Anorexia Nervosa.

Symptoms

A mandatory symptom of the disease is a conscious restriction of the amount of food consumed. It can appear in different forms. In the early stages of the disease, patients lie to others about feeling full before it sets in, chewing food for a long time to create the appearance of its long and plentiful consumption. Later, they begin to avoid meetings with relatives and friends at the dinner table, find a reason not to attend family dinners and dinners, talk about an allegedly existing disease ( gastritis , stomach ulcers , 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. Psychostimulants, some antidepressants, tonic mixtures, coffee and tea have an anorexigenic effect. As a result, dependence and addictive behavior are formed. 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 sweating.

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

A common manifestation of a behavioral disorder is food excess, or food binge. This is an uncontrollable bout of eating large amounts of food in a short period of time. With food excess, patients cannot choose products, enjoy the taste and regulate the amount of food eaten. "Drinking" occurs in loneliness. It is not always associated with a feeling of hunger, it is used as a way to calm down, relieve tension, and relax. After gluttony, feelings of guilt and self-hatred develop, depression and suicidal thoughts develop.

Causes

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

•    Genetic. The probability of disease is determined by several genes that regulate the neurochemical factors of eating disorders. To date, the HTR2A gene, encoding 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, overweight and thinness. Anorexia is more common in families where relatives have a confirmed diagnosis of the disease, which demonstrates the neglect of food, refusal to eat.

•    Personal. The disorder is more prone to persons with an 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 the beauty of a woman. The ideals of a slim body are promoted at different levels, shaping the desire of young people to lose weight in any way.

•    Stressful. Anorexia can be triggered by the death of a loved one, sexual or physical abuse. In adolescence and young age, the cause is uncertainty about the future, the impossibility of achieving the desired goals. The process of losing weight replaces areas of life in which the patient fails to realize himself.
 

Treatment

The intensity and duration of therapy depends on the severity of the pathology, its causes, the age of the patient, his mental and physical condition. Treatment can be carried out on an outpatient or inpatient basis, 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 tells the patient and his relatives about the importance of sufficient intake of nutrients, explains the needs of the body and the consequences of starvation. The treatment menu is compiled taking into account the taste preferences of the patient. To restore normal nutrition and weight gain, the caloric content of the diet is increased gradually over several months. In severe cases, intravenous glucose solutions are first administered, then the patient begins to consume nutrient mixtures, and only after that does he switch to regular 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 choice of the patient are discussed. A positive perception of personality and body image is formed, anxiety is reduced, 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.

•    Medical correction. To accelerate puberty, growth and strengthening of the bones of the skeleton, sex hormone replacement therapy is prescribed. H1-histamine blockers are used for weight gain. Antipsychotics eliminate obsessive-compulsive symptoms and motor arousal, promote weight gain. Antidepressants are indicated for depression, and SSRIs are used to reduce the risk of relapse in patients with refeeding and weight gain.

Tests Required for Diagnosis

Diagnosis is characterized by a high level of agreement between clinicians, is reliable, but can be complicated by dissimulation of patients - conscious 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 the following five signs are present:

1.    Deficiency in body weight. The weight of patients is less than normal by at least 15%. BMI is 17.5 or below.

2.    Patient initiative. Weight loss is caused by active actions of the patient himself, and not by somatic diseases or external situational conditions (forced hunger). Avoidance, avoidance of meals, open refusals of food, provocation of vomiting, medication and excessive exercise are revealed.

3.    Obsession and body dysmorphic disorder. 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 reduce weight become overvalued ideas.

4.    Endocrine dysfunction. Hormonal disorders affect the hypothalamic-pituitary-gonadal axis. In women, they are manifested by amenorrhea, in men - by loss of libido , a decrease in potency.

5.    Delayed puberty . At the onset of anorexia in puberty, secondary sexual characteristics are not formed or are formed late. Growth stops, the mammary glands do not increase in girls, the juvenile genitalia remain in boys.