Anorexia nervosa symptoms and treatment. Anorexia nervosa: stages and clinical picture

In today's world, more and more people suffer from eating disorders. The most common of them is anorexia nervosa, this disease is often found in adolescents and leads to very sad consequences. The most obvious symptom of this disease is an obsession with thinness and refusal to eat, leading to exhaustion. Learn more about what this disease is, how it manifests itself, is treated, and what complications it can lead to.

What is Anorexia Nervosa

This name in psychiatry is a disease from the category of eating disorders. People with this nervous ailment tend to deliberately do everything to lose weight, pursuing one of two goals: losing weight or preventing overweight. Girls are more likely to suffer from anorexia nervosa. One of the characteristic signs of the disease is a panic fear of getting better. Patients perceive their body in a distorted way. They believe that they are overweight and should lose weight, although in most cases this is absolutely not true.

Who is at risk

Mental anorexia is more common in girls, especially in adolescence. Among the inhabitants of the planet, almost 1.5% of women and 0.3% of men are sick. The vast majority of people with this diagnosis are girls from 12 to 27 years old (80%). The remaining 20% ​​are men and mature women. The disease occurs even in those representatives of the weaker sex who have reached the menopause period.

Causes of the disease

The factors that provoke the disease can be biological, psychological or social. Each group of reasons should be described in more detail:

• physiological features (overweight, early onset of menstruation, dysfunction of neurotransmitters that regulate eating behavior);
• psychological trauma (the presence of relatives or acquaintances suffering from anorexia nervosa, bulimia nervosa, obesity, alcohol abusers, drug addicts, depression, any stress, episodes of sexual or physical violence in the past);
• socio-cultural factors (living in an area where thinness is considered an essential sign of female beauty, popularization of models, adolescence and youth);
• heredity (the desire for thinness on the verge of a mental disorder can be transmitted from parents to children, this is a genetic predisposition that manifests itself in an unfavorable situation, a certain chromosome is responsible for it);
• personal factors (obsessive-perfectionist personality type, low self-esteem, self-doubt).

How does anorexia nervosa syndrome manifest?

Sometimes the disease goes unnoticed by relatives and friends for a long time. Many people deliberately hide the signs, go to various tricks so that others remain in the dark for as long as possible. They completely deny the fact that they are sick and need help. Mental anorexia is recognized by symptoms, a detailed description of which will be described below. These include signs:

• external;
• psychological;
• behavioral.

External signs

Serious changes gradually occur in the form of the patient. What happens to appearance

1. Weight at least 15% below normal. Body mass index is 17.5 or less. In patients in puberty, there is an inability to gain weight during a period of intensive growth.
2. There is a general endocrine disorder of the body. Women stop menstruating. Men cease to feel sexual desire, experience problems with potency.
3. The manifestations of puberty are slowed down or even absent. In girls suffering from eating disorders, mammary glands stop developing, menstruation does not occur, or menstruation comes very rarely and in small quantities. In young men, the genitals may remain juvenile.
4. Violations of the functioning of the body. Problems with the menstrual cycle, arrhythmia, muscle spasms, weakness.

Psychological symptoms

Internally, a person changes no less than externally. He sees and perceives his body distortedly. A strong fear of obesity takes on a psychopathological form, and weight loss becomes an obsessive overvalued idea. The patient believes that only at low weight he will look beautiful and feel harmonious. Gradually, the following symptoms appear:

• sleep disorders;
• depressive state;
• frequent states of resentment, causeless anger;
• mood swings from very sad and irritable to euphoric;
• biased self-assessment.

behavioral signs

The habits of the patient become specific. If relatives are attentive to a person, they should notice that his behavior has changed. The patient develops one or more of the following obsessive habits, but at the same time he completely denies the problem:

• avoiding foods that are fat;
• inducing vomiting after meals;
• the use of many laxatives;
• using the wrong way of eating (eating standing up, crushing food into microscopic pieces);
• passion for everything related to food: new recipes, ways of processing products;
• intensive sports;
• unwillingness to participate in family feasts;
• taking diuretics or appetite suppressants;
• preparing chic meals for loved ones (while the patient does not participate in the meal).

Signs of anorexia in a teenager

Since the disease in the vast majority of cases occurs in girls of puberty, parents should be extremely careful and know its manifestations in order to identify the problem in a timely manner. What are the signs that a teenager has anorexia:

1. The child is dissatisfied with his figure. He spends a lot of time in front of the mirror and often starts talking about appearance, beauty.
2. Thoughts about food become obsessive, episodes of counting calories become more frequent.
3. Eating behavior is changing. Parents should be alerted if the child began to eat from very small dishes (saucers, etc.), cut food into tiny pieces, swallow without chewing. Sometimes children vomit after eating.
4. The teenager completely refuses to eat, secretly takes some drugs for weight loss, diuretics, laxatives.
5. The child goes in for sports to the point of exhaustion.
6. The teenager becomes secretive, irritable, often depressed, shows hysterical character traits. He loses friends, wears baggy clothes.
7. There are changes in appearance. The eyes are sunken, the face becomes puffy, the hair grows dull and falls out, the skin is dry, the nails exfoliate, the ribs and collarbones protrude, the joints seem too large.

Stages of anorexia

The disease is divided into several stages: initial, anorectic, cachetic, reduction. Each stage has its own characteristic features: external manifestations, changes in the body, behavioral habits. The sooner treatment of anorexia is started, the greater the patient's chances for a full recovery without serious negative health consequences. Each stage of the disease should be described in more detail.

Initial

At the initial stage, the patient has thoughts that he is inferior, has excess weight. A person sincerely believes that it is necessary to lose weight in order to become happier. This state is accompanied by a constant examination of oneself in the mirror, a depressed state, anxiety. The first signs of a change in eating habits appear. A person limits himself, changes his diet in search of the ideal food, in his opinion, and gradually comes to the need for fasting. The duration of the period is 2-4 years.

Anorexic

This period can last a very long time (up to two years) and begins against the background of persistent starvation. For the anorectic stage of the disease, the following symptoms are characteristic:

• weight is reduced by 20-30% and this does not cause concern, but euphoria and pride in oneself;
• a person tightens his diet more and more, first refusing foods rich in proteins and carbohydrates, and then switching to dairy and vegetable foods;
• a person convinces himself and others that he has no appetite;
• physical activity is brought to the limit and becomes exhausting;
• the patient underestimates the degree of weight loss;
• too little fluid circulates in the body, resulting in hypotension, bradycardia;
• a person constantly feels chilly, freezes;
• the skin becomes dry, thin, dystrophic;
• alopecia begins;
• menstruation stops in women, and sexual desire disappears in men;
• impaired functioning of the adrenal glands.

cachectic

There are irreversible changes in the internal organs, their dystrophy occurs. The stage begins 1.5-2 years after anorexia. During the period of cachexia, patients have already lost 50% or more of their normal weight. Protein-free edema begins, the water-electrolyte balance is disturbed, and potassium deficiency occurs in the body. The dystrophic changes characteristic of this period lead to the fact that all organs and systems do not function correctly and this cannot be corrected.

reduction

This stage is called recurrent or relapse. After a course of treatment, the patient gains weight, which again causes fears and delusions in him. He again makes attempts to lose weight, returns to diets, fasting, exercise. To avoid the reduction stage, the patient after discharge from the medical facility must be constantly under the strict control of relatives and doctors. Relapses can occur over several years.

Methods for diagnosing psychogenic anorexia

Doctors must take a series of measures to make sure that the patient has an eating disorder. Types of diagnostic studies:

1. Questioning the patient. Specialists should ask the patient about how he perceives his body, how he eats, find out what internal psychological problems he has.
2. Blood sugar test. If a person is sick, the indicators will be significantly lower than normal.
3. Thyroid hormone analysis. When sick, their amount in the blood is reduced.
4. Computed tomography of the brain. It is carried out in order to exclude tumor formations.
5. X-ray. To detect bone thinning.
6. Gynecological examination. It is carried out to exclude organic causes of menstrual irregularities.

Treatment of anorexia

To combat the disease, complex therapy is used, each stage of which is very important for a complete recovery. Treatment is aimed at improving the somatic condition of the patient. The main focus is on behavioral, cognitive and family therapy, while medication is an additional measure. Alimentary rehabilitation is necessarily carried out, actions are taken to restore weight.

Primary Therapy

If the patient himself goes to the doctor and realizes that he has problems, then the treatment can be outpatient, but in most cases hospitalization and a long stay in the hospital are required. Treatment is carried out in several mandatory stages:

1. Non-specific. 2-3 weeks. Strict adherence to bed rest and the appointment of an individual diet are required. In order for the patient not to refuse food, insulin is administered intramuscularly, adding 4 IU per day. An hour after the injection, he has an appetite. If the patient refuses food, he is transferred to compulsory treatment, an intravenous glucose solution with insulin is administered, and he is fed through a tube.
2. Specific. It begins when the patient gains 2-3 kg. The duration of specific therapy is 7-9 weeks. Half-bed rest is observed, smoothly transferred to normal. Psychotherapy begins, the consequences of fasting are explained to the patient, family sessions are held.

Individual diet

The nutrition plan is developed taking into account the physiological and mental characteristics of each patient. Table No. 11 according to Pevzner is taken as the basis. It aims to restore the chemical composition of tissues and the proper functioning of body cells. Features of an individual diet:

1. The primary calorie content of the daily diet at the non-specific stage of treatment is 500 kcal.
2. 6 meals of 50-100 g are prescribed. First, all liquid, diluted juices are given. Later grated dishes are added. The diet consists of compotes, jelly, smoothies, jelly, liquid cereals on the water with a small amount of milk, baby food, cottage cheese, weak meat and fish broths.
3. The staff of the medical institution ensures that the patient does not spit food.
4. Atropine may be given subcutaneously to prevent vomiting.
5. When a specific stage of treatment begins, the patient is transferred to a vegetarian, and then a high-calorie diet. Gradually, steam and boiled fish, meat chopped with a blender, jellied dishes, omelettes, pates, salads are introduced into the diet.

Medical treatment

Taking medications for eating disorders is an additional, but very important stage of therapy. There are no drugs that could eliminate the disease itself, but drugs are prescribed that fight mental manifestations and a number of consequences that the disease causes. With this diagnosis, the patient can be assigned:

• hormonal drugs;
• tranquilizers;
• antidepressants;
• vitamin and mineral complexes.

Hormonal drugs

Such drugs are usually prescribed to women to restore the menstrual cycle and prevent pregnancy, which is highly undesirable during the treatment of anorexia and can have a negative effect on the body. In addition, side effects of hormonal drugs include weight gain. If the patient has anorexia nervosa, he may be prescribed:

• Duphaston;
• Dexamethasone;
• Clostilbegit.

tranquilizers

Drugs in this group are prescribed to overcome anxiety, tension. Such drugs act quickly and help the patient to relax from obsessive thoughts, relax. This group of drugs:

1. Alprazolam. Relaxes, improves mood, stabilizes the hypothalamus.
2. Grandaxin. A mildly acting tranquilizer that helps to cope with the disease. The drug stimulates thought processes.
3. diazepam. A powerful tranquilizer that reduces the ability to resist.

Antidepressants for the treatment of psychiatric disorder

In most cases, anorexia is accompanied by depression and severe depression. Antidepressants and antipsychotics effectively correct the mental state. The patient may be prescribed:

1. Amitriptyline. Improves mood, slightly stimulates appetite.
2. Elzepam. It has a sedative effect, helps to optimize the processes of eating.

Vitamins and trace elements

It is difficult to ensure access of all necessary substances to the body from food even with a normal diet, so the patient must be prescribed complex drugs. Means must contain vitamins B12, A, E and D, iron, folic acid, potassium, sodium, magnesium and zinc. The presence of all these substances contributes to the normal functioning of the body.

Behavioral and cognitive psychotherapy

This stage is one of the most important treatments for those with anorexia nervosa. Behavioral psychotherapy aims to increase the weight of the patient. It includes bed rest, moderate exercise, reinforcing stimuli, and therapeutic nutrition. The calorie content of food is increased gradually according to one of the schemes chosen by the doctor. Nutrition is selected so that side effects (edema, mineral metabolism disorders and damage to the digestive organs) are completely excluded.

Cognitive therapy is performed to correct the patient's distorted view of their body. As a result, the patient should stop considering himself fat, inferior. The main elements of cognitive therapy:

1. Restructuring, during which the patient analyzes his own negative thoughts and finds a refutation of them. The conclusion obtained in the course of these reflections must be used to correct one's own behavior in the future.
2. Problem solving. The patient must identify each situation and develop different options for getting out of it. After evaluating the effectiveness of each, you should choose the best one, determine the stages of implementation, and implement them. The last stage is to analyze, according to the result obtained, how correctly the solution to the problem was chosen.
3. Monitoring. The patient is obliged to write down every day everything related to food intake.

Consequences of the disease

Eating disorders have a detrimental effect on the body and do not go unnoticed. Anorexia nervosa can cause the following consequences:

1. Disorders of the cardiovascular system. Arrhythmia, which can lead to sudden death. Fainting and dizziness due to lack of magnesium and potassium, increased heart rate.
2. Mental disorders. Patients cannot concentrate on something, depression or obsessive-compulsive disorder sets in, and the risk of suicide is high.
3. Skin problems. The covers become pale and dry, alopecia begins, small hairs appear on the face and back, the nails deteriorate.
4. endocrine disorders. Slow metabolism, amenorrhea, infertility, lack of thyroid hormones.
5. Disorders of the digestive system. Convulsive spasms of the stomach, chronic constipation, functional dyspepsia, nausea.
6. Disorders of the central nervous system. Decline in strength, depression, reduced performance, alcoholism, decreased concentration, self-isolation, memory impairment, mood swings.
7. Decreased immunity. Frequent colds with purulent complications, stomatitis, barley.
8. Other deviations. Osteoporosis, painful frequent fractures, reduced brain mass.

The disease has several options for the outcome, which should be clearly understood by each patient. What causes psychogenic anorexia:

• recovery;
• periodically relapsing course;
• death due to irreversible damage to internal organs (5-10% of cases).

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Content

Nervous anorexia syndrome is a disease in which a person deliberately refuses to eat in order to lose weight or to prevent weight gain. In 95% of cases, the disease is diagnosed in women, and adolescents. It is less common in adults. Mortality is 10–20%.

Why Anorexia Nervosa Syndrome Develops

The main reason for the development of anorexia on a nervous basis is the deliberate restriction of food intake by a person. The disease is psychological in nature. The patient cannot adequately evaluate his body even at a critically low weight. This condition is called dysmorphomanic syndrome. The main causes of anorexia:

• disharmonic teenage crisis;
• negative statements from the outside about the figure and appearance of a person;
• pathological fear of gaining excess weight;
• psychological illnesses;
• unwillingness to admit their exhaustion.

Risk factors

The main risk factor is the psychological impact from the outside.

Teenagers are especially prone to it, and many comments can be taken too closely.

Other risk factors:

• Personal. These include low self-esteem and high susceptibility to criticism from others.
• Hereditary. Under severe stress in humans, the 1p34 gene is activated, which is transmitted genetically.
• Family. The risk of developing anorexia on nerves is higher if this disease was in relatives.
• Anthropological. Anorexia in this case is seen as a process of everyday overcoming the desire to eat.
• Social. Assumes the observance of the fashion for excessive thinness.
• Biological. Risk factors are early onset of the first menstruation and overweight, as well as dysfunction of neurotransmitters responsible for eating behavior.

Stages of the disease

Anorexia in the early stages is characterized by a complex of psychological symptoms. More striking signs appear on the part of the digestive and other organs after a long refusal to eat. The main stages of anorexia on a nervous basis:

Signs of anorexia nervosa

Symptoms of anorexia on a nervous basis appear at stages 1-2 of the disease. Behavioral signs indicate a violation of the mental balance of a person. In addition to them, physical changes also appear, indicating malfunctions in the functioning of internal organs, especially the digestive system, lack of nutrients, and exhaustion.

Physical disorders

The physical signs of anorexia include objective symptoms, that is, changes in the human body that are visible to others due to the disease. The patient cannot hide such signs from relatives. These symptoms are more common and are central to the diagnosis. Physical disorders in anorexia:

• fragility of nails;
• hair loss;
• menstrual disorders up to amenorrhea;
• dryness and thinning of the skin;
• bradycardia;
• amyotrophy;
• decreased sexual activity;
• cold hands and feet;
• swelling;
• pallor of the skin;
• indigestion in the form of constipation or diarrhea;
• growth of thin fluffy hair along the body;
• low body temperature;
• constant dizziness;
• general weakness.

Behavioral changes

The group of behavioral symptoms includes the subjective feelings of the patient, which he not only does not share with his relatives, but also carefully hides them. These signs relate to the eating and social behavior of a person. Main symptoms:

• the desire to constantly perform hard physical exercises;
• choice of baggy clothes;
• fanaticism in defending one's opinion;
• a tendency to seclusion;
• apathy;
• persistent desire to lose weight and reduce the calorie content of the diet;
• narrowing the range of interests;
• fanatical calorie counting;
• refusal to eat, explained by the fact that “he ate a lot”, “already full”, “I don’t want to”;
• thoroughly chewing each piece of food;
• dissatisfaction with their figure;
• sudden mood swings;
• taking diuretics and laxatives for weight loss;
• sharp denial of his thinness;
• a distorted view of your body;
• aversion to food.

Diagnostics

The main method for diagnosing anorexia on nervous grounds is a thorough examination and questioning of the patient.

The disease is confirmed if a person's weight is 15% below the norm (body mass index less than 17.5).

A psychological test is also important, which reveals deviations in behavior characteristic of anorexia. Additional diagnostic methods include:

• Computed tomography of the brain. Necessary to exclude tumor formations.
• Gynecological examination. It is carried out to exclude organic causes of menstruation disorders.
• Thyroid hormone analysis. Helps to eliminate pathologies of the endocrine system.
• Gastroscopy. It is necessary to exclude diseases of the digestive tract.

Treatment Methods

When diagnosing 3-4 stages of this disease, the patient requires hospitalization. Treatment of anorexia nervosa is aimed at preventing dystrophy and dehydration, restoring mental balance. For this purpose, drugs are prescribed:

• antiemetics;
• antidepressants;
• hormonal;
• sedatives;
• solutions that restore water and electrolyte balance.

At the initial stage of therapy, only moderately high-calorie and light meals are included in the diet. As the patient's condition improves, it is allowed to increase the number of calories and the volume of servings. Power restoration principles:

• in severe cases, parenteral nutrition is indicated;
• food should be liquid or puree;
• you need to eat often - up to 5-6 times a day, but in small portions;
• the patient's diet includes nutritional supplements containing trace elements.

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The term "anorexia" literally means lack of appetite. Anorexia may be associated with diseases or medications that cause loss of appetite. Anorexia nervosa involves a psychological aversion to food, resulting in a state of hunger and emaciation, with weight loss of at least 15% to 60% of normal weight.

Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behavior, severe self-induced weight loss, and psychiatric comorbidities. People with anorexia have a phobia of gaining weight, which prompts them to maintain weight much less than is normal for their height, age, and health. They will do anything to avoid gaining weight, including starvation. Such people have a distorted vision of their body - they think they are fat, even if they are already very thin, and will try to maintain the correct weight in their view and deny the serious consequences that their low weight has on health.

Anorexia is primarily an emotional disorder that focuses on food, but it's actually an attempt to deal with personality issues through strict control of diet and weight. People with this disorder often feel that their self-esteem is tied to the thinness of their body.

Anorexia nervosa is most common among young women in industrialized countries where culture, society and the media cultivate the image of the ideal woman as a thin woman. Fueled by popular magazines and TV shows, anorexia is affecting a growing number of people, especially athletes and public figures.

Today, this disorder is increasingly affecting adolescents, with 3 out of 100 modern teenagers suffering from nervous disorders associated with their weight. Although anorexia rarely appears before puberty, however, associated mental conditions such as depression and obsessive-compulsive behavior tend to be more serious. Anorexia is often preceded by traumatic events, usually accompanied by other emotional problems.

Anorexia is a life-threatening condition that can lead to starvation death, heart failure, electrolyte imbalance, or suicide. For some people, this disorder is a chronic condition that lasts a lifetime. But treatment can help people with anorexia develop a healthy lifestyle and avoid the complications of anorexia.

bulimia

There are two types of anorexia. Patients with the first type are always trying to lose weightby severely restricting themselves in food. Others may overeat and then vomit after eating or take laxatives and diuretics. A condition characterized by such actions is called bulimia. In the case of bulimia, the weight of patients can also drop dangerously low very quickly.

Bulimia nervosa is more common than anorexia and usually begins in early adolescence. It is characterized by cycles of binge eating and purging, and usually occurs in the following pattern:

Bulimia often develops when young women try to lose weight through restrictive diets, fail, and begin to overeat. Binge eating includes eating much more than the usual amount of food in a 2-hour period.

Patients compensate for overeating, usually by inducing vomiting, using enemas, or taking laxatives, diet pills, or fluid-removing drugs, and then returning to a heavy diet and excessive exercise, or both. Then the cycle repeats. In some cases, the condition progresses to anorexia.

Signs and symptoms of anorexia

The main symptom of anorexia nervosa is critical weight loss.

Physical signs of anorexia:

Excessive weight loss
- Scanty or absent periods
- Thinning hair
- Dry skin
- Brittle nails
- Cold or swollen hands and feet
- Stomach upset
- Growth of fine fluffy hair all over the body
- Low blood pressure
- Constant fatigue
- Violation of heart rhythms
- Osteoporosis
- Constant chills and poor circulation
- Fainting and dizziness

Psychological and behavioral signs of anorexia

Distorted perception of themselves, patients insist that they are overweight, even when they are very thin;
- Always preoccupied with food, thoughts are focused on food;
- Refusal to eat
- Memory impairment, absent-mindedness, lack of concentration
- Refusal to recognize the seriousness of the disease
- Depression
- Skipping meals or making excuses not to eat
- Eating only a few foods
- Refusal to eat in public places
- Planning and preparing complex meals for others but do not eat themselves
- Constantly concerned about their weight
- Cut food into small pieces, roll on a plate, but do not eat
- Exhausting physical training

Symptoms specific to bulimia

Regular trips to the toilet immediately after eating
- Eating large amounts of food or buying foods in large quantities that disappear immediately
- Rupture of blood vessels in the eyes
- Dry, cracked skin at the corners of the mouth
- Dry mouth
- Sore gums and erosion of enamel from stomach acid released during vomiting
- Rash and pimples

Causes of anorexia

There is more than one reason for an eating disorder. Despite concerns about weight and body shape playing an important role in all eating disorders, the actual cause of these disorders includes many factors: genetic and neurobiological, cultural and social, behavioral and psychological.

genetic factors. Anorexia is eight times more common in people who have relatives with the disease. Twin studies show that they tend to share specific eating disorders (anorexia, bulimia, obesity). Researchers have identified specific chromosomes that may be associated with bulimia and anorexia.

biological factors. The hypothalamic-pituitary-adrenal system of the body may play an important role in eating disorders. This complex system originates in the following areas of the brain:

The hypothalamus is a small structure that plays an important role in controlling behavior such as eating, sexual behavior, sleep, and also regulates body temperature, hunger and thirst, and is involved in the secretion of hormones.
- Pituitary. The pituitary gland is involved in controlling the thyroid and adrenal glands, growth and puberty.
- Tonsils. These small amygdala structures are associated with the regulation and control of emotional activity, including anxiety, depression, aggression, and attachment.

The hypothalamic-pituitary-adrenal system is involved in the production of certain neurotransmitters (chemical messengers in the brain) that regulate tension, mood, and appetite. Defects in the production of three of these - serotonin, norepinephrine and dopamine - may play a particularly important role in eating disorders. Serotonin has been implicated in well-being, anxiety, and appetite (among other traits), and reduced levels of serotonin in the brain have been linked to depression and severe migraines. Norepinephrine is a stress hormone. Dopamine serves as an important part of the brain's "reward system" because it causes a feeling of pleasure (or satisfaction), which affects the processes of motivation and learning. An imbalance of serotonin and dopamine may partly explain why people with anorexia do not experience a sense of pleasure from food and other typical comforts.

Psychological factors:

Severe trauma or emotional stress (such as the death of a loved one or sexual abuse) during puberty.
- Cultural environment.
- Tendency towards perfection, fear of ridicule or humiliation, desire to always be "good". The belief that being perfect on the outside is a necessary condition for being loved.

- Family history of anorexia. About a fifth of people with anorexia have relatives with an eating disorder.
- Obsessive Compulsive Disorder - an anxiety disorder accompanied by obsessions, recurrent or persistent mental images, thoughts that can lead to compulsive behavior, which manifests itself in the form of repetitive, harsh, and self-prescribed procedures designed to prevent the manifestation of obsession. Women can become obsessed with exercise, diet, and food.
- Phobias. Phobias often precede the onset of an eating disorder. Social phobias, where a person is afraid of being humiliated in public places, are common in both types of eating disorders.
- Panic disorder. It is characterized by periodic bouts of anxiety or fear (panic attacks).
- Post-traumatic stress disorder - an anxiety disorder that occurs in response to life-threatening circumstances.
- Depression. Depression is often to blame for anorexia and bulimia.
- Narcissistic personality disorder: inability to calm oneself, inability to empathize with others, need for admiration, hypersensitivity to criticism or defeat.
- Overweight . Extreme eating disorders, including the use of diet pills, laxatives, diuretics, and vomiting, are more common in overweight patients than in normal weight adolescents.

Risk factors for anorexia

Age and gender - anorexia is most common among adolescents and young adult women.
- Increased concern for their own weight, passion for diets.
- Weight gain.
- Unintentional weight loss
- Puberty
- Life in industrialized countries
- Depression, obsessive-compulsive disorder or other anxiety conditions. Obsessive-compulsive disorders associated with an eating disorder are often accompanied by an obsessive ritual around food, such as cutting food into small pieces.
- Participation in sports and professional competitions, where a beautiful body is demonstrated - dancing, gymnastics, running, figure skating, horse racing, modeling, wrestling.
- constant stress
- Pessimism, tendency to anxiety, inability to resist difficult life situations.
- History of sexual abuse or other traumatic events
- Changes in life, such as moving to a new school, a new job
- Low self-esteem.

Diagnosis of anorexia

People with anorexia often feel they are in control of their illness and need help. But if you or a loved one is experiencing signs of anorexia, it is important to seek help in time. If you are a parent who suspects anorexia in a child, take the child to the doctor immediately. You may need to do some lab tests and undergo a psychological evaluation.

Usually, for the initial diagnosis, the doctor asks a few simple questions developed in the UK. Answering yes to at least 2 of the following questions is a strong indicator of an eating disorder:

- "Do you consider yourself complete (complete)?"
- "Do you control how much and what you eat?"
- "Have you lost more than 5 kg lately?"
- "Do you believe that you are fat (fat) when others say that you are thin (thin)?"
- "Thoughts about food dominate your life?"

Lab tests may include:

Blood tests for signs of anemia, electrolytes
- Liver and kidney function tests
- Electrocardiogram allows you to detect abnormal heart rhythms
- Osteoporosis test measures bone density
- Thyroid function tests
- Analysis of urine
- Measurement of body mass index. The normal BMI for women over the age of 20 is 19 - 25. A BMI below 17.5 is considered a risk threshold for health problems associated with anorexia. (However, younger adolescents may have a lower BMI that is not necessarily associated with anorexia.)

If the diagnosis of anorexia is confirmed, you will likely need to work with a team of doctors, including a psychologist or psychiatrist, a nutritionist, and a therapist.

Treatment of anorexia

The main areas of treatment for anorexia nervosa are:
- Increasing social activity
- Decreased physical activity
- Using meal schedules

The main goal of treatment is to restore normal body weight and eating habits, weight gain of 0.4 - 1 kg per week. Treatment of physical complications and any complications associated with mental disorders, prevention of relapse is also important.

The most successful treatment for anorexia is a combination of psychotherapy, family therapy, and medical treatment. It is important that the anorexic sufferer himself take an active part in the treatment. As a rule, patients do not consider that they need treatment. It should also be understood that the treatment of anorexia is a long-term task that can last a lifetime. Patients remain vulnerable to relapse as they go through stressful times in their lives.

Cognitive behavioral therapy, along with antidepressants, may be an effective treatment for eating disorders. Complementary and alternative therapies can help fill nutritional deficiencies.

Hospitalization may be necessary in the following cases:

Continued weight loss despite outpatient treatment
- Body mass index (BMI) is 30% below normal.
- Irregular heart rhythm
- severe depression
- Suicidal tendencies
- Low potassium levels
- Low blood pressure

Even after some weight gain, many patients remain quite thin and the risk of recurrence is very high.
It is worth considering some social factors that can complicate the recovery process:

Friends or family who admire the slimness and thinness of the patient
- Instructors or sports trainers who promote thinness and harmony
- Refusal to help parents or other family members
- Convincing the patient that extreme thinness is not only normal but also attractive, and that not eating is the only way to avoid being overweight.

Therefore, the involvement of friends and family members during treatment can be helpful.

Lifestyle change

Treatment for anorexia nervosa includes major lifestyle changes:

Practice regular eating and healthy eating
- Treatment development and menu planning
- Participate in a support group to help you cope with stress and emotional problems
- Getting rid of the habit of constantly weighing yourself
- Reducing compulsive and exhausting exercise, if it was part of this disease. Once the patient has gained weight, the doctor may recommend exercise programs to improve overall health.

Restoring normal weight and nutrition

Nutritional intervention is important and necessary. Weight gain is associated with a decrease in the number of anorexia symptoms and with an improvement in both physical and mental functions. Restoring normal nutrition can help reduce bone loss. Increased caloric intake and exercise can normalize hormonal functions. Weight restoration is also important, only then can the patient fully benefit from additional psychotherapeutic treatment. Patients usually start with a low calorie intake of 1000 to 1600 calories per day, then gradually increase the ration to 2000 to 3500 calories per day. Initially, patients may experience an increase in anxiety and depressive symptoms, as well as fluid retention, in response to weight gain. These symptoms decrease over time as the weight is maintained.

parenteral nutrition. This type of food is not commonly used in the treatment of anorexia, as it can prevent the return to normal eating, also because many patients interpret its use as punishment and as force-feeding. However, for patients who are at significant risk, or who refuse to eat, tube feeding may help with initial weight gain and improvement in the patient's general condition.

Intravenous nutrition. Intravenous nutrition may be necessary in life-threatening situations. It involves inserting a needle into a vein and infusing a fluid containing nutrients directly into the bloodstream. Indications for intravenous nutrition are: muscle weakness, bleeding from the mouth, cardiac arrhythmia, convulsions and coma.

Medications

Antidepressants. There are no specific medications to treat anorexia. However, antidepressants are often prescribed to treat the depression that can accompany the illness. Medications may also be prescribed to manage obsessive-compulsive disorder or anxiety. However, antidepressants cannot work alone and must be used in conjunction with a holistic approach that includes nutrition and psychotherapy.

Recent studies show that the use of antidepressants can cause suicidal thoughts in children and adolescents. Adolescents who take these drugs should be very carefully screened for potential suicidal behavior.

Vitamins and minerals. People with anorexia often don't get the essential nutrients their bodies need, so potassium, iron, or other supplements may be prescribed to make up for the deficiency.

Antihistamines. Sometimes cyproheptadine may be prescribed to help stimulate the appetite.

Nutrition and nutritional supplements

Bulimics are more likely to have vitamin and mineral deficiencies that can negatively affect their health. Vitamin deficiency can contribute to cognitive difficulties such as myopia or memory loss. Getting enough vitamins and minerals in the diet or through nutritional supplements can correct problems.

Always tell your doctor about the herbs or supplements you use or plan to use, as some supplements may interfere with conventional treatments.

These few tips can help improve your overall health:

Avoid caffeine, alcohol and tobacco.
- Drink 6 - 8 glasses of filtered water a day.
- Use quality protein sources - such as meat and eggs, whey, vegetable and protein shakes - as part of a balanced program to build muscle and prevent wasting.
- Avoid refined sugars such as candy and soft drinks.

As a solution to vitamin and mineral deficiencies in the diet, it is advisable to pay attention to the following supplements:

Daily intake of multivitamins containing antioxidant vitamins A, C, E, vitamins and trace elements such as magnesium, calcium, zinc, phosphorus, copper and selenium.
- Omega-3 fatty acids such as fish oil, 1 - 2 capsules or 1 tablespoon of oil, 2 - 3 times a day, which reduce inflammation and increase immunity. Fish such as salmon or halibut are good sources of omega-3s, so it is recommended to eat 2 servings of fish per week.
- Coenzyme Q10, 100 - 200 mg at night, for antioxidant, immune and muscle support.
- 5-hydroxytryptophan (5-HTP), 50 mg 2-3 times a day, to stabilize mood. Talk to your doctor before taking 5-HTP. Do not take 5-HTP if you are taking antidepressants.
-Creatine 5 - 7 g per day for muscle weakness and wasting.
- Probiotic supplements containing lactobacillus acidophilus. 5 - 10 billion CFU (Colony Forming Units) per day are needed to maintain gastrointestinal and immune health.

Treatment of anorexia with herbs

Herbs are generally a safe way to strengthen and improve the overall tone of the body. You can use herbs in the form of dry extracts (capsules, powders, teas), or tinctures (alcohol extracts).

Ashwagandha, for general benefit and stress management. May cause drowsiness and therefore caution should be exercised when combined with sedatives.
- Fenugreek helps stimulate appetite. Fenugreek may not be safe for children, may lower blood sugar and therefore may interact with diabetes medications, and may interact with medications that cause slow blood clotting (anticoagulants).
- Milk thistle or milk thistle for liver health.
- Cat mint. Take as a tea 2-3 times a day to calm the nerves and the digestive system. Women with heavy menstrual bleeding should avoid catnip. Catnip may interact with lithium and certain sedative medications.

Homeopathy in the treatment of anorexia

There is no evidence in the scientific literature to support the successful use of homeopathy for the treatment of anorexia. However, homeopathy can be considered on a case-by-case basis and homeopathic treatment can be recommended to address both your underlying disease and any current symptoms.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is one of the most effective treatments for anorexia. With the help of cognitive behavioral therapy, a person learns to replace negative and distorted thoughts and beliefs with positive, real ones. The sufferer is also encouraged to acknowledge their fears and develop new, healthier ways to deal with problems.

Within 4 - 6 months, the patient builds his menu 3 times a day, including including foods that he had previously avoided.
During this period, the patient monitors and records the diet daily, along with any habitual unhealthy reactions and negative thoughts towards food as they arise.
The patient also records any relapses (vomiting, laxatives, exercise) objectively and without self-criticism or judgment.

These notes are then discussed with the cognitive therapist at regular appointments. Ultimately, the patient is able to accept false ideas about seeing his body, and realize that this is at the root of nutritional and health problems.
Once these habits are recognized as harmful by the patient himself, the choice of foods expands, and the patient himself begins to challenge his own ingrained and automatic ideas and reactions. The patient then replaces them with a variety of realistic beliefs, along with acting on a reasonable self-expectation.

Family Therapy

In addition to individual therapy for patients with anorexia, family therapy is also recommended, which includes the participation of parents, brothers and sisters, friends and the immediate environment. Parents and other family members often experience intense guilt and anxiety. Family therapy aims, in particular, to help parents or partners understand the seriousness of this disease and find ways to help and support the patient on the path to recovery.

Maudsley method

For adolescents and young patients in the early stages of anorexia, the Maudsley method can be effective. The Maudsley method is one of the types of family therapy, which considers the patient's family as the main link in the nutrition of the patient's recovery. Parents take responsibility for planning and supervising all meals and snacks for the patient.
As the patient recovers, the patient gradually takes on more personal responsibility for deciding when and how much to eat. Weekly family meetings and family counseling are also part of this therapeutic approach.

Hypnosis

Hypnosis may be useful as part of a comprehensive treatment program for anorexia nervosa. It can help a person build self-confidence and develop the ability to deal with stress and depression. Hypnosis can also help promote a return to healthy eating, body image awareness, and greater self-esteem.

Pregnancy and anorexia

After weight gain, estrogen levels tend to recover and menstruation returns. However, in some patients with severe anorexia, even after treatment, normal regular menses never return.

Anorexia carries potential problems for women who are pregnant or who want to become pregnant:

Difficulty getting pregnant
- Increased risk of low birth weight and chance of birth defects in infants
- Malnutrition (particularly lack of calcium) during fetal growth
- Increased risk of complications
- Increased risk of relapse due to stress associated with pregnancy or parenthood

Complications of anorexia

Complications associated with anorexia include:

- Irregular heart rhythm and heart attacks
- Anemia, often associated with a lack of vitamin B12
- Low levels of potassium, calcium, magnesium and phosphate
- high cholesterol
- Hormonal changes, and as a result, the absence of menstruation, infertility, bone loss and growth retardation
- Osteoporosis
- Swelling and numbness in hands and feet
- Decrease in white blood cells, leading to an increased risk of infection
- Severe dehydration
- Acute malnutrition
- Problems in the thyroid gland
- Caries
- Disorganized thinking
- Death (suicide is noted in 50% of deaths associated with anorexia).

Forced vomiting can cause:

Swallowing problems
- Rupture of the esophagus
- Weakening of the rectal wall
- Rectal prolapse is a rare but serious condition that requires surgery.

Forecast anorexia

The prospects for recovery for patients with anorexia are very vague, recovery often takes from 4 to 7 years. There is also a high chance of recurrence even after recovery. Long-term studies show that 50-70% of people recover from anorexia nervosa. However, 25% never fully recover. Many, even after they are considered "cured", continue to display traits of anorexia such as maintaining thinness and striving for perfection.

Anorexia is associated with high mortality from natural and unnatural causes (suicide).

Prevention of anorexia

The most effective way to prevent anorexia is to develop healthy eating habits and body awareness from an early age. It is important not to instill cultural values ​​that promote perfect body shapes and excessive thinness. Make sure you and your children are aware of the dangers of anorexia.

For those who have already recovered from anorexia, the main goal is to avoid relapse.
Family and friends should be urged not to obsess over food, weight, and perfecting your body. Do not discuss this during meals. Instead, devote your mealtimes to social interaction and relaxation.

Watch for signs of relapse. Careful and regular monitoring of weight and other physical signs by a health care provider can detect problems early.

Cognitive behavioral therapy or other forms of psychotherapy can help a person develop coping skills and change unhealthy thoughts.

Family therapy can help address any problems in the family that may be contributing to a person's anorexia.

Anorexia in men has its own characteristics:

• Anorexia in men is often associated with various mental disorders - schizophrenia, neuroses.
• Men do not talk about their desire to lose weight. They are more secretive, unlike women who are constantly discussing ways to lose weight.
• Men are more purposeful, they firmly adhere to the word given to themselves to refuse certain products. They are less likely to have food breakdowns.
• A large percentage of sick men refuse food for ideological reasons. They are supporters of cleansing the body, raw food, veganism, sun-eating or other nutrition systems.
• Anorexia affects not only young men who strive to meet the standards of beauty, but also men over 40, who are fond of cleansing the body and various spiritual practices. You can often hear phrases from them that “food is a hindrance to spiritual development”, “refusal of food prolongs life and purifies the spirit”.
• Asthenic and schizoid features predominate in the character of patients, in contrast to women, who are characterized by hysterical features.
• Crazy ideas about imaginary fullness sometimes serve as a distraction for a man. At the same time, he tends to ignore real physical flaws, sometimes disfiguring his appearance.

Factors that provoke anorexia in men

• Growing up in an incomplete family in an atmosphere of excessive guardianship from the mother's side. The boy is afraid that with weight gain he will grow up and lose the love of his relatives. By staying thin, he tries to avoid the responsibilities and hardships of adulthood. Such men continue to live with their parents into adulthood.
• Critical statements from others regarding excess weight. This can cause psychological trauma.
• Participation in certain sports requiring tight control over body weight - sports dancing, ballet, running, jumping, figure skating.
• Professions related to show business- Singers, actors, fashion models. People engaged in these professions sometimes pay excessive attention to their appearance, which causes thoughts about their own imperfection and excess weight.
• Self-punishment. Boys and men wear themselves out by reducing their feelings of guilt for unrevealed aggression towards their father or forbidden sexual desire.
• Schizophrenia in one of the parents, the tendency to which is inherited. The risk of anorexia nervosa is high in young men whose parents suffered from anorexia, phobia, anxiety depression, psychosis.
• Homosexuality. In specialized publications, a cult of lean male bodies is created, which encourages young men to refuse food.

• Painful attention to one's appearance.
• Tendency to eat normally once and then starve for weeks.
• Tendency to hide food. To reassure relatives that the patient is "eating normally", he may hide or throw away his portion of food.
• Decreased sexual interest and potency, which is analogous to female amenorrhea (absence of menstruation).
• Ways to lose weight are traditional - refusal to eat, excessive exercise and vomiting, enemas, colon therapy. However, painful attachment to vomiting is less common than in women.
• Unmotivated aggression. Rude attitude towards close people, especially to parents.
• Refusal to be photographed. Patients argue it by the fact that in the photographs their "completeness" is more noticeable.
• Hypochondria. A man is overly worried about his health, he suspects that he has serious illnesses. Natural sensations (especially the feeling of filling the stomach) seem painful to him.
• Changes in appearance appear after a few months - weight loss (up to 50% of body weight), dry skin, hair loss.
• The tendency to alcoholism is an attempt to cope with emotions and drown out thoughts about food and weight loss.

Men with anorexia do not perceive their condition as a problem. They justify fasting in every possible way by cleansing the body and striving for enlightenment. Their relatives are more likely to seek medical help. If this does not happen in time, then the man ends up in the hospital with cachexia (extreme exhaustion) or in a psychiatric hospital with an exacerbation of mental illness.

Treatment of anorexia in men includes psychotherapy, drug treatment, and reflexology. Together, these measures lead to recovery of more than 80% of patients.

1. Psychotherapy is an essential part of the treatment. It allows you to correct the thinking of the patient and helps to eliminate the psychological trauma that led to the eating disorder. With anorexia in men have proven their effectiveness:

• psychoanalysis;
• behavioral therapy;
• family psychotherapy with relatives of the patient.

• Antipsychotics Clozapine, Olanzapine are used for the first 6 months of treatment. They promote weight gain and reduce delusions about fullness. The dose of the drug is determined individually. After reaching the therapeutic effect, it is gradually reduced. If an exacerbation occurs, then the dose is increased to the initial one.
• Atypical antipsychotics Risperidone, Risset eliminate the negative manifestations of the disease, but do not reduce performance, do not interfere with work and study. Take drugs constantly or only when symptoms of the disease occur. Treatment with atypical drugs can last from 6 months to one and a half years.
• Vitamin preparations. B vitamins normalize the functioning of the nervous system, helping to eradicate the root cause of the disease. Vitamins A and E improve the production of hormones, contribute to the restoration of the skin and its appendages, as well as the mucous membranes of internal organs.

4. Trainings on the organization of a healthy diet. Special training programs will help the patient to create a menu in such a way that all the nutrients enter the body and there is no discomfort.

5. Intravenous nutrition or the introduction of food through a tube. These methods are applied at an extreme degree of exhaustion in patients who categorically refuse food.

Anorexia in a child, what to do?

Causes of anorexia in a child

• Parents feed the child, forcing them to eat too large portions. The result is an aversion to food.
• Monotonous nutrition, which forms a negative attitude towards food.
• Past severe infectious diseases - diphtheria, hepatitis, tuberculosis.
• Psycho-emotional stresses - sharp acclimatization, death of a loved one, divorce of parents.
• The abundance of harmful and sweet foods in the diet disrupts digestion and metabolism.
• Excessive guardianship and control by parents. It is often found in single-parent families where a child is brought up without a father by his mother and grandmother.
• Dissatisfaction with their appearance, which is often based on criticism from parents and ridicule from peers.
• Hereditary predisposition to mental illness.

• Eating disorders - refusal to eat or a certain set of foods (potatoes, cereals, meat, sweets).
• Physical signs - weight loss, dry skin, sunken eyes, bruising under the eyes.
• Behavioral changes - sleep disturbances, irritability, frequent tantrums, poor academic performance.

• Make eating an enjoyable experience. Create comfort in the kitchen. While the child is eating, take a few minutes to sit next to him, ask how the day went, what was the most pleasant event today.
• Start eating healthy as a family. For example, instead of pies, cook baked apples with cottage cheese, instead of frying potatoes or fish, bake them in foil. Focus not on the fact that this is losing weight, but that proper nutrition is the basis of beauty, health and vigor. Slimness is just a pleasant consequence of a healthy lifestyle.
• Observe family rituals related to food. Bake meat according to your grandmother's recipe, pickle fish, as is customary in your family. Share these secrets with your child. Rituals make the child aware of being part of the group and give a sense of security.
• Go shopping together. Make a rule: everyone buys a new, preferably "healthy" product. It could be yogurt, an exotic fruit, a new kind of cheese. Then at home you can try it and decide whose choice is better. Thus, you instill in the child the idea that healthy food brings pleasure.
• Don't insist on yours. Give your child a choice, strive for a compromise. This applies to all aspects of life. A child who is overly controlled in everything takes control of what is left for him - his food. Avoid categorical requirements. If you think it's cold outside, then don't yell for your daughter to put on a hat, but offer the child an acceptable choice: headband, hat, or hood. The same applies to food. Ask what the child will be, offering a choice of 2-3 acceptable dishes. If the daughter flatly refuses dinner, reschedule lunch for a later time.
• Involve your child in the cooking process. Watch cooking shows together, choose recipes on the Internet that you would like to try. There are plenty of tasty and healthy low-calorie meals that do not increase the risk of gaining weight.
• Encourage dancing and sports. Regular physical training increases appetite and contributes to the production of endorphins - “happiness hormones”. It is desirable that the child engages in for his own pleasure, as professional activities aimed at winning competitions can provoke a desire for weight loss and cause anorexia and bulimia.
• Consult a beautician or fitness trainer if the child is dissatisfied with their appearance and weight. Children often ignore the advice of their parents, but listen to the opinions of unfamiliar experts. Such specialists will help to create a proper nutrition program that improves skin condition and prevents weight gain.
• Listen carefully to the child. Avoid categorical judgments and do not deny problems: “Don't talk nonsense. You are of normal weight. Argument your arguments. Together, calculate the formula for the ideal weight, find the minimum and maximum values ​​\u200b\u200bfor this age. Promise to help in the fight for the ideals of beauty and stick to your word. It is better to cook a diet soup for your child than a rebellious daughter fundamentally skips a meal consisting of a high-calorie roast.
• Find areas where your child can fulfill himself. He should feel successful, useful and irreplaceable. To generate interest in various activities, attend a variety of events with your child: exhibitions, dance group competitions and sports. Encourage him to try his hand at a wide variety of sections and circles. Genuinely praise every small accomplishment. Then the idea will take root in a teenager that success and positive emotions can be associated not only with physical attractiveness. And new acquaintances and vivid impressions will distract from thoughts about the imperfection of your body.
• Help your child to get complete and versatile information. If a child wants to stick to a diet, then find detailed instructions on this topic. Be sure to read the contraindications together, read about the dangers and consequences of this diet. For example, it has been proven that supporters of protein diets are at risk of getting cancer. The more your child knows, the better he will be protected. So, from a misunderstanding of the danger of the problem, many girls are persistently looking for advice on the Internet “how to get anorexia?”. In their view, this is not a serious mental illness, but an easy path to beauty.

How to avoid relapse of anorexia?

How to avoid relapse of anorexia?

Scientists agree that anorexia is a chronic disease characterized by periods of calm and relapses. This food addiction is compared with diabetes mellitus: a person must constantly monitor his condition, follow preventive measures, and when the first signs of the disease appear, start drug treatment. Only in this way is it possible to stop the return of anorexia in time and prevent a relapse.

The article discusses anorexia nervosa. We tell what it is, the causes of occurrence, symptoms and signs of the disease. You will learn what treatment is used for nervous anorexia, possible complications and necessary prevention.

Stages of anorexia nervosa

Experts distinguish 3 stages of pathology: dysmorphomanic, anorectic and cachetic. Let's take a closer look at each of the stages.

The dysmorphomanic (initial) stage is characterized by:

• prolonged (more than 30 minutes) examination of one's reflection in the mirror, as a rule, in a naked state and with the door to the room locked;
• searching for different diets;
• feeling of constant anxiety;
• the first food restrictions;
• lack of mood;
• obsessive thoughts about their inferiority and inferiority, imaginary completeness.

anorectic stage:

• prolonged fasting;
• loss of appetite;
• decreased sexual desire;
• cessation of menstruation;
• inadequate assessment of one's own appearance and weight;
• weight loss of 20 percent or more;
• a decrease in the volume of fluid circulating in the body, resulting in hypotension, bradycardia, dryness of the dermis, hair loss, a feeling of cold, adrenal insufficiency;
• compliance;
• persuasion of oneself and others in the absence of appetite;
• excessive interest in sports activities;
• the excitement associated with the first achievements.

Cachectic (running) stage:

• a rapid drop in potassium levels;
• alimentary dystrophy;
• weight loss of 50 percent or more;
• violation of water and electrolyte balance;
• irreparable dystrophy of internal organs;
• inhibition of the functions of organs and systems;
• death.

In the absence of therapy, the patient goes through all the stages described above, the last of which leads to death due to organ failure or suicide. Suicide is also possible at the anorexic stage, but much less frequently.

Symptoms

The main signs of a nervous form of an eating disorder include:

• BMI below 17.5;
• body weight is 15 percent lower than expected;
• endocrine disorders - in women it manifests itself in the form of amenorrhea, in men there is a decrease in libido, an increase in the amount of cortisol and growth hormone, problems with insulin secretion and the production of thyroid hormone;
• fear of weight gain and obesity;
• inadequate assessment of one's own body;
• delayed physical development at puberty;
• weight loss occurs as a result of refusal to eat, artificially induced vomiting after each meal, the use of diuretics and diuretics;
• enhanced physical activity.

Mental symptoms include:

• depression;
• weighing every day;
• prolonged study of oneself in the mirror;
• improper eating behavior, which is expressed in the form of eating only cold or thermally unprocessed food, eating food while standing, crushing food into small pieces;
• low self-esteem;
• incorrect settings: “With a height of 175 cm, I weigh 55 kg, but I want to weigh 41 kg”;
• avoidance of common meals;
• denial of the problem;
• lack of desire to communicate with anyone;
• sudden mood swings;
• panic fear of weight gain;
• feeling fat;
• excessive passion for diets, the modeling world;
• irritability.

Physical disorders in anorexia nervosa are manifested in the following:

• muscle spasms;
• violation of the menstrual cycle;
• fast fatiguability;
• severe weakness;
• algomenorrhea;
• cardiac arrhythmia.

If you find such signs in your loved ones, you should immediately seek qualified help. This is due to the fact that the patient does not see any problem in such a condition and believes that everything is in order with him.

Diagnostics

Syndrome "anorexia nervosa" experts put after certain diagnostic measures:

• Complete blood count and ESR.
• X-ray, sigmoidoscopy.
• General urine and stool tests to determine if the patient was taking laxatives and diuretics.
• X-ray contrast study of the gastrointestinal tract.
• Examination of feces for the presence of hidden blood, fat.
• Gastroscopy.
• MRI or CT scan of the head.
• Esophagomanometry.

The “Eating Attitude Test” is also used to make an accurate diagnosis.

Treatment

Outpatient treatment of anorexia nervosa is possible in the initial and anorexic stages. With cachexia, as a rule, the patient is treated in a hospital. The duration of treatment can be from several months to several years for a complete recovery.

Therapy of mental anorexia nervosa consists of 4 stages. Let's look at each of them.

Behavioral Psychotherapy

This technique includes:

• Cognitive reconstruction - the patient independently identifies negative thoughts in himself, learns to control his own emotions and behavior, and draws reasonable conclusions.
• Monitoring - compiling detailed daily records describing the foods eaten during the day, what emotions the food caused, etc.
• Training in the correct solution of emerging problems - the patient himself must find a problem in his behavior, while developing several ways to solve it. On their basis, forecasts are made of how each of the decisions will end, after which the best option is selected with its further following.
• Refusal of incorrect self-esteem - the patient is taught an adequate assessment of himself, while eliminating such attitudes as “I am ugly”, “I am fat”, “No one loves me because of my fullness”.

Family Psychotherapy

The family environment and the support of loved ones play an important role in the treatment of anorexia nervosa. At the same time, communication with a psychotherapist is required not only for the patient, but also for his family members. The specialist finds out if there are problems in the family, suggests how to solve them correctly. It also explains why it is impossible to put pressure on an anorexic, as this can lead to a new breakdown and a deterioration in his well-being.

Maudsley method

This technique is one of the varieties of family therapy, it can be used in the early stages of mental anorexia nervosa. This method consists in drawing up a menu by relatives or parents of the patient, as well as control over how much and when he ate.

Over time, as correct judgments about nutrition are restored, the patient makes his own decisions about when and how much to eat. Every week, the results of therapy are discussed with a psychotherapist, who evaluates the effectiveness of the technique and gives additional recommendations.

Medical therapy

The following groups of drugs are used for treatment:

• Antidepressants - Eglonil, Paxil, Cipralex, Coaxin, Ludiomil, Zoloft, Fevarin. Used in the treatment of severe forms of depression, eliminate anxiety.
• B vitamins (B9 and B12), ascorbic acid (vitamin C).
• Microelements and macroelements - potassium, iron, zinc, magnesium.
• Improve appetite - Elenium, Pernexin, insulin, Frenolon, anabolic steroids (Primobolan), Peritol.
• Drugs to stabilize metabolic processes in the body - Berpamin and Polyamine.
• Atypical antipsychotics (used to reduce anxiety) - Asenapine, Clozapine, Sertindole, Ziprasidone.

You can use these funds only after the permission of the doctor. Self-administration is prohibited, as it can lead to negative and irreversible consequences.

diet therapy

It is developed by a nutritionist individually for each patient. It differs in consistency and steps: every day the calorie content of dishes increases by 50 kcal, and the volume of servings by 30-50 g, until the desired indicators are reached (at least 1500 calories per day and the weight of each serving is at least 0.3 kg).

At the beginning of the diet, the emphasis is on fruits and vegetables, after which protein foods (chicken, fish, seafood), a small amount of carbohydrates, as well as natural sweets in the form of honey and dried fruits, begin to be introduced into the diet.

This technique contributes to the formation of new eating habits in an anorexic woman: eating strictly by the hour, fractional nutrition, giving up bad habits, as well as an explanation of what the balance of BJU is.

Hypnotherapy

Hypnotherapy is sometimes used as part of the complex therapy of an eating disorder. It helps the patient feel more confident, increases stress tolerance, helps restore adequate self-esteem about himself and his appearance. After the sessions, many patients return to normal nutrition.

home treatment

In some cases, anorexia can be treated at home with the help of traditional medicine. But this can be done only after consulting a specialist.

Home treatment includes several stages: work with the patient, normalization of nutrition and the use of restorative agents. Let's consider each of the stages.

Patient care includes:

• Understanding and identifying the problem by the anorexic himself.
• Calculation of BMI with subsequent comparison with normal values.
• Moral support from family and friends.
• Watching movies, studying literature on this topic.
• Creating a positive atmosphere in the family and environment.
• Restoration of systematic nutrition.
• Mandatory medical examination, compliance with the recommendations of specialists.

Nutritional stabilization involves the gradual introduction of the following dishes into the diet:

• 1 week - mashed potatoes, broths, soups, cereals cooked in water;
• 2nd week - bananas, carrot-apple puree, berries;
• Week 3 - low-fat boiled or steamed fish, milk porridge, meat soup, freshly squeezed non-citrus juices that are diluted with water;
• Week 4 - vegetable salads, steamed or boiled meat, a small amount, bread.

Means for the general strengthening of the body:

1. Foods to improve appetite: white bread, nuts, dill and apples.
2. Herbal decoctions and infusions that have a calming effect: oregano, linden, lemon balm, black milkwort, mint, adonis, valerian.
3. Herbs that stimulate appetite: gentian, wormwood, calamus, horseradish, mint, tarragon, St. John's wort and centaury.

It is possible to treat pathology at home only in the initial stages and under the close supervision of a specialist.

Pregnancy and anorexia nervosa

Anorexics often have problems conceiving. But after a therapeutic course, weight gain, an increase in the level of estrogen and, as a result, the onset of pregnancy is possible. Despite this, a woman can observe such problems caused by hormonal disruptions:

• high risk of complications during childbearing, childbirth;
• development of fetal hypotrophy;
• difficulties with conception;
• congenital defects in a child;
• probable relapse against the background of stress that arose in response to the news of the onset of pregnancy.

Even after therapy for severe forms of pathology, a woman's menstrual cycle is not always restored, which is why there is no possibility of independent conception.

Effects

What predictions do doctors give for anorexia nervosa? They can be different, based on how quickly therapy was started. Among them:

• recovery;
• probable relapses due to nerves;
• overeating, which entails the psychological problems associated with it;
• death (based on statistics, death occurs in 10 percent of cases).

Eating disorders affect health in the following ways:

• constipation;
• pain in the stomach;
• prolonged depression;
• nausea;
• slow metabolism;
• infertility;
• inattention;
• lack of thyroid hormones;
• hair loss;
• osteoporosis;
• decrease in intelligence;
• fragility of nails;
• increased dryness, unhealthy skin color;
• bradycardia;
• heart failure;
• regular bone fractures;
• suicide.

It is possible to recover from the disease, only in some cases its consequences can haunt the anorectic throughout life.

Prevention

Preventive measures of nervous eating disorder are concluded in:

• balanced and complete nutrition;
• limiting communication with people who negatively affect the patient's psyche;
• visiting a psychoneurologist in the presence of a severe emotional state.

Anorexia nervosa is a serious disease, often leading to death. Remember, each person is unique, so you should not be equal to another. Love yourself and your body!

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