Treatment of eating behavior. Treatment of eating disorders and the path to recovery. Frequent fluctuations in weight

Look out for warning signs. You must be honest with yourself if you find such symptoms. Remember, eating disorders can have life-threatening complications. Don't underestimate the seriousness of an eating disorder. Also, don't think you can handle it on your own without someone's help. Don't overestimate your strengths. Key warning signs to look out for include:

• You are underweight (less than 85% of the normal range for your age and height)
• You are in poor health. You notice that you often bruise, you are emaciated, you have a pale or sallow complexion, dull and dry hair.
• You feel dizzy, you feel cold more often than others (the result of poor circulation), you feel dry eyes, your tongue is swollen, your gums bleed, fluid is retained in the body.
• If you are a woman, your period is three months or more late.
• Bulimia is characterized by additional symptoms, such as scratches on one or more fingers, nausea, diarrhea, constipation, swollen joints, and so on.

Pay attention to changes in behavior. In addition to physical symptoms, eating disorders are also associated with emotional and behavioral changes. These include:

• If someone tells you that you are underweight, you will be skeptical about such a statement and will do everything possible to convince the person otherwise; you don't like talking about being underweight.
• You wear loose, baggy clothing to hide sudden or significant weight loss.
• You ask for forgiveness for not being able to be present at meals, or find ways to eat very little, hide food, or induce vomiting after meals.
• You are fixated on a diet. All conversations come down to the topic of dieting. You try your best to eat as little as possible.
• You are haunted by the fear of becoming fat; you are aggressively opposed to your figure and weight.
• You expose your body to exhausting and severe physical stress.
• You avoid socializing with other people and try not to go out.

An eating disorder (eating disorder) is a psychogenic behavioral syndrome associated with eating disorders.

a) the long-established binge-purge cycle is harder to change;

b) recovery is slower when the "overeating-purging" cycle replaces the patient with another, more "normal" activity - for example, socializing with friends, outdoor activities, etc .;

c) the change is fraught with additional difficulties when the patient suffers from severe depression or other emotional distress.

Atypical bulimia nervosa is also distinguished when one or more of the key signs for bulimia nervosa are absent, but otherwise the clinical picture is typical. Most often this applies to people who are normal or even overweight, but with typical periods of overeating, accompanied by vomiting or taking laxatives.

Binge eating, resulting in excess weight, and a reaction to distress, may follow bereavement, accidents, surgery, and emotional distress, especially in persons predisposed to corpulence.

Founder and director of the Clinic for Eating Disorders, psychologist, expert on eating disorders, author of treatment methods for anorexia, bulimia, compulsive overeating.

Treatment for Eating Disorders and the Path to Recovery

How to Beat an Eating Disorder and Regain Your Confidence

Many patients treated for anorexia and bulimia are convinced that they will never be able to become happy, that they will constantly be forced to sit on strict diets in order to be slim and beautiful, that they will never get rid of suffering, pain, constant fatigue from racing for a thin and athletic figure. But it is not so. The main thing to remember is that nothing is impossible, and that everything is in your hands.The help of a qualified therapist, a specialist in eating disorders, support from loved ones and work on yourself can save you from depressive thoughts, destructive ways to lose weight, help you get rid of food addiction and regain self-confidence, happiness and pleasure in life.

How to get rid of an eating disorder, where to start?

First of all, you need to find the strength in yourself to recognize the existence of a problem. This can be tricky, especially if you are still convinced (somewhere deep in your soul) that losing weight through bulimia or anorexia is the key to success, happiness, and self-confidence. Even if you “intellectually” understand that this is not the case at all, it may be difficult for you to get rid of old habits.

The good news is that if you are serious about change and willing to ask for help, you will succeed. But at the same time, it is important to understand that for a full recovery it is not enough just to “forget” about unhealthy eating behavior. You will have to "get to know" the girl behind these bad habits, thoughts of losing weight and striving for the "perfect picture" again.

Ultimate recovery is possible only if you learn:

• Listen to your feelings.
• Feel your body.
• Accept yourself.
• Love yourself.

You may feel that you are unable to cope with this task. But remember - you are not alone. Qualified specialists are always ready to help you, you just have to take the first step!

Step one: Get help

It can be scary and terribly embarrassing for you to approach strangers about this issue, but if you really want to get rid of your addiction, you must overcome your fear. The main thing is to find someone who can really support you and listen without judgment and criticism against you. This could be a close friend or family member, or someone you trust. You may be much more comfortable discussing this problem with a therapist or psychologist.

How to confess to the interlocutor about your illness?

There are no clear rules on how to tell the interlocutor about your illness. But pay attention to the time and place - ideally, no one should rush and interrupt you.

How to start a conversation. Perhaps this is the most difficult. You can simply say, “I have something very important to confess to you. It is very difficult for me to talk about this, so I will be very grateful if you will let me talk and listen to me carefully.” After that, you can talk about how your disease arose, how it all began; about your experiences, feelings, new habits, and how your eating disorder has changed your life.

Be patient. Your girlfriend or family member will probably react very emotionally to your confession. They may be shocked, amazed, embarrassed, frustrated, and even annoyed. It is possible that they will not even know how to properly respond to your confession. Let them digest what they hear. Try to describe in as much detail as possible the characteristics of your particular eating disorder.

Explain how specifically your interlocutor can support you. For example, tell him that he can check in with you from time to time about how you feel, ask if you've seen a specialist for help, help you create a healthy eating plan, and so on.

There are many different treatment options available to patients today, but it is important to find the approach or course of treatment that works best for you.

• Find a Specialist in Eating Disorders
• The chosen specialist must have a higher education in the specialty "psychotherapy" or "medicine", as well as a higher education in the field of psychology and sufficient experience in the treatment of eating disorders
• You should not contact gastroenterologists, psychiatrists, neurologists, nutritionists at the first stage of treatment for an eating disorder. All these specialists should be contacted already at the stage of an eating disorder. Our Clinic employs all the necessary specialists for the successful completion of the recovery phase.

Step 2: Make a long-term treatment plan

Once you address your health concerns, your personal "treatment team" can create a long-term plan for treating your eating disorder. It may consist of:

Individual or group psychotherapy. Working with an eating disorder specialist is essential in order to “uncover” any underlying issues that have led to the eating disorder. A specialist will help you restore your self-esteem, as well as teach you how to properly respond to stress and emotional experiences. Each specialist has his own methods of treatment, so it is important to discuss with him in advance what results you expect from the course of treatment.

Family therapy. Family therapy can help you and your family members understand how an eating disorder affects your relationship and how problems in the family can trigger the disorder and prevent it from being cured. You will re-learn how to communicate with each other, respect and support each other...

inpatient treatment. In rare cases, you may need hospitalization and inpatient treatment. In most cases, hospital treatment is required for severe anorexia and severe bulimia. You will be under the supervision of specialists 24 hours a day, which will significantly increase your chances of recovery. As soon as the doctors make sure that your condition is stable, you can continue treatment at home.

Step 3: Learn "self-help" strategies

When entrusting the solution of a problem to specialists, do not forget that your personal contribution to treatment is no less important. The sooner you figure out what exactly led to the development of your eating disorder, and the faster you learn "healthy" ways to solve this problem, the faster you will get better.

How to build a healthy relationship with food

While food itself isn't a problem, building a healthy relationship with it is essential to your recovery. It can be very difficult for many patients to control their behavior when it comes to food - often they first severely limit their diet, and then abruptly break down and begin to uncontrollably absorb everything that comes to hand. Your task is to find the optimal balance.

Forget about rigid dietary rules. Severe food restrictions and constant control of everything you eat during the day can trigger the development of an eating disorder. That's why it's so important to replace them with healthy eating habits. For example, if you constantly limit yourself to sweets, try to soften this “rule” at least a little. You can occasionally allow yourself to eat ice cream or a cookie.

Stop dieting. The more you limit yourself to food, the more likely it is that you will constantly think about it and even become obsessed with it. So instead of focusing on what you "shouldn't" eat, focus on nutritious foods that will give you energy and vitality. Think of food as fuel for your body. Your body knows perfectly well when it needs to replenish its energy reserves. Listen to him. Eat only when you are really hungry, stop eating as soon as you feel full.

Stick to a regular meal schedule. Perhaps you are used to skipping certain meals or not eating anything for a long time. But remember that when you do not eat anything for a long time, all your thoughts become only about food. To avoid this, be sure to eat something every 3-4 hours. Plan your main meals and snacks in advance and don't skip them!

Learn to listen to your body. If you have an eating disorder, chances are you have learned to ignore the hunger and satiety signals your body sends. You may not even recognize them anymore. Your task is to learn how to respond to these natural signals again so that you can plan your meals according to your physiological needs.

Learn to accept and love yourself just the way you are.

When you base your self-worth solely on looks, you forget about your other qualities, accomplishments, and abilities that make you attractive. Think about your friends and family members. Do they love you for the way you look? Chances are, your looks are at the bottom of their list of things they like about you, and you probably rate them on roughly the same scale of values. So why is your appearance so important to you?

Paying too much attention to how you look, you "slide" into low self-esteem and lose confidence in your own abilities. But you can learn to perceive yourself in a positive, "harmonious" way:

Make a list of your positive qualities. Think of everything you like about yourself. Clever? Kind? Creative? Faithful? Cheerful? What do people around you consider your good qualities? List your talents, skills, and accomplishments. Also think about negative qualities that YOU DON'T HAVE.

Focus on what you like about your body. Instead of looking for flaws when you look in the mirror, appreciate what you like about your appearance. If “imperfections” distract you, remind yourself that no one is perfect. Even supermodels get retouched in their photos.

Stop thinking about yourself in a negative way. As soon as you notice that you start thinking negatively again, harshly criticizing yourself, judging, feeling guilty, stop. Ask yourself, do you have any real basis for such judgments? How can you refute them? Remember, your belief in something else is no guarantee of the truth.

Dress for yourself, not for others. You should be comfortable in the clothes you wear. Choose clothes that emphasize your personality and make you feel comfortable and confident.

Get rid of fashion magazines. Even knowing that all the photos in these magazines are completely photoshopped, they can still make you feel insecure and inferior. It is better to stay away from them until you are sure that they do not undermine your self-esteem.

Pamper your body. Instead of treating your body like an enemy, look at it as something valuable. Treat yourself to a massage, manicure, facial, candlelit bath, or scented lotion or perfume of your choice.

Lead an active lifestyle. Movement is essential for your mental and physical well-being. It is best if these are outdoor workouts.

Eating Disorder Prevention Tips

Treating eating disorders is a long process. It is very important to maintain the achieved results in order to avoid recurrence of the disease.

How to prevent the return of an eating disorder?

Gather a "support group" around you. Surround yourself with people who support you and want to see you healthy and happy. Avoid people who sap your energy, encourage erratic eating behavior, or make you feel bad. Refuse to communicate with girlfriends who always comment on your changes in weight. All these comments are not made out of good intentions, but out of envy.

Fill your life with something positive. Make time for things that bring you joy and satisfaction. Try something you've always wanted to do, learn something new, pick up a hobby. The more rewarding your life becomes, the less you will think about food and weight loss.

The enemy must be known by sight. Decide under what conditions the likelihood of a relapse is highest - during the holidays, during the exam session, or during the “swimsuit season”? Identify the most dangerous factors and develop an "action plan". For example, you may visit your eating disorder specialist more frequently during these times, or ask for additional moral support from your family and friends.

Avoid sites on the Internet that promote an unhealthy attitude towards your body. Avoid information resources that advertise and encourage anorexia and bulimia. Behind these sites are people who are trying to justify their unhealthy attitude to the body and nutrition. The "support" they offer is dangerous and will only hinder your recovery.

Be sure to follow your individual treatment plan. Don't skip visits to an eating disorder specialist or other parts of your treatment, even if you see improvement. Strictly follow all the recommendations developed by your "treatment team".

eating disorders or eating disorders - a group of mental disorders that are associated with eating. Eating disorders can be manifested by partial refusal of food, periods of gluttony alternating with periods of fasting, artificially induced vomiting after eating, as well as other eating habits that go beyond the norm. The most common eating disorders are anorexia and bulimia.

The causes of eating disorders are varied. This is a violation of the functioning of the nervous system, a failure of the processes occurring in the body, heredity, childhood psychological trauma and upbringing, the pressure of beauty standards imposed by society and emotional disorders. Some occupations increase the risk of developing eating disorders. So among models, dancers and TV hosts, the figure reaches 40-50%. All professions associated with publicity and requiring an impeccable appearance are considered risky in this regard.

Over the past 50 years, the number of people with eating disorders has increased tenfold. Such statistics are associated with an increase in the number of urban residents, an increase in stress levels, a cult for thinness and a toned figure. Among people suffering from eating disorders, the majority are women, but the percentage of men is growing rapidly. Over the past 10 years, their number has doubled, and now accounts for 15% of those suffering from eating disorders. The number of children with eating problems is also on the rise.

The consequences of eating disorders are not nearly as harmless as they might seem. Anorexia and bulimia rank first in terms of mortality among mental disorders of all types. Among their consequences: diabetes, heart and kidney failure. People with eating disorders are at high risk of suicide attempts.

How is appetite formed?

In order to understand the nature of eating disorders, it is necessary to understand how appetite is normally formed.

In the cerebral cortex, the hypothalamus and the spinal cord there are centers responsible for eating behavior. They analyze the signals coming from the digestive system and the whole body, and then analyze them. When it comes time to replenish nutrient stores, blood glucose levels drop. Sensitive cells in "hunger centers" pick up these signals and analyze them. In response, foci of excitation appear in the brain, which form appetite.

Appetite is a pleasant anticipation of eating food. It is he who is responsible for the actions of a person in obtaining and preparing it: buying food, cooking and eating. Appetite also activates the work of the digestive organs - saliva, gastric juice, pancreatic secretion, bile are produced. So the body prepares for the processing and assimilation of food.

There are two types of appetite

General Appetite- occurs when the sensitive cells of the hypothalamus feel a lack of all nutrients. At this moment, a person wants to eat any habitual food.

selective appetite- this is a state when there is a desire to eat a certain type of food - sweets, fruits, meat, fish. Selective appetite is formed in the cerebral cortex when sensitive cells detect a deficiency of certain substances.

After eating, a person feels full and satisfied with food. The receptors of the stomach send a signal of satiety to the centers of digestion, at this stage the person feels that he has eaten enough and stops eating.

What problems may arise

Lack of appetite- in the centers that are responsible for its appearance, there is no excitation. This is possible if there is a violation of the signal transmission from the digestive system to the brain, a violation of the interaction between nerve cells, with problems with the reuptake of serotonin, the predominance of inhibitory processes in the brain (for example, with depression)

Increased general appetite- associated with a persistent focus of excitation in the hypothalamus. Causes bouts of gluttony and a tendency to overeat.

Desire to eat only certain foods. This behavior is the responsibility of the cerebral cortex, more precisely, a group of neurons located in the centers of hunger. Eating selectivity, orthorexia, and perverted appetite are signs that these parts of the brain are not working properly.

Relationship between eating disorders and psychiatric factors

The occurrence of eating disorders is associated with a number of mental factors. Some personality traits are believed to contribute to these disorders:

• Low self-esteem;
• Dependence on the opinions of others;
• The need for approval;
• The desire to control what is happening, at least within your body;
• Striving for perfectionism and unattainable ideals of beauty.
• As a rule, the beginnings of eating disorders are laid in childhood, which is facilitated by:
• Lack of emotional support from parents;
• Domineering mother and father who paid little attention to the child;
• Excessive demands on the child, which he is unable to justify;
• Frequent reproaches, expression of dissatisfaction, criticism of appearance, manners;
• Problems with separation from parents in adolescence. Increased dependence of the child on the parents. So one of the popular theories explains the development of anorexia and bulimia by the desire to return to childhood;
• Overprotection and lack of freedom in adolescence.
• It can be argued that an eating disorder develops in a person who has certain mental characteristics, if life circumstances contribute to this.

Anorexia nervosa

Anorexia nervosa- an eating disorder, which is manifested by the refusal of food and an obsessive desire to lose weight. The goal of not eating is to lose weight or prevent obesity. It is common for patients to experience an unreasonable fear of being overweight, although, as a rule, they are thin or have a normal physique.

The vast majority of patients are young women and girls. Up to 5% of this population group suffers from various manifestations of anorexia. Anorexia nervosa in men is 10 times less common than in women.

Causes of Anorexia Nervosa

- from parents to children, the features of the functioning of the nervous system are transmitted, which cause a tendency to the appearance of anorexia nervosa (low self-esteem, infantilism, need for approval). The suit increases in people who have close relatives suffering from anorexia and bulimia.

Neurotransmitter metabolism disorders(serotonin and dopamine), which provide communication between nerve cells. At the same time, the interaction of cells in the brain centers responsible for eating behavior is disrupted.

Wrong upbringing. Anorexia nervosa develops if, in childhood, a person did not feel unconditional approval: “Whatever happens, you're done. There are mistakes, but they can be corrected. Criticism, high demands and lack of praise did not allow the child to form a healthy self-esteem. Fighting appetite and defeating yourself in the form of refusing food is a perverted way to increase self-esteem.

severe crisis of adolescence. Violation of contacts with parents and unwillingness to move into adulthood. The thinking pattern is approximately as follows: “I am thin and small, which means I am still a child.”

social standards. Thinness in modern society is associated with beauty, health and willpower. The stereotype that it is easier for thin people to succeed in their personal lives and careers pushes people to constant experiments with diets and weight loss drugs.

offensive remarks about being overweight from parents, peers, teachers. Sometimes memories of mental trauma can resurface years later and provoke the development of a disorder.

Some activities. Occupation in the modeling business, show business, dancing, athletics.

Stages of anorexia nervosa

There are three stages in the development of anorexia nervosa:

Pre-anorexic stage- an obsessive desire to lose weight quickly. Constant criticism of your body and appearance. The discrepancy between one's appearance and the "ideal image" that a person has drawn in the mind, which is caused by low self-esteem. A person constantly tries on himself various cardinal methods of losing weight: diets, drugs, procedures, enhanced sports. Duration 2-4 years.

anorexic stage- Refusal of food and weight loss. Losing weight is satisfying, but patients continue to consider themselves fat and refuse to eat. The patient constantly has a fear of getting better, the emotional background and vitality are reduced. The result is a weight loss of 20-50% of the original body weight. Violation of the menstrual cycle or complete cessation of menstruation.

stage of cachexia- severe depletion of the body. The patient's weight is less than 50% of the norm, while he continues to limit himself in food, fearing obesity. Dystrophy of the skin, skeletal muscles, and cardiac muscle begins. There are changes in all internal organs. Exhaustion is accompanied by increased fatigue, inactivity.

Some researchers distinguish the stage of elimination from cachexia. This is the stage of treatment, which is accompanied by anxiety associated with weight gain, unusual sensations associated with the digestion of food, which are perceived as painful. Patients continue to try to restrict themselves in food. Delusional thoughts may appear: "food spoils the skin."

Symptoms and manifestations of anorexia nervosa

Symptoms of the pre-orexic stage

Dissatisfaction with your appearance. The inconsistency of the invented ideal image with the reflection in the mirror. As a rule, this coincides with the beginning of sexual development, when a teenager critically perceives the changes taking place with his body.

Constant struggle with excess weight. Regular attempts to lose weight by exercising, dieting.

Causes of Bulimia Nervosa

To mental illness, inherited. High need for endorphins, impaired metabolism of neurotransmitters.

Metabolic disorders- increased resistance to insulin, impaired metabolism of fats and carbohydrates.

Excessive demands on the child in family that cause fear of not meeting expectations, disappointing parents.

Low self-esteem. It provokes an internal conflict between the ideal self-image - "what I should be" and the real position - "what I really am."

Loss of control over emotions. The development of bulimia is promoted by depressive moods, strong negative emotions.

Family conflicts- violation of interaction between family members (parents, partner).

Addiction to diets and fasting. It is noted that the stricter and longer the diet, the higher the risk of failure. With the systematic observance of diets, a behavior model is fixed - “starvation-breakdown-purification”.

Mental illness. Bulimia nervosa can be a symptom of epilepsy and schizophrenia.

Types of bulimia nervosa

primary bulimia- uncontrolled hunger, followed by bouts of binge eating and periods of cleansing.

secondary bulimia, which arose on the basis of anorexia. Bouts of gluttony after prolonged refusal to eat.

Types of bulimia according to the method of "cleansing"

The bouts of gluttony are followed by periods of "cleansing" - vomiting, taking laxatives, enemas;

Bouts of binge eating are followed by periods of strict diets and starvation.

Symptoms and manifestations of bulimia nervosa

As a rule, the onset of the disease occurs at the age of 13-14 due to dissatisfaction with one's figure. As in the case of drug addiction, patients are obsessed with thoughts of food and the fear of being overweight and at the same time deny the existence of a problem. Most of them believe that they can return to a normal diet as soon as they want.

Obsessive thoughts about food. A person wants to eat all the time. The feeling of hunger is exacerbated by diets and restrictions.

stealth. Bulimics tend to keep their habits private, unlike anorexics who like to talk about diets.

Haste when eating. Insufficient chewing, swallowing food in pieces.

Eating large amounts of food. Bulimic sufferers deliberately prepare a lot of food in order to get the most out of their meal. It can be sweet food, favorite dishes, or vice versa, inedible food.

Artificially induced vomiting. After a meal, bulimics often retire to the toilet to induce vomiting. They also use laxatives or enemas to cleanse the body of what they have eaten.

Dieting. To maintain their desired weight, people with bulimia nervosa follow a diet most of the time.

Physiological manifestations of bulimia

Weight fluctuations. A bulimic person may get better and then lose weight dramatically.

Frequent sore throats. Frequent vomiting leads to inflammation of the mucous membrane of the throat, causing pharyngitis and tonsillitis. When the vocal cords are irritated, the voice becomes hoarse.

Problems with teeth. The acid contained in the gastric juice destroys tooth enamel. This leads to cavities and tooth loss.

Diseases of the digestive system. There is a high probability of developing gastritis, peptic ulcer of the stomach and duodenum, pain in the right hypochondrium and along the intestines.

Increased salivation and enlargement of the salivary glands are characteristic signs of bulimia.

Decreased vitality. Restriction in food and an unhealthy lifestyle disrupt the metabolism. This is manifested by general weakness, increased fatigue during exercise.

Signs of dehydration. Flabbiness of the skin, dryness of the mucous membranes and eyes, rare urination are caused by large losses of water during vomiting and taking laxatives.

Diagnosis of bulimia nervosa

The diagnosis of "bulimia nervosa" is made in the presence of the following diagnostic criteria:

• Bouts of gluttony (consumption of large amounts of food in a short period of time), recurring at least 2 times a week for 3 months;
• Loss of control over food cravings during a bout of binge eating
• Compensatory behavior aimed at eliminating the consequences of overeating - inducing vomiting, starvation, significant physical exertion;
• Excessive fear of fullness, always present;

Treatment for bulimia nervosa

Psychotherapy for bulimia nervosa

Cognitive-behavioral psychotherapy. The psychologist teaches you to identify “eating disorder thoughts” and replace them with healthy attitudes. He gives the task to track the situation in which obsessive thoughts about food appear more often, what feelings they cause. In the future, it is recommended to avoid these situations, for example, to delegate the purchase of products to other family members.

Family Oriented Psychotherapy. The most effective option for patients of adolescence and youth. The task of loved ones is to help strengthen self-esteem and instill the right eating habits that will help keep weight normal without suffering from hunger.

Medical treatment for bulimia nervosa

Antidepressants third generation SSRIs increase the activity of serotonin and the transmission of impulses along the chain of nerve cells - Venlafaxine, Celexa, Fluoxetine.

Tricyclic antidepressants– Desipramine

Treatment of bulimia with antidepressants reduces the likelihood of binge eating by 50%, regardless of whether the patient has depression or not.

Prevention of bulimia nervosa

Preventive measures are the formation of an adequate self-esteem in a child, the correct attitude to food, the preparation of a diet that corresponds to energy costs.

Psychogenic overeating

Psychogenic overeating or binge eating- eating disorder, which is manifested by overeating, which occurs in response to stress and leads to obesity. In other words, this is overeating on a nervous basis. It can be a reaction to the death of a loved one, trouble at work, loneliness, illness, and other psychological trauma. Binge eating attacks can be rare or systematic and occur in response to any negative emotions.

This eating disorder is more common among adults, and especially people who tend to be overweight. According to statistics, 3-5% of the adult population suffers from it.

The consequences of psychogenic overeating are obesity, diabetes mellitus, atherosclerosis, diseases of the heart and joints.

Causes of psychogenic overeating

genetic predisposition. Individual genes have been identified that are responsible for overeating even in the absence of hunger, low sensitivity to satiety. The tendency to psychogenic overeating is transmitted from relatives with diabetes and obesity.

Inability to deal with negative emotions- fear, longing, sadness, guilt, anxiety. Eating foods, especially sweet foods, quickly raises blood glucose levels. "Sweet" blood, washing the brain, promotes the production of neurotransmitters serotonin and dopamine, which are also called hormones of pleasure. As a result of eating food, the mental state temporarily improves. However, it is followed by a feeling of guilt and dissatisfaction with his weak will and his own body.

Feelings of inferiority and their own inconsistency with other people's expectations. These feelings are based on low self-esteem.

Psychological trauma in childhood age. It has been established that people with psychogenic overeating in childhood suffered from rough treatment by parents, conflicts between adults, and were brought up in a family where there was a cult of food.

social standards. Modern standards of beauty imply the absence of excess weight. People suffering from their fullness experience guilt and displeasure with their bodies. Negative emotions push them to "seize" problems, which leads to further weight gain. Thus, a vicious circle is formed.

Types and forms of psychogenic overeating

External overeating- A person eats food when it is available to him. Buys too much food, overeats at a party, cannot stop while there is food on the table. The provoking factor is the sight and smell of food.

Emotional overeating– The cause of strong cravings for food is not hunger, but an increased level of the stress hormone – cortisol. A person overeats, experiencing negative emotions.

Symptoms and manifestations of psychogenic overeating

Uncontrollable bouts of binge eating which are caused by stress and negative emotions, and not by hunger. Boredom often becomes a provoking factor, so watching TV, reading is also accompanied by the absorption of food.

No power system. A person eats not according to the schedule, but at will. Sometimes an attack of overeating can last throughout the day. Night eating also occurs.

During an attack, a person consumes large amounts of food. He is unable to stop, despite the feeling of fullness in his stomach.

The process of eating is accompanied by pleasure, however, guilt and self-loathing soon follow. A person reproaches himself for the lack of self-control. Negative emotions about their appearance and weakness of character cause new bouts of overeating.

Attempts to hide the amount eaten. Eating in company with other people, a person can consume food in moderation. Left alone, the patient absorbs food in large quantities, as a rule, until everything is eaten.

Stockpiling food to eat alone. The patient tends to prepare for overeating by buying or preparing food in large quantities.

There are no attempts to cleanse the body of food. People do not induce vomiting, do not exhaust themselves with training. At the same time, they often try to stick to diets, but do not withstand restrictions.

Despair and depression about the inability to control the amount eaten.

Weight gain. Already a few weeks after the onset of the disorder, a significant weight gain is observed.

Diagnosis of psychogenic overeating

A psychogenic disorder is diagnosed when a person has 3 or more symptoms of the disease:

• Eating a large amount of food, despite the lack of hunger;
• Overeating episodes that last for a certain time (up to several hours), which end with an unpleasant feeling of fullness;
• Eating is much faster than most people do;
• Feelings of guilt that arise after bouts of overeating;
• Embarrassment about eating too much, which makes people prefer to eat alone.

Treatment of psychogenic overeating

Psychotherapy for neurogenic overeating

Informational psychotherapy. The psychologist explains that compulsive overeating is a complex biopsychiatric disorder. The reason for its development is not weak character and spoiled. He talks about the futility of trying to diet. Instead, a rational nutrition system will be offered. The psychologist will teach you to keep a food diary, it indicates what time and what was eaten. A psychologist helps to increase motivation, which allows a person to adhere to a healthy diet and exercise.

Cognitive Therapy. It aims to reduce dependence on food. The task of the psychologist is to teach the patient constructive ways to deal with stress, to increase stress resistance and self-control. The technique has proven itself well for psychogenic overeating. Therefore, it is recommended to use it from the beginning of treatment.

Psychoanalysis. During the sessions, the psychologist helps to identify the underlying problems that caused the eating disorder. One of the main stages of treatment is the acceptance of tormenting thoughts and pronouncing them.

Group psychotherapy. When treating compulsive overeating, interacting with people who have the same problem is helpful.

Drug treatment of neurogenic binge eating

Appetite suppressants are not effective for compulsive overeating. Preference is given to drugs acting on the central nervous system.

Antidepressants. This group of drugs normalizes the level of serotonin in the nervous system - Topamax.

Prevention of psychogenic overeating

Prevention of compulsive overeating is the formation of the right attitudes about nutrition - food is not a pleasure or a reward, but a necessity. It is also necessary to increase stress resistance and form healthy eating habits - eating in small portions by the hour.

psychogenic loss of appetite

psychogenic loss of appetite- lack of need for food due to nervous shocks. Refusal of food can be caused by stress, conflicts in the family and at work, the loss of a loved one. The consequence of loss of appetite on a nervous basis is the rapid exhaustion of the body, loss of physical strength, aggravation of the emotional state, and the development of depression.

With psychogenic loss of appetite, unlike anorexia, the goal of a person is not to fight excess weight. He does not consider himself fat and adequately perceives his body.

The prevalence among women is 2-3%. It is more common among those seeking to lose weight, because at a subconscious level they have a desire to refuse food.

Psychogenic disorders do not include loss of appetite due to infectious diseases and diseases of the digestive system.

Causes of psychogenic loss of appetite

Stress and strong emotional stress. Conflicts, situations that threaten life or well-being, preparing for exams or reports, losing a job, breaking up relationships.

Stress hormone imbalances. Decreased synthesis of digestive hormones (ghrelin and insulin), which are responsible for the appearance of appetite. Violation of the production of hormones of the hypothalamus and pituitary gland.

Violations of the functioning of the centers of hunger in the brain and spinal cord. Negative emotions and intense mental work can change how the brain works. Stress causes disturbances in the transmission of nerve impulses between centers of appetite.

Depression This is one of the most common causes of loss of appetite.

Types of psychogenic loss of appetite

Primary psychogenic loss of appetite- develops immediately after stress or during strong mental or mental stress. Causes the development of depression

Secondary psychogenic loss of appetite- develops against the background of depression and neurosis, which arose after a psychological trauma.

Symptoms and manifestations of psychogenic loss of appetite

Lack of appetite. The person does not feel the need for food. At the same time, he may feel discomfort in the stomach caused by hunger, but not respond to them.

A person deliberately forces himself to eat, despite the lack of appetite. This is a favorable variant of the course of the disorder.

Refusal of food. The offer to eat is rejected on principle - this is the second possible model of behavior in this situation. She speaks of severe psychological trauma.

Diagnosis of psychogenic loss of appetite

The diagnosis of "psychogenic loss of appetite" is made on the basis of complaints of the patient or his relatives, provided that the person does not have diseases of the digestive system and other causes of loss of appetite. The following are taken into account:

• Refusal of food
• Weight loss,
• Depressed mental state
• Signs of physical exhaustion.

Treatment of psychogenic loss of appetite

Psychotherapy for psychogenic loss of appetite

Cognitive behavioral therapy. At the initial stage of psychotherapy, it is necessary to minimize the consequences of psychological trauma, after which they begin to treat the eating disorder. The psychologist helps to form a positive attitude towards food intake.

Medical treatment psychogenic loss of appetite

Vitamin complexes with minerals to combat beriberi - Multitabs, Pikovit.

Appetite enhancers plant-based - tincture of wormwood, plantain juice.

Nootropics to improve the functioning of the nervous system - Bifren, Glycised.

Prevention of psychogenic loss of appetite

Prevention is to increase resilience to stress and develop a healthy self-image and relationship with food.

psychogenic vomiting

psychogenic vomiting or nervous vomiting - a reflex eruption of the contents of the stomach under the influence of stress. Sometimes psychogenic vomiting is not preceded by nausea. The contents of the stomach are ejected spontaneously as a result of spasm of the muscles of the abdominal wall and stomach.

Unlike bulimia, vomiting occurs unintentionally. A person does not set himself the goal of emptying the stomach in order to avoid digestion of food and gaining excess weight.

Isolated cases of psychogenic vomiting were in 10-15% of people. People with an excitable nervous system regularly face this problem. In most cases, these are children, adolescents and young women under 35 years of age. Men, among those suffering from this disorder, only 1/5.

Causes of psychogenic vomiting

Fear and anxiety. The most common reasons. In this case, vomiting occurs only before a significant and exciting event.

stress. Psychogenic vomiting is caused by acute stress, chronic stressful situations (loneliness, divorce of parents), prolonged nervous tension - a difficult period at work.

Excessive emotionality - a personality trait that increases the likelihood of nervous vomiting.

Hyperexcitability nervous system. Excitation processes predominate in the brain, which can affect the functioning of the vomiting centers located in the medulla oblongata, thalamus, and cortex. Excitation in this area causes morning psychogenic vomiting in children.

hereditary predisposition. The risk of developing the disorder is higher in people whose parents suffered from motion sickness and psychogenic vomiting.

Types of psychogenic vomiting

anxiety vomiting response to fear and anxiety.

Jet vomiting- appears on the basis of unpleasant associations at the sight of food: pasta - worms, homemade sausage - excrement.

hysterical vomiting– reaction to stresses and the negative emotions connected with them;

habitual vomiting- a manifestation of the fact that a person constantly suppresses his emotions.

Symptoms and manifestations of psychogenic vomiting

• Vomiting without nausea, especially on an empty stomach and not associated with poisoning by infections and diseases of the digestive system.
• Vomiting after stress or before frightening events.
• Vomiting at the sight of food that causes unpleasant associations.
• Vomiting against the background of negative emotions that a person cannot throw out.

Diagnosis of psychogenic vomiting

First you need to be examined by a gastroenterologist to rule out diseases of the digestive system. When diagnosing nervous vomiting, the doctor pays attention to the connection of seizures with the emotional and mental state of a person, with food intake, as well as their frequency and regularity.

Treatment of psychogenic vomiting

Psychotherapy

Cognitive and behavioral therapy. The techniques used by the psychologist will help increase stress resistance and make it easier to respond to problems and conflicts.

Suggestive therapy. Its goal is to improve the work of the central and autonomic nervous system. Elimination of foci of excitation in the vomiting centers.

Medical treatment

Electrolyte solutions to correct electrolyte disturbances. Necessary for dehydration caused by frequent bouts of vomiting - rehydron, human electrolyte.

Antipsychotics used to treat nervous nausea and vomiting - Haloperidol, Prochlorperazine.

Antidepressants used to reduce the excitability of the nervous system - Coaxil

Prevention of psychogenic vomiting

Allotriophagy

Allotriophagy has other names - a perversion of taste or a perversion of appetite. This is an eating disorder in which a person has a tendency to lick or swallow inedible or inedible objects - coal, chalk, coins.

Taste perversion is more common in low-income and dysfunctional families. Young children and pregnant women are more susceptible to it. Similar behavior occurs in mentally healthy people, as well as in autism and schizophrenia.

Appetite perversions are a common problem among children under 3 years of age, but the older the child becomes, the less often taste perversions appear.

Psychological trauma- separation from loved ones, pathological relationships with parents.

Boredom. This reason is typical for children. It has been established that allotriophagy occurs in children who lack toys and attention.

Hormonal changes in the body during pregnancy and adolescence.

Nutrient deficiency with malnutrition or malnutrition. For example, eating dirt can indicate a lack of iron or charcoal in the body, eating chalk - a calcium deficiency, soap - a lack of zinc.

Incorrectly formed ideas about edible and inedible. The reason may be the peculiarities of upbringing or cultural traditions.

Types of allotriophagy

Eating inedible objects- sand, stones, nails, paper clips, glue;

Eating inedible objects - coal, chalk, clay, animal food;

Eating raw foods - minced meat, raw dough.

Symptoms and manifestations of taste perversion

Licking and chewing. Associated with a keen desire to taste them.

Eating inedible substances. The goal is boredom, the desire for new impressions and sensations.

Swallowing inedible objects - caused by an inexplicable desire that a person is unable to resist.

Diagnosis of allotriophagy

The diagnosis of "allotriophagia" is made when eating inedible objects based on complaints from the patient or his relatives.

Treatment of allotriophagy

Psychotherapy

Behavioral Psychotherapy. Its main principles are to avoid situations in which there is a desire to taste inedible objects (do not play in the sandbox while eating sand). Noticing thoughts about eating and replacing them with others, and rewarding success for success is a method of positive reinforcement.

Family Therapy- building relationships in the family. Parents are advised to communicate more with the child. The tone should be calm and friendly. The method of isolation from stress is practiced. If possible, it is required to exclude all factors that overexcite the nervous system: do not scold the child, limit the time in front of the TV, tablet, phone. Engage your child in quiet games.

Prevention of allotriophagy

Prevention of allotriophagy includes: good nutrition, a variety of activities and hobbies, a friendly atmosphere in the family.

Nervous orthorexia

Nervous orthorexia- an obsessive desire to eat right. Orthorexia differs from the desire for a healthy lifestyle by obsession, it crowds out other interests and hobbies. The topic of healthy food dominates in conversations, a person actively agitates others to switch to his nutrition system.

Nervous orthorexia makes a person indifferent to the taste of food. Products are judged solely on their health benefits. At the same time, a person significantly limits the list of consumed products, which can lead to a lack of nutrients. For example, vegetarians are deficient in essential amino acids and B vitamins.

The consequences of orthorexia are: limited social circle and deficiency of vitamins and chemical elements. Restrictions in food can lead to anemia, beriberi, changes in the internal organs.

Causes of orthorexia nervosa

Tendency to hypochondria- fear of getting sick. Proper nutrition is an attempt to prevent disease.

Neurotic temperament. The development of orthorexia in mentally healthy people is facilitated by increased suggestibility, scrupulousness. In addition, an obsessive desire for healthy food can be a manifestation of obsessive-compulsive disorder.

Heightened self-esteem. Adhering to his nutrition system, a person feels his superiority over others.

Types of Nervous Orthorexia

The most common food systems that can become the basis of an eating disorder:

Veganism and vegetarianism- exclusion of products of animal origin.

raw food diet- refusal of food that has undergone thermal processing (frying, boiling, stewing).

Refusal of products containing GMOs. Genetically modified organisms are products with a modified genetic structure.

Symptoms and manifestations of orthorexia nervosa

An obsession with consuming only "healthy" foods. Moreover, the degree of usefulness is assessed subjectively. Often his interests, thoughts and conversations are limited to the topic of proper nutrition.

Restricted diet. A person refuses food that is not included in his list of "useful". In some cases, the menu includes only a few products.

Cooking can take the form of a ritual. Only the right products are used, the cutting board and knife must be ceramic, the dish must be marinated or cooked for a strictly defined period of time.

Social circle changes. A person communicates exclusively with like-minded people who adhere to the same principles of catering. There were cases when such people organized a commune to grow food and live separately.

Feelings of guilt arising from the consumption of "harmful" foods, although in fact, they do not pose a health hazard. If one’s “diet” is violated, a person experiences psychological discomfort and severe anxiety. On a nervous basis, after consuming unusual foods, nausea, vomiting, and abdominal pain may occur.

The fear of "harmful" foods can look like a phobia. In this case, they are disgusting. A person will not consume them for food, even if he is hungry, and there is no other food.

Diagnosis of orthorexia nervosa

To date, the diagnosis of "nervous orthorexia" is not included in the list of diseases.

Treatment of orthorexia nervosa

Psychotherapy is the main method of treatment. In most cases, the method of persuasion is used. The psychologist talks about the benefits of other products. When only certain foods are consumed, they, like medicine, can cause side effects: peptic ulcers from eating acidic fruits, phosphate kidney stones from dairy products.

Prevention of orthorexia nervosa

Formation in children and adults of rational ideas about proper nutrition.

Selective eating disorder

Selective eating disorder A type of eating disorder that is characterized by a refusal to consume certain foods. At the same time, a person is guided not by health benefits, but by subjective criteria: color, shape, associations. At the sight of these products, he experiences fear and disgust. A phobia can be caused by the smell of this food, and even talking about it.

This disorder differs from the usual pickiness in food by a large set of products that a person cannot tolerate. This significantly impoverishes the diet, causes weight loss and complicates communication with others. For example, a person is forced to refuse business lunches or family holidays, accompanied by a feast.

Selective eating disorder is a relatively rare disorder that children are more susceptible to.

Selective eating disorder can be a health hazard if a person's diet is excluded from most foods, and his diet is limited to only certain dishes.

Causes of Selective Eating Disorder

Psychological trauma associated with these products.

Diseases developed after the consumption of these products. Moreover, it is not necessary that the product caused poisoning or food intoxication, perhaps its consumption coincided with the onset of the disease.

Incorrect introduction of complementary foods. Often disgust and phobia are associated with those foods that parents forced the child to eat against his will.

Types of Selective Eating Disorder

• Refusal of vegetables and fruits
• Refusal of animal products
• Refusal of any solid food

Symptoms and manifestations of selective eating disorder

Fear arising from the thought, sight, or smell of certain foods or meals. It can be a variety of phobias: fear of hot or cold, round or colored foods, fear of sour, bitter, salty tastes.

Rationalization of fear. A person gives an explanation for his fears: “I'm afraid to choke, choke. I'm afraid the food will stick to my throat and I won't be able to breathe. I'm afraid to get poisoned."

Diagnosis of Selective Eating Disorder

An selective eating disorder is a disease only if one or more of the following conditions are met:

• Refusal of a large set of products;
• The disorder adversely affects a person's health by causing vitamin or protein deficiencies;
• Body weight decreases in adults, physical development in children and adolescents slows down;
• Dependence on certain foods develops;
• Fear and negative emotions associated with foods interfere with emotional well-being.

Treatment for Selective Eating Disorder

behavioral therapy. In the process of treatment, a person performs tasks that are aimed at getting used to the products. For example, he is offered to choose vegetables, then cook them, at the next sessions they move on to tasting new dishes. Gradually, addiction sets in and the fear goes away.

Prevention of selective eating disorder

Prevention is the gradual and non-violent accustoming of a child or adult to a variety of dishes. Expansion of its menu according to age.

Eating Disorders in Children

Eating disorders in infancy and childhood

Eating Disorders in Children early age are widespread. In varying degrees, they are observed in 25-40% of children from 6 months to 6 years. In most cases, these are temporary phenomena that disappear with age.

Causes of eating disorders in children

• Violation of mother-child contact when little attention is paid to the child.
• Incorrect type of feeding - feeding the child during sleep, long feedings lasting more than an hour.
• Food that does not correspond to the age of the child does not please him in terms of taste. Too early introduction of complementary foods and solid foods, early spoon-feeding.
• Too persistent introduction of new food causes internal protest and disgust for any products.
• Psychological conflicts in the family.
• Stress - animal attack, trauma, hospitalization.
• Attempts to manipulate adults, demanding children who are the center of attention of the family.
• Extreme fastidiousness about food.
• Curiosity. The child is interested in new tastes and new behaviors. In the event that his act caused an emotional reaction from an adult, then the child is likely to repeat this action.
• Among the causes of eating disorders, we do not consider mental retardation, diseases of the oral cavity or digestive organs, although these diseases can have the same manifestations as eating disorders.

Types of eating disorders in children

• Refusal of food. The child refuses to open his mouth, turns away when feeding, spits out food. This is the so-called childhood anorexia.
• Rumination disorder. Regurgitation of food followed by chewing. The child regurgitates a small amount of food and re-chews it. However, he does not feel nausea and the urge to vomit.
• Perversion of taste - eating inedible objects. It is very widespread, since up to 2 years a child may not distinguish between edible and inedible. Therefore, this behavior in younger children is not considered a disorder.

Diagnosis of eating disorders in children

The described violations are manifested daily for a month or more, despite the attempts of parents to change the situation.

Treatment of eating disorders in children

• The basis of treatment is psychotherapy. It includes:
• Creating a calm and friendly environment - spend more time with the child, take him to quiet games and walks, reduce TV viewing.
• Elimination of situations in which eating disorders manifest themselves - do not allow playing in the sandbox if the child eats sand.
• Adjust the diet. Feed when the child is hungry, no earlier than 4 hours after the previous feeding, exclude snacks - cookies, fruits. They are offered after the main meal.

Prevention of eating disorders in children

The child should receive food appropriate for his age. If he refuses to try new foods, don't push him. Re-offer them in 2-3 weeks. Don't force feed. Make sure your child works up an appetite. Get rid of stress as much as possible.

Eating Disorders in Adolescents

Eating disorders in adolescents are common and have been attributed to a variety of causes. Adolescents focus on their appearance, considering appearance and slenderness the basis of success among their peers. In addition, adolescence is psychologically difficult - mood swings and changes in appearance caused by hormonal changes, separation from parents and the formation of independence, as well as instability of self-esteem create the basis for eating disorders.

Causes of eating disorders in teenagers

Relationship disorders between mother and child in the first year of life. From the point of view of psychoanalysis, attention deficit and early refusal of breastfeeding cause fixation on the oral-dependent period. It is believed that this can cause eating disorders in children and adults.

hereditary predisposition. Often, eating disorders in adolescents cause genetically determined features of the nervous system, which are inherited from parents.

Social factors. The statements of parents and peers about excess weight, the imposed stereotype of harmony as a mandatory component of success, the desire to please the opposite sex push teenagers to extreme measures of weight loss. Due to ignorance, teenagers do not realize the danger and harm of their actions.

personality traits. Low self-esteem and lack of confidence in their attractiveness are the main factors that form all eating disorders in adolescents.

Types of Eating Disorders in Adolescents

Teenage anorexia- Refusal of food in order to lose weight. Teenagers consider themselves fat for no reason and actively use all means of losing weight available to them. Anorexia ranks third among the chronic diseases of adolescents.

Teenage bulimia- artificially induced vomiting, to reduce the absorption of food. It also aims to reduce weight.

psychogenic vomiting- unintentional vomiting associated with nervous tension, mental fatigue and experienced stress.

perversion of taste, perversion of appetite - the desire to experience the taste of inedible and inedible objects (lime, chalk, coal, matches), sometimes swallowing them. It is less common than other eating disorders in adolescents.

Symptoms and manifestations of eating disorders in adolescents

Symptoms of teenage anorexia

• Expression of dissatisfaction with one's body, fullness, volume of the hips, chubby cheeks.
• Refusal of high-calorie foods. Significant reduction in portions of food eaten.
• Sudden weight loss in a short period of time. Growth stop.
• Intense sports, other means to accelerate weight loss, pills to reduce appetite, tea for weight loss.
• Depressed mood, lethargy.
• Chilliness, cold hands and feet.
• Menstrual irregularities or absence of periods.

Symptoms of teenage bulimia

• The alternation of periods of self-limitation in food, gluttony and "cleansing" of the body.
• Careful calorie counting and selection of low-calorie foods.
• Dissatisfaction with being overweight. Pangs of conscience after overeating.
• Habit of seclusion after eating to induce vomiting and clear the stomach.
• As a rule, overeating and cleansing teenagers are kept secret and parents may not know about it for a long time.
• Depression, tendency to depression.
• Multiple caries, frequent throat problems, hoarseness.
• Weight fluctuations. Stunted growth.

Symptoms of adolescent psychogenic vomiting

• Attacks of vomiting during periods of increased mental stress, anxiety, fear, anxiety, after stressful situations.
• Vomiting as a manifestation of protest. It can occur when a teenager is forced to do something against their will, whether it be travelling, studying or eating.
• Vomiting as a way to attract the attention of adults.
• Increased excitability of the nervous system, manifested by excessive emotionality, anger, tearfulness for minor reasons.
• Attacks are not associated with food intake, poisoning and diseases of the digestive system.

Symptoms of teenage taste perversion

A teenager is diagnosed on the basis of information collected during a survey of the child and his relatives. At the same time, it is necessary to examine the general condition of the body in order to identify disorders in the organs caused by an eating disorder. The survey includes:

• Blood tests, urine, feces;
• Ultrasound of the abdominal organs;
• Gastroscopy and other studies (if necessary).

Treatment of eating disorders in adolescents

The basis of treatment is diet. Food is given in small portions 5-6 times a day. At first, the calorie content of the daily diet is 500 kcal, gradually it is increased to the age norm.

Psychotherapy

Family Therapy plays a leading role in the treatment of adolescents, since support and good relationships within the family are the basis of successful treatment. The psychologist gives advice on how to improve relationships with a teenager and between other family members.

Behavioral Therapy It is aimed at changing stereotypes of thinking, forming a healthy attitude towards one's body and food, and increasing self-esteem. The psychologist will tell the teenager how to change his thinking and behavior in order to get rid of the eating disorder. A change of scenery and social circle is recommended. Good results are obtained by treatment in a sanatorium.

Suggestive and hypnotherapy. Suggestion in a state of drowsiness helps to remove negative attitudes towards treatment and food.

Medication for eating disorders in adolescents

Treatment begins with the restoration of the functions of internal organs. Gradually return the teenager to normal nutrition.

Antidepressants, tranquilizers and antipsychotics are prescribed only in cases where the disorder is not amenable to other methods of treatment.

Prevention of eating disorders in adolescents

• It is important to avoid strong stress on the nervous system. Significant training loads, a large number of additional tasks cause overwork of the nervous system and foci of excited neurons in different parts of the brain.
• Balanced diet. The menu should include delicious and varied dishes. The amount of food should meet the needs of the teenager and ensure normal growth and development.
• Food should not be a reward and the main source of pleasure.
• It is necessary to support a teenager for the formation of adequate self-esteem in him.