irritable attitude towards others. This applies to behavior in the circle of peers, may extend to the adult environment. The most criticized are overweight people.
• Incontinence in behavior, often provoking conflict situations.
• Aggressiveness, eventually turning into apathy.

Under the influence of minimal psychotraumatic factors, such as troubles in the family or at school, the first sexual experience, the death of close relatives, the divorce of parents, moving to another city, etc., the initial manifestations progress. Such symptoms of anorexia begin to appear, which are characteristic of the disease and allow differentiating various psychogenic pathologies.

Clinical picture

A pronounced change in the patient's attitude to food intake appears after hearing the comments of others about being overweight. The reaction of the patient may be a decrease in portions of dishes or the rejection of any products. In addition, there are changes in behavior:

• Adolescents carefully watch nutritional value food intake, trying to choose the least calorie foods.
• When force-feeding is attempted, it may throw away or hide offered foods.
• Often forcefully induces a gag reflex or gastric lavage big amount water to cleanse the digestive tract.
• Takes food in small portions, chewing it for hours.

There is also excessive activity of patients. They are constantly doing physical exercise, reworked several times homework, the minimum time is spent in a sitting or lying position.

Characteristic signs of anorexia in girls are changes in posture and an aggressive attitude towards fat people. The first symptom appears due to the use of tight bandages or corsets. At the same time, the stomach is deeply drawn in, the shoulders are laid back, the head is somewhat thrown back. Aggression manifests itself in the form of verbal intemperance even towards relatives.

It is worth noting that in patients with the first signs of anorexia, a feeling of hunger persists, but it is persistently ignored. In the future, the appetite is dulled and the patient does not feel the need to eat.

At the anorexic stage of the disease, depressive phenomena begin to develop. This is expressed in a feeling of anxiety, deterioration of mood, attempts to minimize contacts with other people. Initially, such symptoms appear before meals, then - on an ongoing basis. With insufficient, according to the patient, weight loss, thoughts of suicide are possible.

PATIENT PERSONALITY PICTURE

Examining patients suffering from this psychosomatic illness, doctors came to the conclusion that most of them had a developmental conflict. This was expressed in the unwillingness of the girls to move into the period of maturity. The appearance of periodic menstruation, the development of the mammary glands and other signs of puberty were considered alien and unnecessary by the patients. Refusal to eat has been interpreted by researchers as a defense against growing up and a fight against femininity. It took the form of a phobic fear of normal food. It is worth noting that with such symptoms of anorexia, no significant somatic or endocrinological diseases were detected in women.

Quite typical for patients with anorexia is the level of intellectual development. Almost all of them show excellent results in education, showing high work capacity and activity in the learning process. Due to this, patients with anorexia look socially adapted, but a detailed examination of them reveals a lack of communication with peers. Girls prone to such a mental illness try to be inconspicuous, minimizing contact with classmates.

IN home environment children are obedient, actively help in everyday life, sometimes independently redoing the work entrusted to them several times until the best results are obtained. The atmosphere of perfectionism that imbues family relationships, affects the desire of the child to have an ideal body weight.

FORECAST AND PREVENTION OF ANOREXIA

It is extremely difficult to predict the further condition of a patient with such a psychosomatic illness. In some patients, there is a stable recovery with a full set of proper weight, in others, the course of the disease is undulating, where after a period of remission, recurrence of symptoms may occur. Timely treatment, started at the first symptoms of anorexia, restores metabolic processes. However, the dystrophic changes to which internal organs, primarily the liver, significantly increase the risk of developing functional multiple organ failure.

It is worth remembering that anorexia is caused by various factors, the influence of many of which has not been fully studied, therefore, adequate preventive measures have not been developed.

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The article discusses anorexia. We tell what kind of disease it is, its causes, signs, stages and types. You will learn about the necessary treatment and the consequences of the disease, as well as feedback from women about personal experience combat this disorder.

Anorexia is a disease that is characterized by a disruption of the food center of the brain and manifests itself in the form of loss of appetite and refusal to eat. It is based on a neuropsychiatric disorder, manifested by fear and an obsessive desire to lose weight.

Patients with anorexia use various methods for weight loss, ranging from diets, fasting, excessive exercise and ending with enemas, gastric lavage and removal of vomiting after each meal.

With this pathology, there is a strong loss of body weight, depression. Patients experience guilt while eating and fasting, while they lose the ability to adequately assess their own weight.

Anorexia is a dangerous disease that often ends in death (up to 20 percent of total number patients). More than half of deaths occur as a result of suicide, in other cases, death occurs due to heart failure due to general exhaustion of the body.

Approximately 15 percent of women who are fond of losing weight and dieting bring themselves to the development of anorexia. Most of these people are teenagers and young girls who look up to models and representatives of show business. Most often suffer from the disease girls aged 14 to 24 years. Much less frequently observed.

Anorexia and bulimia are common conditions among models, affecting up to 72 percent of those who work on the catwalk. Among the celebrities who died from these ailments, it should be noted model Anna Carolina Reston (died at 22, weighed 40 kg with a height of 178 cm), Mayara Galvao Vieira (died at 14, weighed 38 kg with a height of 170 cm) and Hila Elmaliah ( died at the age of 34, with a height of 167 cm, weighed 27 kg).

Anorexia can occur as a result of taking certain medications, especially in excessive dosages. The main danger of the disease lies in the fact that patients do not perceive the seriousness of their illness and do not notice any health problems in themselves. Untimely treatment of pathology leads to death.

The most common form of the disease in girls and women is anorexia nervosa. This is due to the fear of gaining excess weight, dissatisfaction with their own weight, low self-esteem.

Voluntary refusal from food - a sign of anorexia

Classification

Anorexia is classified according to the mechanism of formation:

• neurotic - negative emotions activate excessive excitation of the cerebral cortex;
• neurodynamic - strong stimuli, for example, pain, suppress the nerve center of the cerebral cortex, which is responsible for appetite;
• neuropsychiatric (nervous cachexia) - refusal to eat occurs due to mental disorders, such as depression, frequent stress, schizophrenia, desire be thin.

Also, the pathology can be caused by insufficiency of the hypothalamus in children, Kanner's syndrome.

Types of anorexia

There are several types of pathology:

• Primary anorexia - lack of appetite in children for various reasons, loss of hunger due to hormonal disorders, oncology or neurological disease.
• Painful mental anorexia - the patient has severe weakness, loss of the ability to feel hunger when awake. A characteristic feature of this species is intense hunger during sleep.
• Drug anorexia - loss of appetite occurs as a result of intentional or unconscious use of certain drugs. With intentional medication, all efforts are directed towards weight loss due to the ability of these medications to remove the feeling of hunger. In this case, anorexia manifests itself as a side effect when taking certain stimulants, antidepressants.
• Anorexia nervosa - occurs as a result of a complete or partial loss of hunger, which is caused by a persistent desire to lose weight (usually this condition does not have an appropriate psychological justification) with excessive restriction of the patient regarding food intake. This type of pathology is fraught with various complications in the form of metabolic disorders, cachexia, etc. With cachexia, the patient is not satisfied with his appearance, he is not afraid of his own repulsive appearance, and satisfaction comes only with a decrease in body weight.

stages

Experts distinguish 4 stages of anorexia. Below we will look at each of them in detail.

Dysmorphomanic stage

The duration of this stage is 2-4 years. At this time, overvalued and crazy ideas regarding weight loss, and leading to disastrous consequences for the body, settle in the patient's head. The patient does not like his own appearance, while changes in appearance are associated with puberty.

The opinion of others for a potential anorexic does not matter, only the reflection in the mirror and the rapid weight loss that makes the bones on the body visible are important. At the same time, any careless remark can cause a nervous breakdown or cause an even greater desire to lose weight.

anorexic stage

The beginning of a new stage in a patient can be determined by the emerging active desire to eliminate shortcomings in appearance. This leads to significant weight loss (up to 50 percent), the formation of somatohormonal abnormalities, the cessation or reduction of menstruation.

A variety of methods are used to reduce weight: exhausting workouts, food restrictions, taking laxatives and diuretics, enemas, large coffee consumption, intentionally induced vomiting after each meal.

Behavioral disorders that manifested themselves at the initial stage begin to give results in physiological terms:

• inflammatory processes occur in the gastrointestinal tract;
• gastrointestinal organs descend;
• persistent constipation occurs;
• there is regular pain in the stomach;
• some time after eating, asthma attacks, tachycardia, hyperhidrosis and dizziness occur.

It is worth noting that even a sharp reduction in the intake of nutrients into the body does not affect the patient's performance and physical activity.

Refusal to eat leads to fatigue and poor health

cachectic stage

At this stage, somatohormonal disorders predominate:

• menstruation stops completely;
• subcutaneous fat disappears;
• there are dystrophic changes in the skin, cardiac and skeletal muscles;
• heartbeat becomes less frequent;
• arterial hypotension is observed;
• body temperature decreases;
• the skin becomes blue and loses elasticity due to a decrease in peripheral circulation;
• nails become brittle;
• hair and teeth fall out;
• anemia develops;
• the sensation of cold becomes constant.

Despite the deterioration of health, patients continue to keep themselves in a phase of extreme exhaustion, refusing to eat normally. At the same time, patients cannot adequately assess their health and in most cases are still dissatisfied with their appearance.

Mobility is lost, and most of the time a person has to spend in bed. Due to a violation of the water-electrolyte balance, seizures are likely to occur. This condition threatens the life of the patient, so it is necessary to proceed to inpatient treatment, even if the patient resists.

reduction stage

The last stage of anorexia is reduction, which is the return of the disease after treatment. After therapy, weight gain is observed, which causes a new surge of delusional thoughts in the patient relative to his appearance.

The patient returns to the old methods of losing weight (enemas, vomiting, medication, etc.). It is for this reason that the patient must constantly be under the supervision of a specialist. The likelihood of recurrence persists for 2-3 years.

weight for anorexia

A reliable sign of pathology is a weight that is at least 15 percent below normal. For an accurate assessment, experts use the body mass index (BMI), which is calculated as follows:

I = m / h2

• m - weight in kg;
• h - height in square meter.

To calculate your own BMI, divide your weight by the square meter of your height. Then compare with the indicators given in the table below.

BMI calculation table

Causes

The presence of various chronic diseases of organs and systems can provoke the development of anorexia. Among the pathologies are:

• disruption of the endocrine system;
• diseases of the digestive system;
• oncology;
• chronic renal failure;
• various chronic pains;
• prolonged hyperthermia;
• dental diseases.

The development of anorexia nervosa may be associated with the use of drugs that act on the central nervous system, antidepressants or tranquilizers, with overuse caffeine, sedatives or drugs.

Pathology can be caused by violation of the rules of feeding, overfeeding.

Symptoms

The main symptoms of pathology are:

• too low body weight, which decreases even more over time;
• unwillingness to gain weight and get better;
• full confidence that the current weight is normal;
• fear of food, regular restriction of food intake and refusal of it under various pretexts;
• fear of weight gain, reaching a phobia;
• feeling of discomfort after eating;
• severe weakness, fatigue;
• feeling of worthlessness.

Photos of patients with anorexia

Appearance(photo) anorexics
Anorexia is a dangerous pathology that leads to death