What are anorexia symptoms. Anorexia: causes and symptoms. Treatment for anorexia nervosa

Young (and not only) girls very often become the owners of all kinds of complexes. They, as a rule, are associated with some specific standards dictated by society. Height, of course, is weight. Today they impose on us what is not clear. Unfortunately, some people take this seriously. In pursuit of ideals, people are often born People fixate on the desire to look "the way it should." This often becomes the cause of various mental disorders.

Many people today know what anorexia is. Some consider this disease not dangerous and even fashionable. There is nothing good about him. This is a terrible thing that can lead to exhaustion or even death.

Anorexia: what is it

Many girls, trying to lose weight, begin to limit themselves in food. It all starts with ordinary diets, but something else develops over time. Of course, the most unfavorable effect on the work of the entire nervous system. Malnutrition affects not only the general state of the body, but also the psyche. What is a very serious disease that should not be started.

Girls suffering from anorexia do not think about anything other than the "harm" that food brings. They look at themselves in the mirror and see fat where there is none, or maybe never was. Patients with anorexia limit themselves to food fanatically. Not eating all day is an achievement, eating sweets is a complete failure.

More often young girls who have not yet reached the age of twenty-five suffer from it. Recognizing the disease is not easy. Here are the main symptoms:

Inadequate perception of your appearance;

Refusal to eat;

Dramatic weight loss;

Painful thinness;

Refusal to communicate;

Reluctance to discuss problems.

For patients with anorexia, deep grudges are also characteristic of any jokes (even the most harmless ones) regarding their appearance.

The consequences of anorexia

This disease has the most unfavorable effect not only on the body, but also on the psyche. A person exhausts himself, becomes vulnerable, emotionally unstable. Mentally, he becomes unable to adequately perceive reality, the world is seen only in dark colors. It is not uncommon for anorectics to commit suicide.

Refusal to eat leads to exhaustion. Fat stores are burned, and the person simply dries up. From the outside, it may seem that a person with anorexia has no muscles - only bones covered with skin. All internal organs suffer. It happens that patients die of exhaustion. It is worth mentioning that anorexia becomes the cause of destroyed immunity. A person will be susceptible to all kinds of colds, infectious and other diseases that he cannot cope with.

Those who have recovered often suffer from diseases of the internal organs. Some become unable to conceive or bear a child.

What is anorexia: treatment

It is good if the treatment was started on time. Success largely depends on the stage at which it started. The patient needs the advice of a psychotherapist. Treatment should be comprehensive. It includes which is aimed at developing some norms of behavior, cognitive and family therapy. In some cases, antidepressants or other medications are prescribed.

Sometimes, treatment is only possible in a clinical setting. We are talking about those patients with anorexia who do not admit their illness and continue to starve themselves.

It is necessary that everyone knows what anorexia is. An adequate perception of this disease is also important. There is nothing "fashionable" about it. This is a terrible mental disorder that ruins people.

This article discusses anorexia. You will learn what this disease is, what symptoms and stages it has. We will tell you what causes the development of this pathology and consider the drug, psychological and psychiatric methods of treating the disease. By following our advice, you will learn how to prevent and follow a special diet. We will highlight the topic of the peculiarities of the treatment of childhood and adolescent anorexia.

Anorexia is a dangerous disease that often has psychological causes

Anorexia is the degree of exhaustion of the body, while the patient himself does not recognize the presence of the disease and considers himself to be overweight... Signs of anorexia include an obsession with losing weight and a fear of gaining weight. Most often, this disease affects girls and women aged 14 to 25 years.

In our time, this pathology is quite common. Most often this is due to a distorted perception of the beauty of the body. In an attempt to become like emaciated fashion models, girls torment themselves with diets.

The danger of pathology lies in the rapid decrease in body weight.... In this case, the body is deprived of the substances necessary for normal vital activity, and this, in turn, leads to disruptions in the work of all organs and systems.

Among the consequences of anorexia are disruptions in the menstrual cycle, arrhythmia, digestive disorders, general weakness of the body, fainting, osteoporosis, weakening and loss of hair. In extreme cases, it can be fatal.

You have learned what anorexia is, and how dangerous the disease is. Now let us consider in more detail the causes of this pathology.

Causes of anorexia

Depending on the reasons that caused the pathology, there are several types of the disease. One of the most common is anorexia nervosa, it is provoked by psychological or mental disorders.

The second no less common form of the disease is medicinal. This pathology develops as a result of taking special medications that reduce body weight. They work by eliminating hunger. At the same time, some of them are addictive, so it can be extremely difficult to refuse to take them on your own, which leads to excessive depletion of the body.

Among the reasons for the formation of anorexia is panic fear of gaining excess weight. This fear is based on disturbances in the perception of one's own body, most often manifested in adolescence, when hormonal changes begin in girls and more rounded hips and breasts appear.

Anorexia often develops in children and adolescents when parents force them to eat

In adolescence, the cause of the formation of anorexia is often pathological self-doubt and low self-esteem. Against the background of overprotection on the part of the parents, this translates into the impossibility of a calm reaction to any slightest criticism regarding the child's appearance.

It is often possible to meet the development of this pathology while waiting for the baby. This is due to the fear of gaining excess weight and not returning to its previous shape after childbirth.

Anorexia and pregnancy are incompatible concepts. During the period of bearing a child, the body needs a larger amount of nutrients, which, due to pathology, generally cease to flow, and the fetus has nowhere to take building material for growth and development.

Anorexia during pregnancy can lead to various pathologies of fetal development. These include gestational diabetes and miscarriage.

You learned what anorexia is and how it appears. Now let's look at the main symptoms and stages of development of the disease.

Symptoms and stages of anorexia

The first signs of how anorexia begins are difficult to determine. This is due to the fact that at the initial stage of the disease there is no pronounced thinness, and some signs can be observed in healthy people. Nevertheless, upon close examination and attentive attitude towards a loved one, you can notice changes in behavior.

There are behavioral and physiological symptoms of anorexia. And if physiological ones appear at later stages of the disease, then changes in behavior can be noticed immediately.

A person suffering from anorexia of the 1st degree, first of all, begins to express dissatisfaction with his own appearance, in particular, his figure and weight. Such people begin to get involved in all kinds of diets, regardless of their health condition, they can severely limit themselves to food, cause vomiting after eating.

The physical signs of anorexia in women include disruptions in the menstrual cycle, up to the complete cessation of menstruation. Disorders of the digestive system appear: bloating, pain syndrome, intestinal obstruction.

In stage 1 of anorexia, weight loss begins. Along with this, dizziness, a sharp deterioration in well-being and a breakdown appear. Loss of 20% of the total weight is a warning sign and an indication for immediate medical attention.

To say with what weight anorexia begins, you can only calculate the body mass index. This indicator is individual for everyone. To determine it, it is necessary to divide the patient's weight by the squared height in meters. The resulting numerical indicator should not go beyond 18.5 to 25 units. Modern medicine has established a critical BMI at 17.5 - this is the threshold for the development of anorexia. Look at the ratio of weight and height in the table for anorexia.

There are 4 stages of anorexia. They develop gradually, following one after another. Let's consider them in more detail.

Typically, the first stage of anorexia lasts 2 to 4 years. This preparatory period is characterized by the formation of a critical opinion about one's appearance. At the same time, the positive opinion of others is not taken into account, but an inadvertently expressed remark or criticism is perceived rather painfully and can serve as an impetus for the transition to the second stage of the disease.

If at the initial stage of anorexia, the patient only has thoughts about how to correct his appearance, in particular his figure, then starting from the second stage he begins to take active actions. There is a passion for diets and a strict restriction of oneself in food.

With 2 degrees of anorexia, there is a visible and quite significant weight loss - from 20% of the total body weight. This entails hormonal disruptions and disruptions in the work of most organs and systems.

The cachectic stage or grade 3 anorexia is characterized by an aggravation of the patient's condition. At this time, somatohormonal disorders predominate: menstrual flow stops, subcutaneous fat disappears, dystrophic conditions of the skin and muscles are formed.

With grade 3 anorexia, the heartbeat slows down, the pulse becomes weak, blood circulation is impaired and blood pressure decreases. The patient is constantly freezing, and the skin becomes cyanotic.

In parallel with this, the condition of the hair, nails and teeth is significantly deteriorating. They become more brittle and lifeless, bleeding and soreness of the gums appear.

At this stage of the disease, medical attention is needed. It is impossible to cope with anorexia on your own without psychological help and medications.

The last stage of the disease is characterized by the return of obsessive thoughts about their appearance. Since after treatment the weight begins to return to normal, panic states appear due to excess body weight. The last stage of anorexia can last up to 2 years. All this time, the patient must be closely monitored, otherwise he will break into another hunger strike.

Depending on the stage of the disease, there is a constant loss of body weight. See the ratio of weight loss and stages of anorexia in the table.

You have learned the stages, symptoms and causes of the development of anorexia disease. Now let's talk about the methods of drug, psychological and psychiatric treatment of the disease.

Treatment methods for anorexia

The success of the treatment of anorexia lies in an integrated approach and the patient's desire to recover. To return a person to his usual way of life, it is necessary not only to restore the work of all organs and systems of the body, but also to normalize and adapt his mental state.

Therefore, to the question of which doctor treats anorexia, it is absolutely possible to answer that consultation of many highly specialized specialists, including psychologists and psychiatrists, will be required. Consider individual methods of treating pathology.

Drug therapy

Before curing anorexia with drug therapy, it is necessary to consult a therapist. As a rule, doctors are faced with the task of restoring the work of the digestive system, normalizing metabolic processes in the body and the work of the heart, smoothly increasing body weight, preventing the development of dystrophy.

At the initial stage, the patient must comply with bed rest. Most often, treatment is carried out in a hospital setting, but sometimes, when the risk to life is not confirmed, the patient can be transferred to home maintenance. How to treat anorexia at home, the doctor will also tell you.

At first, the patient requires constant supervision. To restore appetite and help in the digestion of food, insulin-containing drugs are administered to the patient. The doctor may also prescribe a glucose solution to recuperate.

To normalize eating behavior, Frenolone is prescribed. Berpamine and Polyamine will help restore water-salt balance and metabolic processes. For complex treatment and relief of the condition, the doctor may prescribe antidepressants: Zoloft, Eglonin, Coaxin.

You have learned how to treat anorexia with medication. Consider the importance of psychological intervention in the healing process.

Psychological treatment

Psychological treatment of anorexia consists in adjusting the perception of one's own body, in accepting oneself as a person and social adaptation after the therapy. The moment of accepting the problem and the desire to get rid of it is also important.

The psychologist preliminarily conducts a test for anorexia, thereby determining the main cause of the formation of the disease. Family members play an important role in recovery and can both help and hinder therapy.

Thanks to the competent work of psychologists, behavioral habits are corrected, the formation of a normal reaction to one's own body and weight in particular. Classes with a specialist are conducted both individually and in a group of patients with similar problems.

Psychiatric treatment

In the case of the formation of anorexia against the background of severe mental illness, the intervention of a psychiatrist will be required. For example, it is indispensable for schizophrenia, depressive and obsessive-compulsive disorders.

For the treatment of anorexia, the methods of group, family and individual psychotherapy are used. If necessary, the doctor intensifies drug treatment, adding tranquilizers and antipsychotics to the list. Hypnosis is sometimes used.

Diet for anorexia

Nutrition is an important part of anorexia rehabilitation

For a faster recovery from anorexia, it is necessary to maintain a special diet. It must be carefully calculated and balanced in order to help the body recuperate as quickly as possible without putting undue stress on weakened organs.

To determine the appropriate menu, it is necessary to conduct a bioimpedance measurement. This study will assess the deviation from the norm in body weight, muscle tissue and the degree of dehydration. Based on the data obtained, the nutritionist compiles a suitable menu.

Food is introduced into the patient's diet in fractionally small portions. As a rule, the patient should eat at least 5 times during the day. At the same time, it is equally important to drink a sufficient amount of clean water - at least 1.5-2 liters per day.

Features of the treatment of childhood and adolescent anorexia

Most often, adolescents with a fragile psyche are at risk of developing anorexia. A child's inability to calmly respond to stress, problems and criticism leads to rejection of himself and, as a result, to an attempt to change his appearance, in particular weight.

Parents and close relatives play an important role in the formation of anorexia and recovery from the disease. If a child grows up in an atmosphere of constant criticism and misunderstanding, then in the form of a subconscious protest, he may start trying to change his appearance to change his attitude towards him.

Attention to changes in the behavior of a child on the part of adults can eliminate the very cause of the formation of pathology. In this vein, it is especially important for adolescents to maintain a trusting relationship with their parents.

The adolescent child needs support and understanding, even if he denies it. Therefore, parents should be extremely careful about children who are somehow trying to artificially influence their own appearance. The sooner you pay attention, the less chances that the disease will develop into a serious pathology that will require specialized treatment.

Is it possible to fully recover from anorexia?

Doctors are divided on the possibility of full recovery from anorexia. Some believe that with effective psychotherapeutic treatment, complete healing of the disease is possible.

Others argue that this pathology is a cyclically arranged disease in which the stages of remission are replaced by relapses. In this case, a person can lead a normal life for several years, but eventually he will return to a sick state.

Prevention methods

In order to prevent anorexia, attention should be paid to the nutrition of the child from an early age. Never force-feed or overfeed children. This can lead to weight gain and, as a result, dissatisfaction with your own body and a whole bunch of psychological disorders. The diet should be balanced and contain fruits and vegetables.

The formation of anorexia is greatly influenced by the atmosphere in the family in which the child grows up. If at home he finds constant support, care and words of love, then he will feel much more confident.

If your child is gaining excess weight, try to be as careful and tactful as possible about it and offer your help. Do not leave children alone with this problem, otherwise it will develop into anorexia.

For the purpose of prevention, medical examinations should be carried out annually by a therapist (pediatrician), endocrinologist and gastroenterologist. Most educational institutions employ psychologists. It will not be superfluous to contact them for advice on assessing the behavior of your child and timely warning of any deviations.

If the first symptoms of the disease are detected, do not postpone a visit to a specialist. The sooner you see a doctor, the more chances you have to do only with psychological support without medication.

For more information on anorexia, see the video:

What to remember

1. Most often, adolescents with a fragile psyche and women under the age of 25 who are unhappy with their appearance are at risk of developing anorexia.
2. Symptoms of anorexia in women are most clearly manifested in menstrual irregularities up to the complete cessation of menstruation. Disorders of the digestive system appear: bloating, pain syndrome, intestinal obstruction, weight loss and weakening of the body.
3. The success of the treatment of anorexia lies in an integrated approach and the patient's desire to recover. For therapy, drug treatment, psychological and psychiatric treatment are used.

Anorexia nervosa has become the real scourge of our time. In pursuit of harmony, girls, young women, and in some cases, young men, refuse to eat, thereby causing a dangerous illness, accompanied by mental disorders.

Mental illness is mainly observed in persons of puberty. Experts blame the media for this, causing young people, more often girls, to want to lose extra pounds. After looking through bright magazines and shots of skinny models, they go on a strict diet in which healthy types of foods are completely absent. Often, an obsessive desire to lose "extra" pounds arises after an unsuccessfully thrown joke regarding weight, or jokes from peers or a company. Experts note that adolescents fall into addiction, who are reproached for their excessive enthusiasm for high-calorie food, even members of his family. Then the problem develops into psychological dependence. With their already impeccable weight, girls completely refuse to eat. The disease is accompanied by a serious mental disorder, bouts of bulimia occur, and as a result, a lethal outcome is possible. In most cases, adults do not pay attention to the behavior of their children, which is why pathological processes in the body develop.

Sometimes anorexia is the result of a nervous disorder

From the moment of the onset of sexual development, children begin to take an interest in their appearance, because everyone wants to have a beautiful figure, skin, hair, etc. The still unformed psyche of adolescents leads to the fact that the struggle for beauty turns into a real mania. This is when parents begin to understand what anorexia nervosa is. Before starting treatment, you need to understand the factors that provoke mental illness.

This ailment does not develop suddenly. The patient forms a time bomb in his own body for many months. Patients experience a rapid weight loss, and dangerous symptoms appear. The main problem is that the sick person continues to consider himself complete. Appetite is not lost, but he is afraid to eat even a small piece of food for fear of getting extra calories.

To acquire the syndrome, biological and social factors are required.

1. Heredity... The psyche of the child is genetically akin to the psyche of the parents. Most often, the desire to lose weight is observed in girls whose self-critical mothers are also overly worried about their appearance.
2. Social factor... The social circle in which thinness is "put" in the cult also causes the desire to get rid of "extra" pounds.
3. Reasons also include mental disorders, depression, powerful stress... Anorexia nervosa can begin with refusal to eat due to lack of mood, abusive words thrown in the direction of a plump person.

In the past two decades, the official number of patients has grown exponentially. Basically, residents of cities and megalopolises of economically developed countries suffer from the problem. In the international classification of diseases, the syndrome of anorexia nervosa belongs to the ICD 10. This reflects the direct connection of the disease with mental disorders that are dealt with in the field of psychiatry.

Important: Anorexia nervosa and anorexia nervosa exist. The latter is caused by weight problems associated with poor health. Diseases such as diabetes, gastrointestinal upset, problems with the kidneys, liver and other organs, oncological pathologies, autoimmune processes directly affect a person's appetite, which causes weight loss.

Anorexia nervosa: symptoms and treatment

Before proceeding with adequate therapy, it is necessary to carry out an accurate diagnosis. An experienced specialist collects anamnesis based on the clinical manifestations of the disease. The main point is the patient's denial of his deplorable situation. Most often, he does not go to the doctor on his own, but at the insistence of his relatives, who have noticed dangerous signs of serious diseases in a loved one caused by a sharp decrease in body weight.

Symptoms of anorexia nervosa

• loss of more than 15-20% of weight;
• lack of body fat;
• the patient's fear of being overweight;
• denial of a dangerous condition;
• failure or absence of menstruation - amenorrhea.

Often, signs of anorexia can be the result of pathologies such as enteritis, brain tumor, psychopathic disorders, etc. For this reason, before undertaking adequate treatment, a specialist conducts differential diagnostics in order to exclude other causes of excessive thinness.

Signs of anorexia can be a consequence of pathologies such as enteritis, brain tumor, psychopathic disorders

Important: Weight loss and other symptoms similar to anorexia may be associated with amphetamines.

The doctor only then makes a diagnosis if there is a pronounced lack of weight - the main syndrome of the disease. The patient deliberately refuses to eat, induces vomiting to clear the contents of the stomach, takes diuretics, laxatives. Weight deficiency does not appear immediately, therefore there are already a number of pathologies caused by the behavior of losing weight. Initially, the patient mistakenly visits a therapist, gastroenterologist, endocrinologist, so it takes more than one year before the appropriate specialist begins to deal with the problem. It is based on the DSM-3 criteria adopted by the Association of Psychiatrists, which include:

• fear of getting fat does not go away even with significant weight loss;
• problems with the perception of one's own body - despite exhaustion, a person feels fat;
• unwillingness to maintain weight, normal for height, age;
• amenorrhea.

There are 2 types of patients. The 1st includes persons who have limited food intake. The 2nd type includes patients who not only limit the amount of food, but also artificially - through vomiting, taking laxatives, diuretics, cleanse the stomach of food.

People with an aggravated problem have the following signs of anorexia nervosa:

• Overeating attacks. In 1-2 hours, a large amount of food is eaten, enriched with calories, fats, sugars.
• The patient does not notice how he is absorbing a huge amount of food.
• Eating is inhibited only when there are abdominal pains, a strong desire to sleep, artificial vomiting is undertaken, forced to switch to other things.
• Body weight often changes, with overeating, an increase in weight occurs, refusal of food - sharply decreases.
• Binge eating attacks are repeated at least 2 times a week and last from 3 months or more.

Anorexia nervosa is the patient's understanding that wanting to eat is an abnormal desire, as well as the development of fear of the impossibility of voluntarily refusing food. Also, doctors give their own, scientific formulation of the condition - it is a disease, the main symptom of which is refusal to eat due to a malfunction in the neuroendocrine structure.

Sometimes people with anorexia artificially limit food intake

How does the disease develop?

The disease, as we already know, is more common among adolescents, mainly among girls. Body weight with anorexia is rapidly falling and can be 40-50% below the norm. To constantly lose weight, the patient is constantly engaged in physical exercises, takes diuretics, laxatives, emetics, very often induce vomiting in an artificial way. As a result, there is a complete depletion of the body, a person freezes, chills, growth stops, pressure drops, there is a lack of coordination, disorientation.

Physiological changes

1. CNS, brain... A person loses memory, concentration of attention, academic performance decreases, work, fatigue, aggression, anxiety arise.
2. Hairline... Due to the lack of trace elements, vitamins, minerals, impaired blood circulation, the hair loses its shine, grows dull, thinns, and can completely fall out.
3. Cardiac system... The pressure decreases, there is a weakness of rhythms, arrhythmia, insufficiency.
4. Blood... There is an excess of leukocytes, anemia.
5. Muscle and bone structure... Muscle tissues atrophy, become excessively soft and torn, calcium is washed out, which causes fragility of bones - osteoporosis, joints become inflamed and swollen.
6. Renal system... Urolithiasis develops, insufficiency, inflammation occurs, which leads to a stop of the kidneys.
7. Gastrointestinal tract... The patient suffers from flatulence, bloating, constipation, peristalsis is disturbed, which causes hemorrhoids, during defecation, cracks in the rectum appear, from which blood flows. In the stomach, gastritis, peptic ulcer disease develops due to thinning of the mucous membrane and metabolic disorders.
8. Hormonal system... In women, menstrual cycles stop, which causes a lack of sexual desire, infertility develops.

And finally, anorexia is something that clearly affects the condition of the skin - it becomes pale, "transparent", the whole body is covered with wrinkles, dryness, flaking. Nails exfoliate, bend, grow poorly.

Gastrointestinal problems begin due to anorexia nervosa

Treatment for anorexia nervosa

Most mental illness is treated on an outpatient basis. Hospitalization is required only with very advanced stages of the disease and the patient's refusal to voluntarily take drugs and carry out procedures.

Anorexia nervosa: treatment

• An experienced specialist in therapy uses medicines designed to restore the lack of vitamins, minerals and trace elements. Zinc and iron deficiency is corrected.
• Taking antidepressant names to help the patient free themselves from heavy, obsessive thoughts.
• Nutrition. High-calorie foods and dishes are introduced into the patient's diet; if the patient refuses food, intravenous administration is used.

Almost everyone who has encountered this ailment understands that this is anorexia nervosa. People usually go to a doctor at an advanced stage. At first, adults are trying to deal with a losing weight "personality", and this is a big mistake. Influencing a serious mental disorder is possible only in a professional way and experienced doctors are engaged in this. Complex treatment: taking medicines, fortifying, visiting a psychiatrist, psychologist. With a serious stage of the disease - cachexia, hospitalization is required in a neuropsychiatric clinic.

Rehabilitation program

It is quite difficult to get a patient out of a state with a serious mental disorder. The disease is often accompanied by relapses, and with self-treatment can be fatal. For this reason, the complex of rehabilitation measures includes not only drug treatment and high-calorie nutrition, but also psychological effects. It is necessary to change the stereotypical idea of ​​a person about his appearance, his behavior in a difficult situation. An exclusively individual approach is taken for each of the patients.

Important: Family members should support the anorexic person, not blame him for past mistakes, and instill confidence in the effectiveness of treatment.

You should not expect quick results; weight should be restored gradually with the weakening of dangerous symptoms.

How to prevent illness

Most doctors are convinced that weight problems in a child do not arise in families with a healthy and active lifestyle, there is harmony in relationships, trust between adults and children. Have conversations about positive things, talk about anorexia nervosa, what it is, what consequences threaten anyone who seeks to lose weight by completely avoiding food. So that an unsuccessful joke about weight, an offensive expression from the outside, does not become the starting point for the adolescent's self-flagellation of his own body, it is necessary to instill in them self-confidence, the products must be exclusively natural and healthy.

Often anorexia begins due to excessive concern for their own weight

If there are fears that your beloved child is dissatisfied with his body, include a video with the participation of girls who have brought themselves to a deplorable state with super diets. Believe me, the sight is not pleasant. Fallen teeth, decrepit skin, protruding bones, the scary face of those who have emaciated of their own free will cause disgust in a teenager, which will be an excellent "inoculation" against dangerous hobbies.

Before we move on to considering the features of anorexia, let us dwell on what is the specified state to which it can lead, that is, on protein-energy malnutrition (abbreviated as PEM).

PEM is defined as a nutritional state caused by an energy imbalance as well as an imbalance in proteins and other types of nutrients, which in turn produces undesirable effects affecting function and tissues, as well as similar clinical outcomes. In the case of anorexia, PEM occurs against the background of inadequate food intake (although along with it can be distinguished such conditions of the body as fever, drug treatment, dysphagia, diarrhea, chemotherapy, heart failure, radiation therapy and other effects on it, leading to PEM) ...

The symptoms of protein-energy malnutrition appear in a number of ways. Meanwhile, it is against its background that weight loss in adults occurs (not too noticeable with obesity or general edema), and in children there are no changes in terms of weight gain and height.

Let us dwell on a generalized consideration of the symptoms of the disease of interest to us initially. Actually, with anorexia (i.e., in the absence of appetite), patients lose weight, and this disease itself can be a companion of another type of disease (oncological, somatic, mental, neurotic diseases). Lack of appetite is persistent, accompanied by nausea, in some cases vomiting occurs as a result of attempts to eat. In addition, there is an increased satiety, in which a feeling of fullness in the stomach even with a small amount eaten.

The listed symptoms can act as the only manifestations of anorexia, and be either the leading manifestations of the patient's general condition, or be accompanied by many other complaints. Diagnosis in this case directly depends on what symptoms of anorexia accompany.

Anorexia can occur in a number of conditions, let's highlight some of them:

• malignant neoplasms with a different nature of manifestation and their own different localization features;
• endocrine system diseases (hypopituitarism, thyrotoxicosis, diabetes mellitus, Addison's disease, etc.);
• alcoholism, drug addiction;
• helminthiasis;
• depression;
• intoxication.

Remarkably, the very definition of "anorexia" is used not only in the designation of the symptom that it presents (decreased appetite), but also in the definition of the disease, which in particular is "anorexia nervosa".

Anorexia determines a fairly high mortality rate for patients. In particular, on the basis of some data, it is possible to determine its rate of 20% for all patients with anorexia. Remarkably, in about half of the indicated percentage of cases, mortality is determined by suicide of patients. If we consider natural mortality against the background of this disease, then it occurs due to heart failure, which, in turn, develops due to general exhaustion achieved by the sick person's body.

In about 15% of cases, women, being carried away by weight loss and diets, reach a state in which they develop an obsessive state in combination with anorexia. In most cases, anorexia is diagnosed in adolescents as well as young girls. Similar to the victims of drug addiction and alcoholism, anorexic people do not recognize the fact that they have any kind of impairment, nor do they perceive the severity of the disease itself.

Anorexia can manifest itself in the following varieties:

• Primary anorexia ... In this case, the states of lack of appetite in children are considered due to various reasons, as well as the loss of hunger against the background of hormonal dysfunction, malignant tumor or neurological pathology.
• Mental anorexia (or cachexia nervosa, anorexia nervosa). In this case, mental anorexia is considered as states with refusal to eat or with a loss of hunger due to suppression of appetite against the background of psychiatric diseases (catatonic and depressive states, the presence of delusional ideas about possible poisoning, etc.).
• Mental painful anorexia ... In this case, patients with anorexia have a painful feeling of weakening and loss of the ability to become aware of hunger while awake. The peculiarity of this type of state lies in the fact that in some cases they are faced with almost "wolf" hunger in a dream.
• Medicinal anorexia ... In this case, conditions are considered in which patients lose their feeling of hunger, provoking this loss either unconsciously (when treating a particular type of disease) or deliberately. In the latter case, efforts are aimed at achieving the goal in the form of weight loss through the use of appropriate drugs, in which there is a loss of hunger. In addition, in this case, anorexia acts as a side effect when using certain stimulants, antidepressants.
• Anorexia nervosa ... In this case, it means a weakening of the feeling of hunger or its complete loss, which arose as a result of a persistent desire to lose weight (often such a desire does not find an appropriate psychological justification) with an excessive restriction of patients themselves in relation to food intake. This type of anorexia can provoke a number of severe consequences, including metabolic disorders, cachexia, etc. It is noteworthy that the period of cachexia is characterized by the exclusion of patients' attention from their own frightening and repulsive appearance, in other cases the results achieved cause them a feeling of satisfaction ...

We considered the states of mental anorexia and painful mental anorexia in sufficient for a general description of these conditions (in particular, this concerns its painful form; mental anorexia, is characterized by a complex picture of the clinic, determined based on the concomitant psychiatric illness). Therefore, below we will consider the remaining forms of the disease (respectively, with the exception of the forms indicated).

Primary anorexia: symptoms in children, treatment

This type of anorexia is in fact a serious problem that exists in modern pediatrics, and this problem is caused by the fact that it occurs quite often, and it is not so easy to treat. Poor appetite in a child - such a complaint often accompanies a visit to the attending physician, and, you must admit, it does not lose its relevance. Signs (symptoms) of anorexia in a child can manifest themselves in different ways: some children cry when it is necessary to sit down at the table, thereby refusing this need, others start a real hysteria, spitting out food at the same time. In other cases, children can eat only one of the dishes from day to day, or even their food intake is accompanied by severe nausea with vomiting.

It should be noted that anorexia in children can be not only primary, but also secondary, in the latter case it is caused by concomitant diseases of the gastrointestinal tract and other systems and organs that are relevant for the little patient. Secondary childhood anorexia in its own symptoms is considered strictly individually, depending on the disease that accompanies it, we will focus on primary anorexia, which occurs against the background of disturbances in the eating regime in healthy children.

As those main factors, the impact of which leads to the development of the considered form of anorexia, the following are distinguished:

• Eating disorders. As our readers probably know, the development of the food reflex, as well as its consolidation, is ensured precisely by the regime in which, accordingly, certain feeding hours are observed.
• Allowing the child to consume easily digestible carbohydrates during the intervals between main feedings. These carbohydrates include sweets, soda, chocolate, sweet tea, etc. Because of this, in turn, there is a decrease in excitability from the food center.
• Food, monotonous in its own composition, the same type of menu in feeding. For example, feeding exclusively with dairy products or fatty foods, or carbohydrates, etc.
• The transfer of a disease by a child of one or another etiology.
• Large portions when feeding.
• Overfeeding the baby.
• A sudden change in the climatic zone.

Anorexia nervosa in children, as one of the forms of primary anorexia, occupies a special place, it is caused by force-feeding. For example, in many families, a child's refusal to eat is almost equated to a drama, which is why parents and family members go to various tricks in order to still feed him. Various methods are used, ranging from the distraction of the child (which implies, for example, distraction by music, fairy tales, toys, etc.), and ending with harsh measures, which, again, are designed to ensure the peace of the parents due to the fact that during their implementation, the child -so ate "right".

Any of the listed methods (of course, these are only two directly opposite options, various actions can be allowed to be used, leading to the same result under consideration) lead to a sharp decrease in the excitability of the food center, and also ensure the development of a negative form of reflex in the child. This reflex manifests itself not only in the form of a negative reaction to the need for feeding with the concomitant repulsion of the spoon and the occurrence of vomiting, but also in the form of a manifestation of a specific reaction, which, again, consists in the appearance of vomiting, but arising even with the mere sight of food.

In bringing the child out of the state of anorexia, it is necessary to focus on the following step-by-step actions (before that, it is important to determine what the mistake that led to this state is):

• Providing feeding in accordance with age, but with a decrease in portions by three times. In addition, products that stimulate appetite are additionally introduced (this measure is permissible if anorexia is eliminated in children from 1 year old): garlic, lightly salted vegetables, etc. Carbohydrates and fats (sweets, sweets, etc.) should be excluded from the child's diet.
• With the return of appetite, the volume of servings can be gradually increased, leaving the proteins in the norm and excluding half of the fat from the established norm in accordance with age.
• Further, a return to the original diet is ensured, fats in it should also be limited.

To the general recommendations regarding primary anorexia in children, we add the following. So, by the first half of the day, it is necessary to give children protein foods and fatty foods, including carbohydrate foods, including dairy products, in the diet of the second half of the day. Gradually, it will be possible to make the transition to the standard diet.

In case of physical or emotional fatigue, it is important to postpone food intake for the time following the rest of the child. No less important is such a moment as focusing on the meal, without any distractions. The introduction of new dishes into the standard diet is carried out in small portions, in particular, you should pay attention to the design and serving.

Beautiful dishes are important, in comparison with the size of the portion, the dishes should look larger - this will "deceive" the child with the fact that there is not much food. If the child refuses food, you should not force him, wait for the next feeding period. Do not force a child with anorexia to completely eat food, in this case there is a benefit in hungry pauses. In a situation where the child has vomited, in no case scold him, on the contrary, try to distract him, waiting for the next feeding. In it, if possible, try to offer the child a choice of several options for dishes, but the "golden mean" is no less important - you also do not need to reduce the meal to a restaurant meal.

To top it off, we note that parents mistakenly relate to hyperactive games with their interruption for meals. This kind of entertainment for the child should be planned for the period following the main meals.

Anorexia nervosa: symptoms

Anorexia nervosa, first of all, is widespread in adolescents (girls), who lose about 15-40% of the mass of the norm against its background, and, unfortunately, cases of anorexia nervosa in this category of patients are only increasing. The basis of the state under consideration is that the child is dissatisfied with his own appearance, which is complemented by an active, but, as a rule, hidden desire to lose weight. To get rid of excess, in their opinion, weight, adolescents sharply limit themselves in nutrition, provoke vomiting, use laxatives, and exercise intensively.

Hence the desire to take a standing position, and not a sitting position, which, in their opinion, provides a greater expenditure of energy. The perception of one's own body is distorted, there is a real horror associated with the possibility of obesity, anorexia patients see only low weight as an acceptable result for themselves.

As a result, children lose weight, and in many cases reaching critical indicators, many develop a negative food reflex. Moreover, this reflex in many reaches such a form that even after the adolescent's own conviction of the need to take food, attempts to do this lead to vomiting. All this becomes the cause of exhaustion, as well as poor tolerance to high / low temperatures, the appearance of chilliness, and blood pressure decreases. Changes occur in the menstrual cycle (menstruation disappears), the growth of the body stops. Patients become aggressive, it is difficult for them to be free to orient themselves in the surrounding space.

Anorexia nervosa develops in several stages.

• Initial (or primary) stage

Its duration is about 2-4 years. Dysmorphomania syndrome is a typical syndrome for this period. In general terms, this syndrome implies that a person has a painful belief, which is delusional or overvalued, regarding the presence of this or that imaginary (exaggerated or overestimated) defect. In the case we are considering with anorexia, such a defect is overweight, which, as is clear from the definition of the syndrome, may not be such at all. In some cases, such a belief in one's own excess weight is combined with a pathological idea regarding the presence of a different type of imperfections in appearance (the shape of the ears, cheeks, lips, nose, etc.).

The determining factor in the formation of the syndrome under consideration is that a sick person does not correspond to the "ideal" chosen for himself, which can be anyone, from a literary hero or actress to a person from his immediate environment. The patient strives for this ideal with all his nature, accordingly, imitating it in everything, and, above all, in external features. In this case, the importance of the opinion of others regarding the results achieved by the patient is lost, however, it is the critical remarks that are perceived by him from the environment (relatives, friends, teachers, etc.) extremely acutely due to increased vulnerability and sensitivity to achieve the goal.

• Anorectic stage

The beginning of this stage is accompanied by an active desire aimed at correcting the appearance, conditionally, the effectiveness of weight loss is reduced to a loss of 20-50% of the initial mass. Here, secondary somatoendocrine shifts are also noted, changes occur in the menstrual cycle (oligomenorrhea or amenorrhea, i.e., a decrease in menstruation in girls or its complete cessation).

The ways in which results in weight loss are achieved can be very different, patients, as a rule, hide them at first. Here, as already noted, many actions are performed while standing, in addition to this, patients can tighten the waist using cords or belts ("to slow down the absorption of food"). Due to excessive efforts in performing certain exercises (for example, "bend-unbend") in combination with increasing weight loss, the skin is often injured (the area of ​​the shoulder blades, sacrum, the area of ​​contraction of the waist, the area along the course of the spine).

Within the first days of food restrictions, patients may not have hunger, but often, on the contrary, it is extremely pronounced at the initial stages, which makes it difficult to refuse food and one has to look for other ways to achieve the goal (actually losing weight). These methods often include the use of laxatives (much less often - the use of enemas). This, in turn, becomes the cause of sphincter weakness, and the possibility of rectal prolapse (sometimes quite significant) is not excluded.

An equally common companion of anorexia nervosa in the pursuit of weight loss is artificially induced vomiting. Mostly this method is used deliberately, although an accidental arrival to such a decision is not excluded. So, in the latter case, the picture may look like this: the patient, unable to restrain himself, eats too much food at once, as a result, due to the overcrowding of the stomach, it becomes impossible to keep food in it. It is because of the vomiting that has arisen in patients that the idea of ​​the optimality of this method of getting rid of food before it is absorbed appears.

In the earlier stages of the disease, the emetic act with its characteristic vegetative manifestations causes a number of unpleasant sensations in patients, however, further, due to the frequent induction of vomiting, the procedure is greatly simplified. So, for this, patients can simply perform an expectorant movement (you can simply tilt the torso for this), pressing on the epigastric region. As a result, everything that was eaten is thrown away, while vegetative manifestations are absent.

Initially, they make a careful comparison of what was eaten with the amount of vomit, then the stomach is washed. Artificially induced vomiting is inextricably linked to bulimia. Bulimia means an overwhelming feeling of hunger, in which there is practically no satiety. In this case, patients can absorb a huge amount of food, and often it can be slightly edible. When eating a huge amount of food, patients experience euphoria, and vegetative reactions appear.

Then they provoke the onset of vomiting, after which they wash out the stomach, then comes "bliss", a feeling of indescribable lightness in the body. On top of this, patients feel confident that their body is completely freed from what has been eaten, as evidenced by the wash water of a light shade, without the taste characteristic of gastric juice.

And although significant weight loss is achieved, patients practically do not experience physical weakness, moreover, they are very active and mobile, their performance remains normal. The clinical manifestations of anorexia within the framework of this stage are often reduced to the following disorders: palpitations (tachycardia), asthma attacks, excessive sweating, dizziness. The listed symptoms occur after eating (after a few hours).

• Cachectic stage

In this period of the disease, somatoendocrine disorders become predominant. Following the onset of amenorrhea (a condition, as we have indicated, in which there is no menstruation), patients lose weight even more rapidly. Subcutaneous adipose tissue is completely absent within this stage, an increase in dystrophic changes affecting the skin and muscles occurs, against which myocardial dystrophy also develops. Conditions of hypotension, bradycardia, some loss of skin elasticity, a decrease in temperature and blood sugar levels are not excluded, in addition to this, signs of anemia are also noted. Nails become brittle, teeth are destroyed, hair falls out.

Due to long-term malnutrition and eating behavior, a number of patients are faced with an aggravation of the clinical picture of gastritis, enterocolitis. Physical activity maintained during the initial stages is subject to decrease. Instead, the prevailing conditions are asthenic syndrome, and with it - weakness (muscle weakness and a sharp decline in strength) and increased exhaustion.

Due to the complete loss of a critical condition, patients also continue to refuse food. Even with an extreme degree of exhaustion, they often continue to claim that they are overweight, and sometimes, on the contrary, they are satisfied with what results they have achieved. That is, in any case, a delusional attitude towards one's own appearance prevails, and the basis for this, apparently, is an actual violation of perception concerning one's body.

With a gradual increase in cachexia, patients often lie in bed, become inactive. Blood pressure is within extremely low levels, constipation occurs. Against the background of water-electrolyte disturbances, painful muscle cramps may occur, in some cases it comes to polyneuritis (multiple nerve damage). Lack of medical attention at this stage can be fatal. Often, the hospitalization necessary in severe cases of this condition occurs forcibly-violently, because the patients do not realize how serious their condition has become.

• Reduction stage

As part of the stage of withdrawal from the previous state, cachexia, asthenic symptoms, fixation on the emerging pathologies of the gastrointestinal tract, fear of recovering occupy the leading positions in the clinic of the patient's condition. An insignificant weight gain is accompanied by an actualization of dysmorphomania, an increase in the depressive state, a desire for a repeated scheme of "correction" of one's own appearance.

Improvement of the somatic state leads to the rapid disappearance of weakness with the appearance of extreme mobility, within which there is a desire to perform complex physical exercises. Here, patients can start taking laxatives in large doses, and after attempts to feed them, they make attempts at artificial vomiting. Accordingly, for the reasons listed, they need careful supervision in a hospital setting.

So, let's summarize what symptoms of anorexia occur in patients, dividing them into certain groups:

• Eating behavior
  • an obsessive desire to lose weight, regardless of the real state of affairs (even with the existing lack of weight);
  • the appearance of obsessions directly related to food (counting calories consumed, focusing on everything related to the possibility of losing weight, narrowing the range of interests);
  • obsessive fear of excess weight, obesity;
  • systematic refusal of food under any pretext;
  • equating the meal with a ritual, with the accompanying thorough chewing of food; meals consist of small pieces, served in small portions;
  • the presence of psychological discomfort associated with the completion of the meal; avoiding any events in which there is a likelihood of a feast.
• Behavioral reactions of a different type:
  • adherence to increased physical activity, the appearance of irritation as a result of the inability to achieve certain results in them during overload;
  • tendency to solitude, exclusion of communication;
  • fanatical and tough type of thinking without the possibility of compromises, aggressiveness in proving one's own rightness;
  • the choice of clothes in favor of baggy outfits, due to which you can hide the "excess weight".
• Physiological manifestations of anorexia:
  • frequent dizziness, weakness, tendency to fainting;
  • a significant lack of weight in comparison with the indicators of the age norm (from 30% or more);
  • the appearance of soft vellus hair on the body;
  • circulatory problems, against the background of which there is constant hunger;
  • decreased sexual activity, women are faced with menstrual disorders, reaching amenorrhea, anovulation.
• Mental state with anorexia:
  • lethargy, depression, decreased ability to concentrate, decreased performance, immersion in oneself, dissatisfaction with oneself in all directions (weight, appearance, weight loss results, etc.);
  • a feeling of the impossibility of control over one's own life, the futility of any efforts, the impossibility of conducting vigorous activity;
  • sleep disorders, psychological instability;
  • rejection of the existing problem of anorexia and, as a result, the need for treatment.

Medicinal anorexia: symptoms

As we noted in the general description of the disease, drug anorexia occurs either on an unconscious level, which occurs in the treatment of a particular disease when taking certain drugs, or deliberately, when such drugs are used for a specific purpose, aimed at getting rid of excess weight. Also, anorexia can occur as a side effect that occurs when taking stimulants, antidepressants.

At the moment, doctors are quite serious about the problem associated with side effects when taking medications of a specific action. Long-term therapy with the use of such drugs determines the possibility of cure from rather serious, and in some cases from fatal diseases, while returning to an active lifestyle. At the same time, the harm caused by this to the immune system becomes the cause of the development of another type of disease, whose result can be no less terrible. This, in particular, includes one of the results of taking drugs in significant quantities, drug anorexia of interest to us.

In light of such an effect achieved with the use of drugs, a definition for it called "drug disease" was introduced in domestic medical practice. It should be noted that this definition implies not only drug anorexia, but also other diseases that arise against the background of appropriate exposure, and these are endocrine diseases, allergies, Addison's disease, asthenia, drug addiction, etc. Almost any drug can lead to a drug disease, accordingly, this does not exclude the possibility of developing drug anorexia against such a background.

The symptoms of drug anorexia, in general, fall under the generalized picture of this disease. So, this includes nausea and lack of appetite, the presence of painful sensations in the epigastric region, general depletion of the body. Frequent urge to vomit also appears, fast satiety occurs when eating, this is accompanied by a feeling of fullness in the stomach. Patients with anorexia in this form deny the existing problem in every possible way, continuing to use drugs due to which weight loss occurs. In the latter case, the signs of drug anorexia become decisive for this disease, therefore it is important to pay attention to them in time, thereby preventing progression.

Anorexia in men: symptoms

Anorexia, although it is considered to a greater extent as a female disease due to the desire of the fair half to achieve "ideal" parameters, is not an exclusively female disease. Anorexia in men is a widespread and gaining momentum, moreover, male bulimia is also connected to this condition, and men face bulimia three times more often than women.

Male anorexia, the symptoms of which we will consider, all also at its core consists of the desire to achieve ideals in terms of their own constitution. Obsessing over it, men engage in intense physical exercise, deliberately refusing food and tracking calories. Remarkably, the age of males attaches this disease to a younger group. So, the first symptoms of anorexia, manifested in a decrease in muscle muscles, are increasingly common in schoolchildren.

Similar to the female perception of self, male anorexia combined with bulimia boils down to weight control and breakdowns due to an overcrowded stomach with the intention of getting rid of what has been eaten by artificial induction of vomiting. After this, a feeling of guilt appears, against the background of which, in turn, psychosomatic disorders develop.

The difference between male and female anorexia is that it generally develops in a later age range (despite the initially indicated tendency towards an increase in the incidence of this disease in schoolchildren). Moreover, anorexia, the symptoms of which are diagnosed in men, in many cases is inherently associated with the relevance of schizophrenic processes for them.

There are certain risk factors for this disease in men, we highlight them:

• the presence of the problem of overweight in childhood;
• engaging in exhausting sports (in this case, the risk of developing anorexia in runners is higher in comparison, for example, with weightlifters, football players);
• the presence of a hereditary predisposition to mental illness;
• cultural features (when fixing the environment on the external physical appearance, diets, etc.);
• the type of activity in which it is important to be "in shape" (artists, male models, etc.).

Until the onset of the disease, patients usually have problems in the form of small stature, underdevelopment of the vascular and muscular system, problems associated with the gastrointestinal tract, appetite disorders, and intolerance to certain types of food.

There is also a certain picture under which future anorexic patients fall, in addition to these problems. So, they are brought up mainly in "hothouse" conditions, parents protect them as much as possible from certain difficulties. In view of this dependence on parents, there is a constant shift on the shoulders of the environment of their own problems. As they grow older, such men are dominated by uncommunicativeness and isolation, emotional coldness (which determines the presence of schizoid traits). It is also possible to evaluate oneself as incompetent, helpless and unbearable individuals (which, in turn, determines their presence of personal asthenic traits). Symptoms of anorexia in women in terms of personality manifestations determine the predominance of hysterical traits in them.

What is noteworthy, some men with anorexia are initially convinced of their own excess weight, but in this case, such a belief is delusional, that is, we are talking about false judgments that cannot be corrected. Accordingly, such beliefs are appropriate for them even if there is a problem of underweight without it. When fixing on fictitious obesity, anorexic men stop responding to really existing, and often ugly, defects in their appearance.

As already indicated, weight loss is achieved through the same measures as in women, that is, through refusal to eat, induce vomiting and excessive physical exertion, due to which the result is determined in the form of pronounced exhaustion. It should be noted that artificially induced vomiting of a severity similar to female vomiting does not cause. As for the refusal of food, it is either motivated in a formal way, or in an absolutely ridiculous way (purification of the soul and body; food is an obstacle in activity and in life in general, etc.).

The development of anorexia in men determines for them the subsequent addition of a different type of schizophrenia signs. Signs of schizophrenia in this case are manifested in a violation of thinking, immersion in oneself, in a narrowing of the usual range of interests.

In addition, of course, anorexia in men can also manifest itself as an independent disease, which determines the generally recognized symptoms of this condition for it.

Anorexia during pregnancy

For women who have previously experienced anorexia and bulimia as a form of eating disorder, trying to get pregnant is comparable to serious difficulties. The basis for this statement is the fact that it is these patients who are twice as likely to resort to artificial insemination, which, accordingly, indicates the negative impact of eating disorders in the future on reproductive function.

Based on the results of one study, it is known that in 11,000 cases with a history of eating disorders, 39.5% of women take more than 6 months to conceive for a successful conception, while this problem occurs without eating disorders in only a quarter of women. ... 6.2% of patients with past eating disorders are patients of artificial insemination clinics, while 2.7% of the total indicated in this case did not have problems in the form of anorexia and bulimia in the past. What is noteworthy, most often pregnancy with anorexia is unplanned, respectively, not in all cases this disease is comparable to infertility.

In case of malnutrition during pregnancy, a miscarriage may occur, the possibility of developing gestational diabetes is not excluded - a disease that passes after childbirth, in contrast to other types of diabetes, which are chronic, characterized by an increased content of glucose in the blood.

During pregnancy, women gain about 10-13 kg, which is necessary to ensure the normal development of the child. In most cases, pregnant women consume about 2000 kcal per day, by the last trimester - about 2200 kcal. With the existing anorexia, it is quite difficult to come to terms with such facts.

In the case of a violation of the body mass index (BMI) during pregnancy, there is a risk of having a small baby, which is especially likely with concomitant smoking. Also against this background, there is a risk of premature birth.

Diagnosis

In general terms, the diagnosis of anorexia is based on comparing general symptoms within the following criteria:

• changes accompanying the condition that occurred before the age of 25 (deviations are possible, including based on gender);
• weight loss in the range of 25% or more of the indicator serving as a starting point for diagnosis;
• the absence of any organic disease that acts as the main cause of weight loss;
• perverted approach to food intake and body weight;
• absence / presence of a concomitant state of mental illness;
• the presence of at least two manifestations from the following list:
  • lanugo (the appearance of very thin body hair);
  • amenorrhea;
  • episodes of bulimia;
  • bradycardia (a condition in which the heart rate at rest is 60 beats per minute or less);
  • vomiting (possibly deliberately induced).

Treatment

Treatment of anorexia in some cases is possible without reaching the stage of development of severe complications, which only accompanies a speedy recovery, often at a spontaneous level. In the meantime, in most cases, patients do not recognize the disease, and accordingly, they do not seek help. Severe forms imply the need for complex therapy, this is inpatient treatment, and drug therapy, and psychotherapy (including for family members of the patient). In addition to this, a normal diet is subject to restoration, in which an increase in the caloric content of the food consumed by the patient is gradually achieved.

As part of the first stage of treatment, the somatic state is subject to improvement, in which the process of weight loss is suspended and the threat to life is eliminated, the patient is withdrawn from cachexia. As part of the next, second stage, they focus on treatment with the use of medications in combination with methods of psychotherapy, while simultaneously distracting the patient from the existing fixation on appearance and weight, in particular, on the development of self-confidence, acceptance of the surrounding reality and oneself. Anorexia, a video and photo of which is available in our article, also determines the possibility of achieving some effect in "reaching out" to the patient, in particular - to his perception of the situation and possible results with further progression of the disease.

Recurrence of anorexia is a frequent stage in this disease, due to which it is often necessary to carry out several courses of treatment. It is extremely rare that overweight or obesity becomes a side effect of therapy.

With anorexia, an integrated approach to diagnosis and treatment is required, therefore, it may be necessary to simultaneously consult a number of specialists: a psychologist (psychotherapist), a neurologist, an endocrinologist, an oncologist and a gastroenterologist.

Is a mental disorder that belongs to the group of eating disorders, characterized by rejection of the body image, refusal to eat, creating obstacles to its absorption and stimulating metabolism in order to reduce weight. The main symptoms are avoiding food intake, restricting portions, exhausting physical exercises, taking drugs that reduce appetite and speed up metabolism, weakness, apathy, irritability, physical ailments. Diagnosis includes clinical conversation, observation, and psychological testing. Treatment is carried out by methods of psychotherapy, diet therapy and drug correction.

ICD-10

F50.0 F50.1

General information

Translated from the ancient Greek word "anorexia" means "lack of urge to eat." Anorexia nervosa often accompanies schizophrenia, psychopathy, metabolic diseases, infections, and gastrointestinal diseases. May be a consequence of or preceding bulimia. The prevalence of anorexia is determined by economic, cultural, and individual-family factors. In European countries and in Russia, the epidemiological indicator among women from 15 to 45 years old reaches 0.5%. Worldwide rates range from 0.3 to 4.3%. The peak incidence is observed among girls 15-20 years old, this group of patients is up to 40% of the total number of patients. Anorexia is rare among men.

Causes of anorexia

The etiology of the disease is polymorphic. As a rule, the disease develops with a combination of several factors: biological, psychological, micro- and macrosocial. In the high-risk group are girls from socially prosperous families, characterized by a desire for excellence and having a normal or increased BMI. Possible causes of the disease are divided into several groups:

• Genetic. The likelihood of illness is determined by several genes that regulate neurochemical factors in eating behavior disorders. To date, the HTR2A gene, which encodes the serotonin receptor, and the BDNF gene, which affects the activity of the hypothalamus, have been studied. There is a genetic determinism of certain character traits that predispose to the disease.
• Biological. Eating behavior is more often disturbed in people with overweight, obesity and early onset of menarche. It is based on dysfunction of neurotransmitters (serotonin, dopamine, norepinephrine) and excessive production of leptin, a hormone that reduces appetite.
• Microsocial. An important role in the development of the disease is played by the attitude of parents and other relatives to nutrition, excess weight and thinness. Anorexia is more common in families where relatives have a confirmed diagnosis of the disease, where neglect of food, refusal to eat is demonstrated.
• Personal. The disorder is more susceptible to persons with obsessive-compulsive personality type. The desire for thinness, starvation, exhausting loads are supported by perfectionism, low self-esteem, insecurity, anxiety and suspiciousness.
• Cultural. In industrialized countries, thinness is proclaimed one of the main criteria for a woman's beauty. The ideals of a slim body are promoted at different levels, shaping the desire of young people to lose weight in any way.
• Stressful. The triggering factor for anorexia can be the death of a loved one, sexual or physical abuse. In adolescence and young age, the reason is uncertainty in the future, the inability to achieve the desired goals. The process of losing weight replaces areas of life in which the patient fails to realize himself.

Pathogenesis

The key mechanism for the development of anorexia is a painful distortion of the perception of one's own body, excessive concern with an imaginary or real defect - dysmorphophobia. Under the influence of etiological factors, obsessive, delusional thoughts about excess weight, their own unattractiveness, and ugliness are formed. Usually the image of the bodily "I" is distorted, in reality the patient's weight corresponds to the norm or slightly exceeds it. Under the influence of obsessive thoughts, emotions and behavior change. Actions and thoughts are aimed at losing weight, achieving thinness.

Severe restrictions on nutrition are introduced, the food instinct and the instinct for self-preservation are inhibited. The lack of nutrients activates physiological defense mechanisms, the metabolism slows down, the secretion of digestive enzymes, bile acids and insulin is reduced. The process of digesting food causes discomfort at first. In the later stages of anorexia, the absorption of food becomes impossible. A state of cachexia occurs with the risk of death.

Classification

During anorexia, several stages are distinguished. Not the first, the initial, the interests of the patient are gradually changing, the ideas about the beauty of the body, its attractiveness are distorted. This period lasts several years. Then comes the stage of active anorexia, characterized by a pronounced desire to lose weight and the formation of appropriate behavior. At the final, cachectic stage, the body is exhausted, the criticality of the patient's thinking is disturbed, the risk of death increases. Depending on the clinical signs, there are three types of the disease:

• Anorexia with monothematic dysmorphophobia. The classic version of the disease - the persistent idea of ​​losing weight is supported by appropriate behavior.
• Anorexia with periods of bulimia. Periods of fasting, severe restriction of food alternate with episodes of disinhibition, decreased focus, in which overeating develops.
• Anorexia with bulimia and vomitomania. Fasting is periodically replaced by gluttony and the subsequent provocation of vomiting.

Symptoms of anorexia

A mandatory symptom of the disease is a deliberate limitation of the amount of food consumed. It can manifest itself in different forms. In the early stages of the disease, patients lie to others about the feeling of satiety before it occurs, chew food for a long time to create the appearance of its long and abundant use. Later, they begin to avoid meeting with relatives and friends at the dinner table, find a reason not to attend family dinners and dinners, talk about an alleged illness (gastritis, stomach ulcer, allergies) that requires a strict diet. In the late stage of anorexia, a complete cessation of nutrition is possible.

To suppress appetite, patients resort to taking chemicals. Anorexic effects are possessed by psychostimulants, some antidepressants, tonic mixtures, coffee and tea. The result is addiction and addictive behavior. Another common symptom of anorexia is attempts to increase metabolism. Patients exercise a lot, actively visit saunas and baths, put on several layers of clothing to increase perspiration.

To reduce the absorption of food, patients artificially induce vomiting. They provoke vomiting immediately after eating, as soon as there is an opportunity to get into the toilet room. Often this behavior occurs in social situations when it is impossible to refuse to eat food with other people. At first, vomiting is induced mechanically, then it occurs on its own, involuntarily when it gets into a suitable environment (to the toilet, a secluded room). Sometimes patients take diuretics and laxatives to get rid of fluids and food as soon as possible. Diarrhea and urine output can gradually become as involuntary as vomiting.

A common manifestation of a behavioral disorder is food excess, or food binge. This is an uncontrolled bout of consuming large amounts of food in a short period of time. With food excess, patients cannot choose foods, enjoy the taste and regulate the amount of food eaten. The "binge" takes place alone. It is not always associated with hunger; it is used as a way to calm down, relieve stress, and relax. After binge eating, feelings of guilt and self-loathing, depression and suicidal thoughts develop.

Complications

Without psychotherapeutic and medical assistance, anorexia leads to a variety of somatic diseases. Most often, young people experience stunted growth and sexual development. Pathologies of the cardiovascular system are represented by severe arrhythmias, sudden cardiac arrest due to electrolyte deficiency in the myocardium. Patients' skin is dry, pale, pasty, and edematous due to lack of protein. Complications from the digestive system are chronic constipation and spastic abdominal pain. Endocrine complications include hypothyroidism (hypothyroidism), secondary amenorrhea in women, and infertility. Bones become fragile, fractures become more frequent, osteopenia and osteoporosis develop. Substance abuse and depression increase the risk of suicide (20% of all deaths).

Diagnostics

Anorexia is an independent nosological unit and has clear clinical signs that are easily recognized by psychiatrists and psychotherapists. Diagnosis is characterized by a high level of agreement between clinicians, is reliable, but can be complicated by dissimulation of patients - deliberate concealment, concealment of symptoms. Differential diagnosis involves the exclusion of chronic debilitating diseases and intestinal disorders, a sharp weight loss against the background of severe depression.

The diagnosis is established on the basis of the clinical picture, in some cases, psychodiagnostic questionnaires are used (Cognitive-behavioral patterns in anorexia nervosa). Anorexia is confirmed when there are five of the following:

1. Deficiency of body weight. Patients' weight is less than 15% less than normal. BMI is 17.5 points or below.
2. Patient initiative. Weight loss is caused by the active actions of the patient himself, and not by somatic diseases or external situational conditions (forced hunger). Avoidance, avoidance of food intake, open refusal to eat, provocation of vomiting, medication and excessive physical activity are revealed.
3. Obsession and body dysmorphophobia. With anorexia, there is always a patient's dissatisfaction with his body, an inadequate assessment of weight and appearance. The fear of obesity and the desire to lose weight are becoming overvalued ideas.
4. Endocrine dysfunction. Hormonal disorders affect the hypothalamus-pituitary-gonad axis. In women, they are manifested by amenorrhea, in men - by loss of libido, decreased potency.
5. Delayed puberty. At the onset of anorexia in puberty, secondary sexual characteristics are not formed or are formed with a delay. Growth stops, the mammary glands do not increase in girls, and the genitals remain juvenile in boys.

Treatment of anorexia

The intensity and duration of therapy depends on the severity of the pathology, its causes, the patient's age, his mental and physical condition. Treatment can be carried out on an outpatient basis or inpatiently, sometimes in an intensive care unit, aimed at restoring somatic health, forming an adequate opinion about one's own body, and normalizing the diet. Comprehensive patient care includes three components:

• Diet therapy. The nutritionist explains to the patient and his family about the importance of an adequate intake of nutrients, explains the needs of the body and the consequences of fasting. The therapeutic menu is made taking into account the patient's taste preferences. To restore normal nutrition and gain weight, the calorie content of the diet is increased gradually over several months. In severe cases, glucose solutions are first administered intravenously, then the patient begins to consume nutritional mixtures and only after that he switches to normal food.
• Psychotherapy. The most effective direction is cognitive-behavioral psychotherapy. At the initial stage, conversations are held, during which the features of the disease, its possible consequences, and the patient's choice are discussed. A positive perception of personality and body image is formed, anxiety decreases, and internal conflict is resolved. At the behavioral stage, techniques are developed and mastered to help restore a normal diet, learn to enjoy food, movement and communication.
• Medication correction. To accelerate puberty, growth and strengthening of the bones of the skeleton, sex hormone replacement therapy is prescribed. H1-blockers are used for weight gain. Antipsychotics eliminate obsessive-compulsive symptoms and motor excitement, promote weight gain. Antidepressants are indicated for depression, and SSRIs are used to reduce the risk of relapse in patients with nutritional status and weight gain.

Forecast and prevention

The outcome of anorexia is largely determined by the time of initiation of therapy. The earlier treatment is started, the more likely a favorable prognosis is. Recovery more often occurs with an integrated therapeutic approach, family support and elimination of the factors that provoke the disease. Prevention should be carried out at the level of the state, society and family. It is necessary to promote healthy lifestyles, sports, balanced nutrition and normal weight. In a family, it is important to maintain the tradition of sharing food associated with positive emotions, to teach children to cook balanced meals, and to form a positive attitude towards appearance.