For cleansing anorexia nervosa is characteristic. Anorexia nervosa

Definition of disease. Causes of the disease

Anorexia nervosa (AN)- a mental disorder characterized by the patient's rejection of his body image and a pronounced desire to correct it by restricting food intake, creating obstacles to its absorption or stimulating metabolism.

According to the International Classification of Diseases (10th revision): anorexia nervosa (F 50.0) is a disorder characterized by deliberate loss of body weight caused and maintained by the patient. The disorder is associated with a specific psychopathological fear of obesity and body sagging, which becomes an obsession, and patients set a low body weight limit for themselves. As a rule, there are various secondary endocrine and metabolic disorders and functional disorders.

Eating disorders (EDs) are serious illnesses that affect both the physical and emotional health of young people, as well as families in general, morbidity and mortality. RPP affects 2-3% of the population, 80-90% of which are women. Anorexia nervosa (AN) is one form of this type of disorder. The prevalence of AN among women aged 15 to 40 years is 0.3-1% regardless of culture, ethnicity and race. European studies have shown a prevalence of 2-4%. Anorexia tends to become chronic in more than 50% of people who develop the condition again after full recovery.

Over the years, various theories have been put forward trying to explain the possible causes of AN. It is assumed that current pharmacological and psychological therapies cannot address the neurobiological factors or mechanisms responsible for development and maintenance because it is not clear what that is. To better understand the etiology of mental illness, including AN, a new transdiagnostic approach, RDoc, is being developed in the United States. This approach explores the causes of features common to many disorders rather than features specific to discrete diagnostic categories. Potentially causal neural abnormalities not previously considered in etiological models can be distinguished using this transdiagnostic approach.

A combination of factors leads to the development of eating disorders.

External factors

There have been many discussions about the influence of the media on the standard of female body image, and they continue to this day. In 2000, a summit was held in the UK between fashion editors and government representatives to assess the link between popular images of women, body and nutritional disorders. Psychotherapist Susie Orbach (2000), a member of the group, spoke about the role of the media and its ability to promote body dissatisfaction in women. One of the conclusions of the conference was that fashion standards do not cause eating disorders, but appear to provide a context in which they can develop.

Transactional analysts explain this phenomenon as follows: some young people accept the "thin model" as an ideal or opportunity to model and internalize the parent's media message as if it were a cultural parent. The image provides an opportunity to feel "OK" through changing the parameters of the figure of people who do not have a sense of their innate "OKness".

The risk group also includes people who have experienced sexual violence and were born into a family with overweight problems.

Internal factors

Over the past three decades, research has established that genetic factors contribute to the development of AN.

Recent results from genetic meta-analyses indicate that serotonin genes may be involved in the genetic etiology of AN. Some studies point to a possible genetic comorbidity of AN with other psychiatric (eg, bipolar disorder) and medical illnesses, as well as a common genetic risk between AN and certain psychiatric and metabolic phenotypes. Dozens of studies have been carried out, but, unfortunately, very little information has been obtained on the genetic contribution to the development of AN. This is due to the insufficient number of studies and the fact that only a fraction of them have been completed to draw definitive conclusions about the significance of their results.

Structural studies using neuroimaging of the brain in AN are mainly focused on changes in gray matter. To date, studies focusing on white matter abnormalities are rare. Thus, recent studies have shown that a structural anomaly of the brain is a prerequisite for the development of AN. Several studies have shown changes in gray matter volume (GVM) using voxel analysis in patients with AN compared with controls. For example, Mühlau et al found a 1-5% decrease in regional CBH volume in the anterior cingulate gyrus of the brain in patients with AN, which correlated significantly with the lowest body mass index (BMI). Boghi and colleagues found a significant decrease in total white matter volume (WW) and localized atrophy of the CBH in the cerebellum, hypothalamus, caudate nucleus, and frontal, parietal, and temporal regions. In addition, an association between BMI and CBH volume was also found in the hypothalamus.

There is scientific evidence to support that the gut microbiome (combination of microbes) of individuals with AN may have unique characteristics that also contribute to maintaining a severely restricted calorie diet.

Personal factors

People with the following traits are most at risk: childhood obesity, female gender, mood swings, impulsiveness, personality lability, perfectionism. As well as people with low, unstable self-esteem, an external locus of control. One of the triggers is adolescence. Puberty itself is a transitional stage, a crisis that brings with it a physical and psychological upheaval as sexuality develops. Some authors emphasize the importance of eating disorders in avoiding or even allowing reversal of sexual development. Which gives secondary benefits in the form of a lack of sexuality, relationships, adult physical characteristics and adult responsibilities. Clinical observations characterize people with AN as highly anxious. This is supported by empirical studies that report high personal anxiety and higher rates of anxiety disorders in this population compared to the general population. An anxiety disorder of varying severity has been documented to precede the onset of the disease and play an important role in its development.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of anorexia

The initial symptoms of this disease are: excessive concern with their appearance, dissatisfaction with overweight or its individual parts, which is subjective. O.A. Skugarevsky and S.V. Sivuha suggest that dissatisfaction with the image of one's own body is a trigger in the development of this pathology. Theoretical and empirical studies on this issue confirm the presence of this phenomenon. Distorted perception of assessments is unstable, may appear due to bad mood, anxiety attacks, external factors described above. The perception of one's own body is formed under the influence of value judgments received from the outside, for example, from parents, friends, popular personalities - the reference group. Moreover, these assessments can be both direct (compliments or name-calling) and indirect (concern about being overweight among the reference group). Such external feedback has a two-way orientation, since its internalization and perception directly depend on self-esteem, the locus of control of a particular individual. It is possible that there is a phenomenon of attributive projection that exacerbates this process.

Against the background of these phenomena, patients resort to measures to correct this problem (diets with strict calorie restriction or radical starvation, increased physical activity, attending trainings, seminars on the problems of excess weight). A behavioral determinant is formed, which at this stage acquires a compulsive character. All conversations with others, thoughts, social activity comes down to the topic of diets and dissatisfaction with the image of one's own body. Departure from this behavior pattern brings an uncontrollable anxiety attack, which the individual tries to compensate for with even greater food restriction / physical activity, since fasting gives a temporary anxiolytic effect. This contributes to the formation of a "vicious circle", the pathogenesis of which will be described below.

It is also worth noting that many eating disorders have references to anorexia. Eating disorders such as malnutrition and "fear of food" are associated with the restriction of food intake and the inability to meet their nutritional needs. While patients may be significantly underweight, this disorder does not always meet the diagnostic criteria for anorexia. People with an eating disorder are different in that they often lose control of their eating behavior and may eat excessive amounts of calories at one meal without compensating for this by purging or subsequently restricting themselves from eating. Bulimic patients will walk in this vicious circle without a low BMI. Perverted appetite can be a manifestation of mental disorders and eating behavior as well. Some patients suffering from anorexia have chronic consumption of substances unsuitable for ingestion. For example, they can dine on toilet paper when they are hungry. This disruption in thinking occurs when patients repeatedly vomit over a period of one month. In the absence of other disorders, the disorder may be identified and only occur during another eating disorder.

Weight loss becomes noticeable to others, and if at first, especially if they have a history of being overweight, they receive positive comments (“strokes”, in TA terms) that praise a new, leaner body and support food restrictions, which increases self-esteem and feelings of satisfaction . Subsequently, the behavior acquires a deviant character, about which others increasingly begin to express their concern. Often, however, young girls feel a sense of superiority, pitying those whose will is weak enough to lose weight. At this stage, many patients begin to hide the presence of this problem, continuing to cherish the image of "ideal thinness". Teenage girls throw away food while their parents are not looking, play sports at night, start wearing loose-fitting clothes so that reduced body weight does not catch the eye and does not attract undue attention.

Against the background of consistently critically reduced body weight and constant malnutrition, almost all patients develop distinct depressive symptoms, which further reduces the quality of life and, possibly, contributes to the emergence of healthy reflection and partial recognition of the problem. At this stage, most often there is an appeal for psychological and medical help. However, it is worth emphasizing that depressive symptoms are little more than a consequence of acute malnutrition and not of major depressive disorder. This assumption is supported by studies showing that depressive symptoms are significantly reduced with weight gain, and that leptin, a hormonal indicator of nutritional status, is associated with depressive symptoms in patients with acute AN. In a study in healthy men, Keys et al. (1950), later known as the Minnesota Fasting Experiment, demonstrated that acute fasting caused depressive symptoms that disappeared with the return of food. This is also consistent with the fact that antidepressants have been found to be ineffective for the treatment of depressive symptoms in patients with severe AN.

The question of the presence of anhedonic symptoms in patients with AN remains unclear. In AN, the primary rewards (food and sex) are often described as unpleasant and are avoided by patients with this diagnosis. Such characteristics have been associated with abnormalities in the reward system of the brain and may be considered an anhedonia-like phenotype. Indeed, neural changes in the processing of beneficial or erratic stimuli, such as food stimuli, or erratic non-specific stimuli, such as monetary rewards, have been the focus of attention of neuroscientists over the past few years.

Studies have found an increase in the level of anhedonia in patients during the acute phase of the course of the disease and during recovery. Depressive symptoms were elevated during the acute phase of the disorder, but a significant reduction in depressive symptoms was shown during recovery. Findings indicate that malnutrition is an etiological factor in depressive symptoms (condition indicator). An average weight gain of 26% contributed to a significant reduction in depressive symptoms, but only partially reduced anhedonia.

These results support the suggestion that anhedonia is a characteristic feature of the anorexic symptom complex and is relatively independent of depressive symptoms.

Pathogenesis of anorexia

Some aspects of the pathogenesis of symptoms accompanied by AN have been disclosed in the previous sections. Here I would like to dwell on the model of the psychodynamic concept and the theory of transactional analysis.

What all authors writing about eating disorder have in common is the importance of self-assessment. In his model of childhood development, Erickson (1959) identified specific tasks at each stage. At the oral stage, he concluded the need to establish a sense of fundamental trust that the environment would respond adequately and reliably. During the anal stage (2-4 years of age), while the child is learning to control his bodily function and mobility, the task is a sense of autonomy which, if not completed, leads to shame and doubt. The main feature of malnutrition is the need for control; we often hear people describe that "most things in my life seemed out of control, but my weight was the only thing I could control." Autonomy is not achieved without completion of this stage, and the lack of this early experience is felt when problems of separation and independence reappear in adolescence. Similarly, when there is an early deficit in basic trust, the adolescent trusts no one but himself, and we see the young person become increasingly isolated from friends as he seeks refuge in the restrictive demands of anorexia. Levenkron compares this anorexic finding to healthy adolescent behaviors of delimitation from a parent to a supportive partner in a group. When people are not perceived as trustworthy, anorexia can become something of a "best friend".

When eating disorder occurs during adolescence, early adaptation seems to be challenged by the onset of puberty. The main challenge for a teenager is to establish a sense of identity that will be different from that of their parents. For a child who has prescriptions for a negative evaluation of sexuality or a ban on the expression of feelings (especially unpleasant ones), the onset of puberty presents an impossible dilemma. According to Mellor (1980), such prescriptions are usually introduced between the ages of 4 months and 4 years, although some authors describe the appearance of these prohibitions at other stages, in response to specific circumstances. His bodily changes imply sexuality, responsibility, and a terrible sense of being unable to control biological forces.

For some young people, eating disorder is the perfect solution to an impasse: it occupies their mind, masks their feelings, and cancels their biological development. This allows you to comply with the prescriptions and at the same time neutralize the pressure of adolescence.

Important for understanding the pathogenesis of AN symptoms is the question of the development of compulsive fasting from a usual dietary restriction, as well as the place of anxiety in the development and maintenance of the disease: is it a de facto characteristic feature of the complex of anorexic symptoms.

Compulsiveness has been identified as a transdiagnostic trait that is central to the development of obsessive-compulsive disorder and behavioral addiction. Compulsiveness describes the tendency to engage in repetitive and stereotyped activities that have negative consequences, resulting from an inability to manage inappropriate behavior. Although people with AN often express a desire to recover, they seem to be unable to stop the behavior that leads to extremely low body weight.

Dieting can reduce the activity of the serotonin (5-HT) and norepinephrine (NA) systems, which modulate anxiety. The effect is achieved by reducing the dietary intake of neurotransmitter precursors (tryptophan for 5-HT and tyrosine for NA). Indeed, women with NA have a decrease in 5-HT metabolites in their cerebrospinal fluid, a decrease in their plasma NA concentration, and a decrease in excretion of NA metabolites, compared to healthy women.

The increase in the ratio of omega-3 fatty acids to omega-6 fatty acids is thought to be the result of a strict calorie and fat restricted diet. There is some evidence that this ratio is negatively associated with anxiety in AN. This is another mechanism by which dietary restrictions can alleviate anxiety. Anxiety relief is easier to achieve and more beneficial for anxious people with anorexia nervosa through fasting, as the anxiolytic effect of the diet is greater in this population.

Experimentally induced tryptophan depletion significantly reduced the anxiety of women undergoing inpatient treatment and recovery from AN, but did not affect the level of anxiety of healthy women. These results can be explained by the personality characteristics of this group of patients, given that the underlying anxiety of healthy women was comparable to that of women suffering from/recovering from AN after tryptophan depletion.

Classification and stages of development of anorexia

According to the International Classification of Diseases (10th revision), ED are classified under F50-F59 (behavioral syndromes associated with physiological disorders and physical factors).

F50.0 Anorexia nervosa. It is set subject to the diagnostic criteria outlined in the manual;

F50.1 Atypical anorexia nervosa. It is put in the presence of obvious anorexic symptoms in a patient in the absence of a strict presence of all diagnostic criteria, most often an insufficient decrease in BMI falls under this criterion.

Allocate (Korkina, 1988) four stages of anorexia nervosa:

1. initial;

2. active correction;

3. cachexia;

The symptoms described above have been listed according to the stages of development of the disease.

Per DSM-5: Feeding and Eating Disorders 307.1 (F50.01 or F50.02)

F50.01 Anorexia nervosa

Atypical anorexia nervosa is described under: specified feeding and eating disorders and unspecified feeding and eating disorders.

Complications of anorexia

Anorexia nervosa has one of the highest mortality rates of any other mental health problem; causes of death: starvation, heart failure and suicide.

It should be noted that AN is no longer a purely psychiatric pathology, since the disease is accompanied by a large set of somatic disorders and complications, which significantly worsens the quality of life of patients and increases the risk of death.

The main somatic complications include:

1. Endocrine disorders:

hypothalamic-pituitary-adrenal system (hypersecretion of cortisol);
hypothalamic-pituitary-thyroid system (low T3 syndrome);
hypothalamic-pituitary-gonadal system (low level of sex hormones).

2. Metabolic disorders in anorexia nervosa:

This is important because the therapist must have a relationship with the patient's medical profile, and this implies a tripartite psychotherapeutic contract. Which emphasizes the relevance of this problem for clinical practice, raises the question of the importance of high-quality interaction between specialists from different fields of medical knowledge.

Diagnosis of anorexia

Diagnostic criteria for AN, according to ICD-10, are:

Weight loss, and in children, loss of weight gain that is at least 15% below normal or expected for a given age or anthropometric measure.
Weight loss is achieved through a radical refusal to eat or a diet with insufficient calories.
Patients express dissatisfaction with overweight or its individual parts, there is perseveration on the topic of fullness, food, as a result of which patients consider very low weight to be normal.
Some endocrine disorders in the hypothalamic-pituitary-sex hormone system, expressed in women by amenorrhea (with the exception of uterine bleeding when taking oral contraceptives), and in men by loss of sexual desire and potency.
Absence of criteria A and B for bulimia nervosa (F50.2).

Per DSM-5: Feeding and Eating Disorders 307.1 (F50.01 or F50.02): Anorexia Nervosa

Symptoms:

Restriction of calorie intake, resulting in significantly lower body weight in accordance with age, sex, level of physical development. Underweight is defined as a weight that is below the minimum normal, and for children and adolescents, it is a weight that is below the minimum expected.
Intense fear of gaining weight, of being overweight, persistent desire to lose weight even at a significantly low weight.
There is an excessive influence of weight and figure on self-esteem or a lack of awareness of the dangers of such a low body weight.

With partial remission: of the above symptoms, symptom 1 did not appear for a long period, but 2 or 3 are still present.

In complete remission: none of the criteria were present for a long period of time.

Severity of anorexia: the initial risk level for this disease is based, for adults, on current body mass index (BMI) values (see below), and for children and adolescents on the BMI percentile*. The ranges below are World Health Organization data for anorexia in adults; for children and adolescents, the appropriate BMI percentiles should be used.

The severity level may be raised to reflect clinical symptoms, the degree of functional disability, and the need for follow-up.

Initial: BMI > 17 kg/m2

Moderate: BMI 16-16.99 kg/m2

Severe: BMI 15-15.99 kg/m2

Critical: BMI< 15 кг/м2

*Percentile - A measure in which the percentage of total values is equal to or less than this measure (for example, 90% of the data values are below the 90th percentile, and 10% of the data values are below the 10th percentile).

It should be emphasized that amenorrhea has been removed from the DSM-5 criteria. Patients who "meet" the new criteria and who continue to menstruate achieved similar results to those who "do not meet".

Treatment of anorexia

The main principles of the treatment of patients is a comprehensive and interdisciplinary approach to the treatment of somatic, nutritional and psychological consequences of anorexia.

The main method of non-drug treatment for adult patients is psychotherapy (cognitive therapy, body-oriented therapy, behavioral therapy, and others). Anhedonia should be the goal of treatment at the beginning of therapy with cognitive behavioral methods.

Transactional-analytical treatment

Ambivalence is always present in working with eating disorders when forming a therapeutic contact. Because the patient's main fear is that others can take control and make him become fat (and unloved). The child needs to hear that we will work together to help him live his life, and not try to survive in the conditional scenario framework. This should be the theme throughout the work, except when safety issues are of paramount importance. The patient must feel that his suffering and fear are understood, and hope that things will be different.

In the first study on the use of deep brain stimulation in patients with AN (bilateral, 130 Hz, 5-7 V), an increase in BMI was observed in three of six patients who maintained their improvement in BMI after nine months. The mean BMI in all six patients increased from 13.7 to 16.6 kg/m2. These results were confirmed and expanded in a second study showing an increase in BMI from 13.8 to 17.3 kg/m2 12 months after including 14 patients. Depressive symptoms also improved, as evidenced by reductions in HAMD (Hamilton Depression Inventory) and BDI (Beck Depression Inventory), obsessive behaviors improved, as evidenced by decreases in the Yale Brown Obsessive-Compulsive Score, eating disorder symptoms and rituals were reduced, and quality of life increases in three out of six patients six months after surgery. Improvements in eating disorder symptoms, compulsive behavior and depressive symptoms were confirmed in a follow-up study twelve months later using the same questionnaires. In addition, anxiety was assessed and reduced in four out of sixteen patients. Two of the six patients did not have any serious side effects, while four patients experienced adverse effects (pancreatitis, hypokalemia, delirium, hypophosphatemia, mood deterioration and seizures in one patient). The authors state that these adverse side effects were not related to the treatment. These data indicate that deep brain stimulation may be an appropriate therapy (in a tolerable manner for most patients) to induce weight gain in patients with severe AN. However, further research is needed, especially using a control group receiving stimulation.

Medical treatment

Despite the fact that patients who seek help show distinct depressive symptoms, antidepressants have been found to be ineffective in combating them. Since they are not a manifestation of an independent depressive disorder, but are a consequence of acute malnutrition and leptin deficiency. When you gain weight, the symptoms of depression go away.

Psychopharmacological agents for the treatment of AN include atypical antipsychotics and D-cycloserine.

Atypical antipsychotics

According to international studies, Olanzapine is the most promising drug for the treatment of patients with AN, since it showed a better result in relation to placebo in terms of weight gain. Also, antihistamine activity can help patients with anxiety and sleep problems. Studies have treated with olanzapine 2.5 mg/day and increased this dose slowly to 5 mg or 10 mg/day. This dose is mentioned in the British National Formulary (BNF), but at the upper limit. For people with slower metabolisms and women, a slow titration schedule (2.5 mg/day the first week up to a maximum of 10 mg/day) and the same titration increment at the end is recommended to improve patient safety.

Aripiprazole- a partial dopamine agonist - may also be effective in the treatment of AN. In a chart review of 75 AN patients treated with either olanzapine or aripiprazole, the latter was most effective in reducing preoccupation with food and its accompanying rituals.

It may be one of the drugs more likely to be recommended to maintain a normal weight after recovery or to enhance the effects of psychotherapy.

Forecast. Prevention

Onset in adolescence is associated with a better prognosis. Between 70% and over 80% of patients in this age group are reported to achieve sustained remission. The worst results are seen in patients who required hospitalization and in adults. Recent studies have shown improved prognosis for treatment and reduced mortality rates than previously reported. However, recovery can take several years and is associated with a high risk of developing other psychiatric disorders even after recovery (mainly affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse). Studies have shown that bulimic symptoms often occur during the course of anorexia (especially in the first 2-3 years). A history of bulimic symptoms is a poor prognostic indicator. Comorbidity with depression is a particularly detrimental factor.

Anorexia nervosa is a disease that is more common in adolescents and young adults, more often in women. This pathological process is characterized by a deliberate refusal of food, which ultimately leads to a critical decrease in body weight and complete exhaustion. In some cases, an irreversible pathological process takes place, which leads to death.

It should be understood that this disease is psychological in nature. In this case, a person does not adequately and loyally evaluate his body, even with a critically low weight, he believes that he has excess weight, and against this background he refuses food completely or adheres to a strict diet. Based on this, we can say that anorexia nervosa in adolescents and adults requires an integrated approach to treatment. According to the international classification of diseases of the tenth revision (ICD-10), this disease is assigned the code F 50.0.

Etiology

Anorexia on a nervous basis can be due to the following etiological factors:

psychological impact on a person - insults, negative statements regarding his figure, weight;
psychological illnesses;
pathological fear of gaining excess weight;
the impact of the environment;
disharmonic teenage crisis.

Separately, it is necessary to highlight the risk factors in the development of this pathological process:

genetic - the 1p34 gene, which is activated during strong and excessive nervous strain, can provoke the development of this disease;
family - at risk are people who have relatives with this disease in the family;
personal - low self-esteem, increased susceptibility to inadequate criticism from outside, moral pressure;
anthropological - overcoming desire is also a fear of normal nutrition;
social - imitation of someone, a fashion for excessive thinness.

Most often, the development of such a violation is due precisely to the psychological influence from the outside and the desire to follow fashion trends.

Classification

There are four degrees of development of this pathological process:

pre-orexic - thoughts about the "fullness", ugliness of one's figure appear, a person begins to look for ways to get rid of "extra" kilograms as quickly as possible;
anorexic - almost complete starvation, weight is reduced to a critical minimum, but the person does not stop, but, on the contrary, tightens the diet;
cachectic - almost complete absence of adipose tissue and exhaustion. An irreversible process of dystrophy of internal organs begins. In most cases, this stage is observed a year after the onset of the development of this pathological process.

At the last stage of the development of the disease, there is a high risk of death, since against the background of extreme exhaustion of the body and dystrophy of internal organs, concomitant diseases occur. At the same time, it should be noted that the protective functions of the body are almost completely absent, which leads to complications.

Symptoms

Signs of anorexia nervosa, as a rule, appear at the first or second stage in the form of such a clinical picture:

categorical refusal of food, which manifests itself gradually - from the exclusion of nutritious food from the diet to the use of only mineral water;
pale skin, hair loss, brittle nails;
frequent dizziness;
fainting states;
violation of the heart rhythm;
sensation of coldness in the whole body;
exacerbation of existing chronic diseases;
violation of the menstrual cycle, and as the pathological process worsens, the complete absence of menstruation;
excessive sensitivity to physical influences;
psychological disorders - sudden mood swings, apathy towards everything around, depression, suicidal tendencies;
weakness, drowsiness.

Since the syndrome of anorexia nervosa is quite often observed in adolescents, some specific symptoms of the development of this disease should be highlighted separately:

dissatisfaction with their figure, fear of obesity;
constant calorie counting;
radical diets;
taking laxatives and diuretics, special preparations for weight loss;
change in behavior - a teenager may abandon their usual pastime;
can be observed to everything around;
sudden mood swings, aggression, irritability;
complaints of a constant feeling of coldness in the hands and feet;
a teenager sharply denies his pathological thinness;
aversion to food, inducing vomiting even with a minimal amount of food eaten.

Diagnostics

Initially, the psychotherapist conducts a conversation with the patient on the subject of complaints and his attitude to his illness, then the anamnesis of the disease and life is clarified with relatives. This is followed by a physical examination of the patient. To confirm the diagnosis are carried out:

general and detailed biochemical blood test;
general urine analysis;
analysis for thyroid hormones;
CT scan of the brain;
Ultrasound of the abdominal organs.

The exact diagnostic program will depend on the current clinical picture. Based on the results of the examination, the doctor will determine the stage of development of the disease and prescribe the most effective course of treatment.

Treatment

The indication for hospitalization in anorexia nervosa is the 3-4 degree of development of the pathological process. Therapy for such a disease should be comprehensive, with drug treatment and a mandatory diet.

Medical treatment may include taking the following drugs:

hormonal;
antidepressants;
sedatives;
antiemetics;
solutions for restoring water and electrolyte balance.

As for the diet, at the initial stage of treatment, only light, moderately high-calorie meals should be included in the diet. As the patient's condition improves, you can increase the calorie content of meals and the volume of servings. You should also consider the following nutritional recommendations for the patient:

in especially severe cases, parenteral nutrition is carried out;
food should be only liquid, in extreme cases, puree;
meals should be frequent (5-6 times a day), but in small portions. Otherwise, the stomach will not be able to digest such a large amount of food;
optimal drinking regime;
it is recommended to include nutritional supplements that contain trace elements in the diet;
if the patient's condition is not critical, then dietary table No. 11 according to Pevzner is prescribed.

In general, the diet is prescribed individually, depending on the stage of development of the disease, clinical indicators and the general condition of the patient.

Prognosis and possible complications

If treatment is started in a timely manner, then the development of serious complications can be avoided. Otherwise, the following dangerous changes are likely to develop:

violation of the functioning of the central nervous system, which is due to insufficient nutrition of the brain;
a decrease in the protective functions of the body, against which a person often gets sick;
violation of mineral metabolism;
acute;

In general, against the background of an exhausted organism, almost any pathological process can develop.

Prevention

proper, balanced nutrition;
exclusion of negative psychological impact;
in the event of the appearance of severe emotional states, contact a neuropsychiatrist.

If you feel unwell, both physically and psychologically, you should consult a doctor, and not self-medicate.

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Diseases with similar symptoms:

Avitaminosis is a painful human condition that occurs as a result of an acute shortage of vitamins in the human body. Distinguish between spring and winter beriberi. There are no restrictions regarding gender and age group in this case.

Anorexia nervosa is an eating disorder in which a person deliberately significantly reduces the amount of food, or refuses to take it at all, wanting to reduce existing weight or prevent weight gain. Eating insufficiently or fasting continues even after the body weight has reached a critical value, while the person does not notice this and continues to struggle with extra pounds. Consider the signs, diagnosis and treatment of anorexia nervosa.

Signs of anorexia nervosa

Signs of anorexia nervosa include:

denial of a problem;
the occurrence of a depressive state;
fear of gaining weight;
development of the opinion that one's own weight exceeds the norm;
the occurrence of eating disorders: the amount of food consumed per day is insufficient or completely absent;
the appearance of sleep disorders;
the appearance of fainting, dizziness;
the occurrence of resentment;
getting rid of ingested food by inducing vomiting or taking laxatives;
development of isolation, loss of contacts with relatives and friends;
the appearance of fixation on the topic of food;
the occurrence of a feeling of discomfort after eating food;
wearing baggy clothes that hide thinness;
the appearance of thin hairs on the body;
accompanied by a constant feeling of cold, worsening of blood circulation;
exhausting your body with physical exertion;
decreased libido.

As a person develops anorexia and the body is depleted, the following functional disorders occur:

the appearance of permanent weakness;
the occurrence of muscle spasms;
the occurrence of menstrual irregularities;
development of disturbances in the work of the gastrointestinal tract;
the appearance of cardiac arrhythmia;
the occurrence of disorders in the endocrine system;
development of osteoporosis;

Diagnosis of anorexia nervosa

When signs of anorexia nervosa appear, one cannot do without contacting a psychiatrist, who will be correctly diagnosed and the course of treatment determined.

The main methods for diagnosing anorexia nervosa are:

conversation with the patient or his close people and relatives. As a rule, during a conversation, a specialist determines the presence of risk factors for the development of anorexia, symptoms and signs of diseases, possible complications;
calculation of body mass index;
conducting a biochemical blood test, a general blood and urine test, determining the level of hormones in the blood;
method of radiography of the bones of the skeleton;
fibroesophagogastroscopy method;
electrocardiography method, etc.

Treatment of anorexia nervosa

For the treatment of anorexia nervosa, it is necessary to identify the cause that caused the development of the disease. Of no small importance is psychotherapy, with the help of which it is possible to determine and eliminate the causes underlying the occurrence of anorexia.

The form of treatment for anorexia nervosa depends on how severe the condition is. The main goals of treatment are the gradual reduction of body weight to normal, the restoration of fluid and electrolyte balance in the body, and the provision of psychological assistance.

If the form of the disease is severe, then the normalization of body weight should be done gradually. A person can gain from 500 g to 1.5 kg per week. An individual diet is compiled for the patient, containing a sufficient amount of nutrients that the body needs. When compiling an individual diet, the doctor takes into account what the degree of exhaustion is, what is the value of the body mass index, and the presence of symptoms of a lack of any substances. The best option is self-feeding of a person, but if the patient refuses to eat, feeding can be carried out through a special tube inserted into the stomach through the nose.

Drug treatment of anorexia nervosa refers to the use of medications that eliminate the effects of anorexia: for example, in the absence of menstruation, hormonal agents are prescribed; with a decrease in bone density, the use of calcium and vitamin D preparations, etc. is provided. Of great importance in the treatment of anorexia nervosa belongs to antidepressants and other drugs used in the presence of mental illness.

Most of the treatment for anorexia nervosa occurs on an outpatient basis. Inpatient treatment is resorted to if the patient stubbornly refuses to eat and the decline in nutrition is growing. Treatment may include medications designed to correct iron and zinc deficiencies. During treatment in a hospital, additional high-calorie nutrition is prescribed; in case of persistent refusal of food, nutrition is administered intravenously.

The duration of the active phase of treatment can approximately be from 3 to 6 months, which should result in a significant or moderate relief of symptoms, complete or partial restoration of a person's weight.

Consequences of anorexia nervosa

Among the consequences of anorexia nervosa are:

the occurrence of disorders in the work of the heart muscle;
the occurrence of disorders of the endocrine system associated with a decrease in the production of female and thyroid hormones. As a result, menstruation stops, sexual desire disappears, lethargy appears, infertility occurs, etc.;
the development of thinning and increased fragility of bones due to a lack of calcium;
the appearance of damage to the esophagus and teeth due to frequent artificial provocation of vomiting. There is inflammation of the mucous membrane of the esophagus (esophagitis), destruction of tooth enamel;
suicide due to depression, feelings of depression, inability to concentrate.

In pursuit of a perfect figure and harmony, many women sacrifice their health. Recently, doctors are increasingly faced with such an ailment as anorexia nervosa. This is a severe mental disorder in which a person voluntarily refuses to eat and perceives his own body weight in a distorted way.

Looking for the cause of the problem

The syndrome of anorexia nervosa was first described in the medical literature about two centuries ago. But anorexia, which has a nervous nature, became a real problem in the middle of the last century.

Interesting! Basically, this disease affects girls of puberty, less often - adult women. 95% of patients are girls. The poor and middle strata of the population do not suffer from such an ailment. .

A person suffering from anorexia nervosa cannot perceive his body objectively. It constantly seems to him that his weight is more than it should be. Although in reality it is not. Many girls have a fear of gaining weight, as a result of which they begin to torture themselves with long-term diets, take various drugs and dietary supplements.

There is another type of anorexia - bulimia. During such an ailment, women immediately after eating artificially provoke a gag reflex. This is very dangerous for the state of health and, first of all, a violation of the acid balance.

Experts have identified several groups of reasons that determine the development of anorexia:

biological;
environment;
psychological.

Most often, anorexia of a nervous nature develops on the basis of psychological disorders. The following factors can provoke the disease:

biased perception of your body and weight;
a constant desire to lose weight, even if the body weight is below normal;
imitation of others;
fear of eating properly and rationally;
depressive state;
psychological trauma of childhood;
fears.

On a note! An important role is played by the genetic factor. Girls in adolescence look at their mothers and grandmothers, under fear of being overweight, they torture themselves and completely restrict food.

Psychological signs of illness

As we have already found out, anorexia nervosa is considered a mental disorder. Symptoms of this disease originate in psycho-emotional disorders. At the initial stages, it is psychological deviations that are noticeable, and later physiological symptoms appear.

Psychological signs include:

a statement about being overweight, and this despite the fact that the body weight is below normal;
gag reflexes after each meal;
frequent weighing and measuring body volume;
obsessive ideas about losing weight;
a person deceives that he eats normally;
lack of any emotions;
decrease in sexual desire;
deterioration in concentration and memory;
irritability;
depression;
exhausting physical activity.

A person suffering from anorexia nervosa is very fond of cooking, but at the same time he does not try the dishes that he has prepared, he refuses festive and family feasts.

Close people should pay attention to such behavior of a person. Even with excessive thinness, he will claim that he is overweight, and obesity will become his biggest fear.

Important! In anorexia nervosa, the person denies having a problem. He will regard his illness as a desire for a healthy lifestyle and a beautiful figure.

Symptoms of the disease

As already mentioned, in the initial stages, mainly psychological signs of a pathological condition are observed, and later anorexia nervosa appears more clearly. Symptoms of the disease are visible to the naked eye.

Anorexia, which is of a nervous nature, is characterized by the following symptoms:

loss of body weight by 15-60%;
exhaustion;
pathological weakness;
sleep disturbance;
lack of appetite;
decrease in blood pressure;
lethargy;
violation of digestive processes;
dry skin;
skin rashes;
decrease in body temperature;
cold extremities;
bloating;
swelling of the legs and arms;
hair loss;
violation of the cycle of menstruation or its absence;
fragility of bone tissue;
infertility;
fragility of the nail plates;
violation of the heart rhythm;
increased fluffiness of hair all over the body;
deterioration in the condition of the teeth;
unpleasant odor from the mouth;
constipation;
frequent dizziness;
increase in vegetation on the skin of the face.

Important! The main symptom of anorexia nervosa is weight loss. This figure can vary from 15 to 60%. It all depends on the stage of the disease and the duration of its development.

For any person, anorexia is a threat. According to statistics, in 20% of cases this disease leads to death, since irreversible processes develop in the body.

For girls of reproductive age, anorexia is fraught with infertility. First, the menstrual cycle is disrupted due to hormonal imbalance. If you do not take measures for treatment, then amenorrhea and infertility will develop in the future.

Features of diagnosis and treatment

The treatment of anorexia nervosa is complex. First, the doctor needs to identify the cause of the development of a mental illness and eliminate it. At the initial stages, it is much easier to cure the pathology. Often, anorexia nervosa is treated on an outpatient basis.

Hospitalization of the patient is required in such cases:

with continued weight loss despite ongoing treatment;
with the manifestation of suicidal tendencies;
in case of deterioration of the patient's psycho-emotional state;
in violation of the functioning of the cardiovascular system.

Important! The patient is subject to mandatory hospitalization if his mass index is one third below the norm for the corresponding age and height.

As medical practice shows, the patient will never agree to treatment on his own. This important role is assigned to close people and relatives. With the manifestation of the primary signs and symptoms of anorexia nervosa, you should seek qualified help.

A psychologist will definitely consult with the patient, make a test and determine the cause that led to the development of anorexia nervosa. The following diagnostic measures are also carried out:

electrocardiogram;
urine and blood tests;
determination of the functioning of the liver, digestive tract and kidneys;
study of the thyroid gland;
examination by a gynecologist.

In order for the treatment of the disease to be effective, the patient himself must strive for this. The therapy is complex and combines psychological consultations, taking pharmacological drugs, and bed rest. The support of loved ones is also important.

At the first stage of treatment, doctors set the task - weight gain by the patient. A favorable prognosis can be built when body weight increases by 0.4-1 kg in seven days. To do this, increase the calorie content of the diet. The patient may be prescribed pharmacological drugs from the group of antidepressants.

What is anorexia nervosa (Anorexia Nervosa), why does it occur, how does it manifest itself and what should be done to break out of the tenacious web of this disease? Anorexia is an eating disorder that occurs mainly in girls between the ages of 14 and 25. This is characterized by a constant desire to reduce weight by any means and maintain it at the lowest level, despite emerging health problems and the condemnation of others.

It turns out that anorexia nervosa is, first of all, a neuropsychiatric disorder and the main problem here is the distorted perception of the body by the brain. Indeed, in accordance with the International Classification of Diseases (ICD-10), anorexia nervosa refers to borderline neuropsychiatric disorders (code F 50.0).
At the same time, at first Anorexia Nervosa balances on the verge between health and illness, but in the absence of adequate help, the psyche gradually goes further and further into an invented, ghostly world, and the perception of one's body becomes inadequate, painful.

How common is anorexia?

According to statistics, this disorder occurs in approximately 1-5% of girls and girls aged 14 to 18 years. In adolescent boys, anorexia nervosa is found 10 times less frequently. It is worth noting that in the absence of adequate treatment, every fifth patient with anorexia dies from exhaustion and related complications.

Why does Anorexia Nervosa occur?

Consider the main risk factors and possible causes of this eating disorder:

Hereditary predisposition - we are talking, first of all, about a predisposition to a certain type of personality (anxious, suspicious, affective, obsessive, emotionally unstable, schizoid, etc.), the presence of signs of eating disorders in relatives, suicidal tendencies, mental disorders
Overweight in childhood and adolescence, early first menstruation, various hormonal disorders
Living in a region (country) where the fashion for harmony, smartness, thinness is cultivated as the main ideal of female beauty
By itself, adolescence (youthful) age is a risk factor for the development of anorexia nervosa. According to some reports, more than half of teenage girls are unhappy with their weight and almost all of them at least once tried to lose weight through diet or exercise.
As a rule, anorexia occurs in girls with certain personality traits - low self-esteem, feelings of inferiority, obsessive thoughts and actions.
Some scholars view anorexia nervosa as an attempt by a girl to challenge her (see above) psychological problems and compensate for her shortcomings. The fight against supposedly overweight and increased appetite allows you to feel “active, purposeful, persistent”, at least in the field of nutrition ... But such a way to increase self-esteem is false, unnatural (although the girl herself with anorexia, unfortunately, usually does not understand this). condition).

How do people with anorexia nervosa lose weight?

These are heavy physical loads (hard work in production and in a personal plot) or active physical education and sports, fitness (running, training on simulators, sports dancing, the so-called "circular training", etc.). Loads to "failure", to exhaustion, to stretching and rupture of the tendons, to the development of pathological changes in the heart muscle
A pronounced decrease in the amount of food consumed. First, patients with anorexia reduce, and then completely exclude meat and meat products, fish, eggs from the diet. Then refuse bread, cakes, pastries, sugar, pasta and others. As a result, the girls (and they, as already mentioned, make up the vast majority of patients with anorexia nervosa) for a long time “sit down” on a harsh dairy-vegetarian diet, which is 400-800 kcal.
If an overvalued idea about a "fat" stomach, hips, buttocks and other parts of the body appears, patients with Anorexia Nervosa begin torturing themselves with exercises specially designed and invented by them. Those suffering from anorexia nervosa refuse a sitting position and do everything standing up (watch TV, read a book, etc.), minimize the time for sleep, squeeze the stomach with belts and tourniquets (so that “food is digested longer”), search the Internet for the most “effective ways to lose weight...
Patients with anorexia often resort to all sorts of stimulants and medications - they drink large quantities of strong coffee instead of eating, smoke continuously, use appetite suppressants, diuretics and laxatives, make enemas
It is not uncommon for those suffering from anorexia nervosa to vomit immediately after eating, which leads to the rapid consolidation of this “method” of losing weight and the development of an obsessive irresistible desire to induce vomiting after any meal (vomitomania). Prolonged use of this "method" causes new health problems - the destruction of tooth enamel, the development of caries, stomatitis and gingivitis, the appearance of erosions (ulcers) on the mucous membrane of the esophagus.

The main signs of anorexia

The first stage of development of anorexia (initial, initial)

The first, initial signs of anorexia nervosa can be detected as early as the age of 8-12 years. During this period, children often develop new interests and hobbies related to their appearance. Girls find their female ideal among the heroines of television series, artists and models who have the "Hollywood standard of beauty" - and this, as a rule, is tall, thin waist, a tendency to thinness. In this regard, the study of methods of losing weight begins, which will help to become the same as the "star".
Gradually, such a characteristic symptom of anorexia nervosa as dysmorphophobia develops - an aggravated experience of one's real or imaginary bodily imperfection, dissatisfaction with one's figure, appearance. A teenager hides his feelings from others and secretly decides on the need to fight "ugliness". And the results of the fight against "extra pounds" soon become visible when weighing: body weight decreases by 15-20% of the initial indicators, body mass index drops to 17-17.5 (at a rate of 20-25).

Second (anorectic) stage

An active fight against “overweight” continues, which leads to a decrease in weight by 25-50% of the initial indicators, the development of somatic and endocrine disorders, including oligo- and amenorrhea (menstrual cycle disorder with rare periods or their complete absence) in girls and women with anorexia nervosa. The gastrointestinal tract is affected, with complaints of heartburn, nausea, vomiting, cramping abdominal pain, constipation, rectal prolapse. When conducting an endoscopic examination of the digestive tract, erosions and ulcers are detected on the mucous membrane of the esophagus, stomach, duodenum, and during an ultrasound examination of the abdominal organs, signs of bile stasis, cholelithiasis, and prolapse of internal organs are revealed.

Anorexia Nervosa is characterized by a perverse, incorrect, painful perception of her own body - a thin girl considers herself "fat, fat", constantly "finds" "new fat deposits" in herself. And it is very difficult to convince, to prove the falsity of such beliefs, because this mental disorder has moved from borderline (dysmorphophobia) to delusional (dysmorphomania). Real help at this stage of anorexia nervosa can only be provided by hospitalization in a specialized hospital and a thorough examination and comprehensive treatment with the involvement of medical specialists of various profiles.

The third stage of anorexia (cachectic)

In this stage of anorexia nervosa, any criticism of one's condition is completely lost, the delusional perception of one's appearance becomes all-consuming. Patients often completely refuse to eat, drink only diluted juices and water. Severe emaciation (cachexia) develops with a complete absence of subcutaneous fatty tissue, degenerative changes in the skin, muscles, including the heart muscle (myocardial dystrophy).

Body weight decreases by 50 percent or more from the initial figures, irreversible pathological changes in internal organs occur, tooth decay, hair loss, stomach ulcers, duodenal ulcers, disruption of the small and large intestines, anemia, severe general weakness, disability . Every fifth patient with anorexia nervosa with cachexia dies from exhaustion, many commit suicide, continuing to count even in such a state that they remain overweight.

Fourth stage of anorexia nervosa (reduction)

This includes patients with anorexia who did not die from exhaustion or suicide, but managed to get to the hospital of a specialized medical institution and underwent a full course of treatment within 1-2 months. After the withdrawal from cachexia and the elimination of the immediate threat to life, the problems do not disappear and the main symptoms of anorexia nervosa still persist. Frequent complaints during this period are general weakness, severe fatigue, disruption of the stomach and intestines (abdominal pain, heartburn, unstable stools, flatulence).

After gaining weight, many again have a fear of gaining weight, their mood worsens, and the desire to “get rid of excess fat” grows. Improvement in general well-being, elimination of physical weakness stimulates patients with anorexia nervosa to continue the “struggle” and resume intensive physical education, fitness, the desire to induce vomiting after eating, the search for stimulants and laxatives, etc. Therefore, during this period, the correct psychological and psychotherapeutic support, the obligatory intake of psychotropic drugs selected by the doctor, is very important.

The restoration of impaired functions of the internal organs and the endocrine system (restoration of the menstrual cycle and fertility in women) usually takes 1-2 years, and some changes are already irreversible, resulting in disability, and the patient with anorexia nervosa becomes disabled.

Diagnostics

It is important to identify the characteristic symptoms (signs) of anorexia:

The patient's body weight is at least 15% below normal values for her age and body type, the body mass index (BMI) is less than 17.5
Body weight decreases due to the deliberate restriction of the diet by the patients with anorexia nervosa - avoidance of food, refusal of high-calorie foods, eating 1-2 times a day in very small portions (coffee without sugar, a few spoons of coleslaw and celery without oil - and this is often the entire daily diet). If it is not possible to refuse food intake, the patient with anorexia nervosa tries to induce vomiting immediately after eating.
Those suffering from anorexia nervosa use laxatives and diuretics for a long time, drugs that reduce appetite, exhaust themselves with physical exertion and gymnastic exercises invented by them.
In patients with anorexia, the normal image of their body is disturbed, distorted, an overvalued idea of the presence of “obesity” develops, and such painful ideas cannot be dissuaded
Common health problems appear and gradually increase: menstrual disorders in women (oligo- and amenorrhea), arrhythmias, muscle spasms, erosive lesions of the esophagus, stomach, intestines, constipation, gallstones, nephroptosis, etc.)
Gradually, neurotic and mental disorders increase - irritability, fear, anxiety, hypochondria, decreased mood, suicidal thoughts, suspicion, delusional perception of the image of one's own body, etc.

To establish the correct diagnosis for anorexia nervosa, a thorough examination is necessary with an examination by various specialist doctors (gastroenterologist, nutritionist, psychiatrist, endocrinologist, gynecologist, etc.), laboratory and instrumental studies.
In the process of diagnosis, it is necessary to exclude other causative factors and diseases with similar symptoms. This is anorexia nervosa syndrome with, weight loss with vegetarianism, endocrine disorders, somatic diseases, tumors, diseases of the nervous system. Often it is not possible to identify the exact cause of anorexia, because in many cases various causative factors are combined.

Anorexia nervosa is found in the poor and the rich, in unknown people and in famous artists. Take, for example, Angelina Jolie, who suffered from anorexia for several years. The weight of the famous actress dropped to 37 kg and Jolie's relatives, as well as her many fans, seriously feared for her life. Why did body weight drop to such a critical level that it caused the development of anorexia - quarrels with Brad Pitt, fear of getting cancer and surgery, taking any drugs, endocrine disorders, or just a desire to remain slim and attractive? The true reason for the appearance of anorexia in Angelina Jolie is unknown, probably to herself. It is important that the actress was able to restore her weight and defeat anorexia. How long? No one knows about this, including Angelina.

Principles of treatment of anorexia nervosa

The main thing is to detect the first signs of anorexia nervosa as early as possible and consult a specialist doctor in a timely manner, and in most cases it should be. In the initial stages, anorexia responds well to treatment using methods of psychotherapeutic influence (behavioral, cognitive psychotherapy).

At the second stage of the disease (anorectic), hospitalization and complex treatment are necessary to improve both the somatic and mental state. At the third (cachectic) stage of anorexia nervosa, it is primarily about saving the patient's life, eliminating or mitigating numerous somatic problems from the digestive, cardiovascular and endocrine systems. At this stage, sometimes you have to feed the patient and forcibly, through a tube.

After the condition improves, complex treatment continues with the use of drugs for healing erosions and ulcers of the digestive tract, restoring the menstrual cycle, taking psychotropic drugs to improve mood, and the appearance of criticism of one's condition. Recovery measures can last several years - the first month or two (sometimes up to 6-9 months) in a hospital, then on an outpatient basis with periodic visits to a doctor, gastroenterologist, nutritionist and other specialists.