How to get rid of anorexia. Anorexia treatment at home. Psychological and behavioral signs of anorexia

Anorexia nervosa is a severe mental disorder that is accompanied by an eating disorder motivated by the goals of losing weight or preventing excess weight. As a result, such a pathological desire to lose weight, accompanied by an all-consuming fear, leads to a loss of 30 to 60% of body weight. Many patients lose their criticality to their condition, they do not notice obvious dystrophy, their metabolism is disturbed, diseases of various systems and organs occur, but it can be extremely difficult to convince them of the need for treatment by a specialist. Some of the patients are aware of their exhaustion, but their fear of eating is so deep that they cannot restore their appetite on their own.

In this article, we will introduce you to the causes, risk factors, manifestations, consequences, ways to identify and treat anorexia nervosa. This information will help you notice anxiety symptoms diseases in yourself or your loved ones, and you will make the right decision about the need to contact a specialist.

Without treatment, anorexia nervosa leads to death in about 10-20% of patients. This condition is rightly called the disease of stereotypes, and more often it develops among wealthy segments of the population. According to statistics in recent years, the number of such patients has been increasing, almost 95% of patients are women. Approximately 80% of all anorexics are girls and young women aged 12-26, and only 20% are men and women of more mature age (up to the period).

Causes and risk factors

The causes of anorexia nervosa are conditionally divided into biological, psychological and social. The following factors can lead to the occurrence of such an ailment:

• genetic - the disease manifests itself when adverse conditions in carriers of certain genes (HTR2A, BDNF), which form a certain type of personality and contribute to the development of mental disorders;
• biological - obesity and early onset, dysfunctions of neurotransmitters regulating eating behavior (serotonin, norepinephrine and dopamine) can deepen pathological disorders with anorexia;
• personal - the likelihood of development mental disorder rises among persons belonging to the perfectionist-obsessive personality type, suffering from feelings of inferiority and the need to comply with some standards and requirements, low self-esteem and insecurity;
• family - the risk of anorexia increases among people in whose family someone suffers from the same disease, obesity, bulimia nervosa, depression, alcoholism and drug addiction;
• age - persons of adolescence and youth are most susceptible to the desire to please opposite sex or imitating idols and stereotypes;
• cultural - living in industrialized cities strengthens the desire to comply with the canons of beauty and success, expressed in the harmony of the figure;
• stressful - physical, psychological, sexual abuse or traumatic events (death of a close friend or relative, divorce, etc.) can contribute to the development of eating disorders;
• mental - a number of mental illnesses (for example, schizophrenia) can be accompanied by eating disorders.

Symptoms

Usually, the disease begins with the fact that the patient has a delusional and obsessive thought that being overweight is the cause of all his troubles (unattractiveness, separation from a loved one, lack of demand in the profession, etc.). Further, the patient develops depression, which leads to a strong and constantly progressive restriction of oneself in food. As a rule, patients try to carefully hide it from others (throw away food secretly, give it away pet, transfer part of their portion back to the pan, etc.).

Constant malnutrition and starvation leads to the appearance of another pathological deviation- at times he "breaks down" and begins to absorb a large amount of food. At the same time, he reproaches himself and comes up with ways to limit its assimilation. To do this, the patient can artificially provoke vomiting, take laxatives and conduct enemas.

Against the background of changes occurring in the body due to malnutrition and metabolic disorders, patients with anorexia nervosa lose their criticality to their condition. Even after they achieve the desired result in losing weight, it begins to seem unsatisfactory to them, and they set themselves new “tasks”.

As a rule, after about 1.5-2 years, the patient loses 20% or more of body weight and develops physical consequences anorexia nervosa - physiological abnormalities in work different systems and organs.

Psychiatric disorders

Prolonged malnutrition leads to a range of behavioral changes and mental state patient:

• denial by the patient of mental disorders and lack of criticality to signs of exhaustion;
• a constant feeling of fullness and a desire to lose weight more and more;
• changes in eating habits (eating in small portions, eating standing up);
• sudden preoccupation with topics about food: collecting recipes, reading books on cookery, organizing gourmet meals for relatives without the participation of the patient himself, excessive enthusiasm for diets;
• panic fear of extra pounds;
• the emergence of unreasonable resentment and anger;
• sleep disorders;
• depressive state: sadness, irritability, periods of euphoria, followed by reduced activity;
• change in activity in the social environment and family: excessive sports training away from home, reluctance to attend events that involve meals (birthdays, corporate parties, etc.), limiting communication with relatives and friends.

One of characteristic features Anorexia nervosa is the following reasoning of the patient: "My height is 168, and now my weight is 45 kilograms, but I want to weigh 35 kilograms." Subsequently, the numbers become smaller.

Any results in weight loss are regarded by the patient as desired achievement, and a set of even a few kilograms is perceived as insufficient self-control and dissatisfaction with oneself. Even patients who are aware of their dystrophy often wear baggy clothes that hide thinness from others. In this way, they try to avoid having to explain themselves and engage in discussion with those who do not support their aspirations for far-fetched "ideal" standards.

One of the most dangerous manifestations Anorexia nervosa is the self-administration of various hormonal agents for weight loss. Such cases are very difficult to treat, and even compulsory treatment may be ineffective.

Mental disorders that occur with anorexia nervosa can cause suicide.

Physical Disorders

Over time, prolonged malnutrition and starvation leads to severe metabolic disorders and the development of diseases of various systems and organs.

Initially, the patient experiences hormonal changes caused by reduced hormone production. thyroid gland, estrogen and increased cortisol levels. They show the following symptoms:

• constant weakness (up to hungry fainting);
• violations menstrual cycle(scanty periods, pain, delay and absence of menstruation, inability to conceive);
• decreased libido;
• muscle spasms;
• bradycardia;
• propensity for.

Subsequently, there are the following violations in the functioning of body systems:

• cardiovascular system - fainting, a feeling of cold, the occurrence of arrhythmias, which can cause;
• blood - signs, a decrease in the level of leukocytes, leading to increased susceptibility to infections;
• digestive system - functional dyspepsia, pain convulsive nature in the stomach, peptic ulcer, chronic constipation, nausea, edema (bloating) of the abdominal cavity;
• skin and hair - dryness and swelling, yellow skin tone, dullness and hair loss, the appearance vellus hair on the face and body, fragility and delamination of nails;
• skeletal system and muscles - susceptibility to fractures and their long healing, tooth decay, swelling of the joints, muscle atrophy;
• urinary system - a tendency to,.

Some of the physical disorders described above can be corrected with treatment of anorexia nervosa and restoration of normal weight and nutrition, but some of them are irreversible.

Excessive fascination with attempts to induce artificial vomiting and holding cleansing enemas can cause the following problems:

• trouble swallowing food and liquids;
• rupture of the esophagus;
• weakening of the rectal wall;
• rectal prolapse.

Pregnancy and anorexia nervosa

Pregnancy with anorexia is often difficult, but after treatment and weight gain, estrogen levels can be restored and conception occurs. Even after therapy in the future, a woman may experience the following problems associated with hormonal imbalance:

• difficulty with the onset of conception;
• increased risk of fetal malnutrition and the appearance of congenital malformations in the unborn child;
• increased risk of complications during pregnancy and childbirth;
• increased risk of anorexia recurrence stressful condition arising in response to the news of pregnancy.

At severe forms ah anorexia nervosa, even after the treatment, there is no restoration of the menstrual cycle, and the woman cannot become pregnant on her own.

Stages of the disease

During anorexia nervosa, the following stages are distinguished:

1. dysmorphomaniac. The patient often has painful thoughts about his own inferiority, associated with imaginary fullness. The mood becomes depressed, anxious. The patient can look at his reflection in the mirror for a long time, often weigh himself, measure the waist, hips, etc. At this stage, he begins to make the first attempts to limit himself in food or seeks and follows an "ideal" diet.
2. Anorexic. The patient is already attempting persistent starvation and has lost about 20-30% of body weight. Such “successes” are perceived with euphoria and are accompanied by the desire to lose weight even more. The patient begins to exhaust himself with excessive physical exertion, eats even less and tries in every possible way to convince himself and those around him that he has no appetite. At this stage, he can no longer be critical of his exhaustion and underestimates its excessive degree. Starvation and lack of nutrients lead to the appearance of the first signs of changes in the physical condition: hypotension, bradycardia, fainting and weakness, menstrual irregularities and libido, dry skin, hair loss. Disturbances in metabolism and the physiological functioning of organs are accompanied by active decay of tissues and lead to even greater suppression of appetite.
3. cachectic. At this stage, there is an occurrence of irreversible disorders caused by dystrophy of organs. As a rule, this period begins 1.5-2 years after the first manifestations of anorexia nervosa, when the patient loses approximately 50% of body weight. In the absence of treatment dystrophic processes lead to the extinction of the functions of all organs and death of the patient.

Diagnostics

Many people with anorexia nervosa think they are not sick or are able to control their condition on their own. That is why they rarely go to the doctor on their own. In such cases, the task of their relatives is to help the loved one understand the problem and resort to the services of a specialist.

Usually, to make a diagnosis, the doctor asks the patient several questions of the test, developed in the UK:

• do you consider yourself complete;
• whether you keep your weight under control and what you eat;
• Have you lost more than 5 kilograms recently?
• whether thoughts about food are dominant;
• do you believe that you are fat (th), if others say that you are thin (th).

Even two “yes” answers indicate the presence of eating disorders.

To confirm the diagnosis and determine the severity of anorexia nervosa, the patient is assigned the following types of studies:

• body mass index calculation (for example, the norm for women over 20 years old is 19-25, the risk threshold is 17.5);
• blood tests to detect anemia and electrolyte disorders;
• blood tests to determine kidney and liver function;
• and sex hormones.

If necessary, examination of a patient with anorexia nervosa can be supplemented (to detect osteoporosis), ultrasound of various organs and (to detect diseases of internal organs).

Treatment

Treatment of anorexia nervosa is carried out by doctors of several specializations and can be carried out on an outpatient basis or in a hospital setting. The need for hospitalization of the patient is determined by the severity of the clinical picture. It is shown in the following cases:

• a decrease in body mass index by 30% below normal;
• progressive weight loss on the background of outpatient therapy;
• violations heart rate;
• hypotension;
• hypokalemia;
• severe forms of depression;
• suicidal tendencies.

The main goal of treatment for anorexia nervosa is to restore weight and eating habits. An increase in body weight of 0.4-1 kg per week is desirable. In addition, therapy is aimed at eliminating mental and physical complications.

The most successful tactic for treating such a disease is a combination of psychotherapy, family and conservative therapy. It is extremely important that the patient himself participate in this process and realize its necessity.

Even after treatment, some patients remain prone to relapses of the disease and need constant psychological support (especially during stressful periods of life). The following factors can complicate the recovery process and increase the risk of relapse:

• communication with friends, sports coaches and relatives who admire thinness and promote weight loss;
• lack of psychological support from close friends and family;
• the impossibility of overcoming the patient's conviction that excessive thinness is the only way combat obesity.

The treatment plan for anorexia nervosa is made depending on the characteristics of the disease and the personality of the patient. Part complex therapy includes several methods.

Lifestyle change

A patient with anorexia nervosa needs the following changes:

• regular and healthy eating;
• proper formation of the diet and menu planning with the help of a nutritionist;
• getting rid of the habit of constant weighing;
• exclusion of debilitating physical activity to reduce weight (only after the patient's condition is normalized, the doctor can include exercises in physiotherapy exercises in the treatment plan);
• increasing social activity;
• psychological support from friends and relatives.

Restoration of normal nutrition and weight gain

This part of the treatment plan for anorexia nervosa is fundamental, as the normalization of nutrition and weight contributes to the restoration of both physical and mental health. In addition, these factors increase the effectiveness of psychotherapy.

To increase weight, the patient is prescribed a diet, the principle of which is aimed at gradually increasing the calorie content of the daily diet. Initially, it is recommended to consume 1000-1600 calories per day, and then the diet gradually expands to 2000-3500. Food should be taken 6-7 times a day in small portions.

In the early stages, the patient may experience anxiety, depression, and signs of fluid retention in the body in response to weight gain. Over time, as you gain weight, these symptoms decrease and disappear.

Parenteral and intravenous nutrition is not usually used for the treatment of anorexia nervosa, as in the future such methods may lead to difficulty in recovery. normal nutrition and many patients perceive such methods as punishment and compulsory treatment. However, in some difficult cases (categorical and prolonged refusal to eat, heart rhythm disturbances, bleeding from the mouth, etc.), such methods can be used temporarily to initial improvement the patient's condition.

Nutrition and supplementation

Patients with anorexia nervosa suffer from a lack of vitamins, minerals and nutrients. Their replenishment significantly improves the mental and physical condition of patients, and therefore food should be nutritious and fortified.

If necessary, diet therapy is often supplemented by taking nutritional supplements. For this, the following dietary supplements can be used:

• multivitamin products (A, C, E) and supplements based on magnesium, zinc, calcium, copper, phosphorus and selenium;
• Omega 3 fish fat, eating fish (especially halibut and salmon);
• coenzyme Q10;
• 5-hydroxytryptophan;
• probiotics based on lactobacilli and acidophilus;
• creatine.

Improve absorption useful substances and general state following recommendations may be followed:

• sufficient intake of drinking water (up to 6-8 glasses per day);
• inclusion in the diet of high-quality protein sources: eggs, meat, dairy products, protein and vegetable shakes;
• quitting smoking and drinking alcohol;
• eliminating or significantly reducing the number of caffeinated products;
• restriction of refined sugars: sweets, sweet water etc.

Cognitive Behavioral Therapy

This method of treatment of patients with anorexia nervosa is the most effective. With this technique, the patient learns to replace distorted thoughts and negative judgments with real and positive ways of solving problems.

Cognitive behavioral therapy consists in the fact that for several months or six months the patient himself draws up his own menu and includes in it products that he previously refused in every possible way. He monitors his diet and records unhealthy thoughts and reactions associated with food. In addition, he notes that he has relapses in the form of vomiting, taking laxatives and excessive physical exertion.

The patient periodically discusses these notes with a cognitive therapist and, as a result, may become aware of false and negative judgments about their weight. After such acceptance, the list of foods in the diet expands, and the awareness of the problems present earlier allows him to get rid of ingrained false judgments. Subsequently, they are replaced by correct and realistic ones.

Family Therapy

The involvement of parents, relatives and friends helps the patient cope with the difficulties that arise. The doctor teaches them to develop the right tactics of behavior with him. In addition, family therapy is aimed at eliminating feelings of guilt and anxiety that arise in the relatives themselves and the patient's relatives.

Maudsley method

This tactic is one of the varieties of family therapy and can be used on early stages anorexia nervosa. The Maudsley method consists in the fact that in the first stages the patient's parents take over the planning of the menu and control the use of prepared dishes. Gradually, as correct judgments about nutrition are restored, the patient begins to make his own decisions about when and how much to eat. Weekly, the results of treatment are discussed with a psychotherapist, who gives additional recommendations and evaluates the effectiveness of this technique.

Hypnotherapy

The use of hypnosis can become part of complex treatment anorexia nervosa. Such sessions allow the patient to regain self-confidence, increase resistance to stressful situations, to restore the correct perception of their appearance and weight. As a result, hypnotherapy can help return to normal eating habits.

Medical therapy

Reception medicines for the treatment of anorexia nervosa is recommended only if it is impossible to eliminate existing problems with the help of psychotherapeutic methods and diet therapy. For this, the patient may be prescribed:

• antidepressants (Fluoxetine, Cyproheptadine, Chlorpromazine, etc.) - for the treatment of severe forms of depression, anxiety and obsessive-compulsive disorders;
• atypical antipsychotics (Azenapine, Ziprasidone, Clozapine, Sertindole, etc.) - are used to reduce an increased level of anxiety.

Besides, drug treatment complemented symptomatic therapy emerging complications of anorexia nervosa (gastritis, peptic ulcer, arrhythmias, etc.). If mental illnesses that cause eating disorders are identified, their treatment is prescribed.

Forecasts

The recovery process of a patient with anorexia nervosa can take about 4-7 years. Even after recovery, there is a possibility of recurrence of the disease.

According to various statistics, approximately 50-70% of patients fully recover from the disease, but 25% of patients fail to achieve such results. Sometimes after treatment, uncontrolled overeating occurs, leading to weight gain and a number of other psychological problems.

The probability of a fatal outcome in anorexia nervosa depends on the stage of the disease, mental and physiological characteristics the patient's body. Death can be caused natural causes(i.e., arising complications and diseases) or occurs due to suicide.

Which doctor to contact

If you are extremely concerned about your weight, refuse to eat openly or hidden from others, and suddenly lose weight, you should contact a psychotherapist. When anorexia nervosa is detected, a nutritionist and a general practitioner are involved in the patient's treatment process.

Anorexia is a serious, life-threatening illness in which a person can starve themselves to death due to psychological, cultural, and physical causes. At this disease higher mortality rate than all other causes of death for women aged 15 to 24. In addition, although the majority of people suffering from anorexia are women, 10-15% of patients are men. In order to cope with this disease, strength, courage and endurance are needed, but with right attitude and support, you will be on your way to recovery very soon.

Steps

How to help yourself deal with anorexia

Write down your feelings. Keep a recovery diary - write down your feelings in it, this will help you maintain awareness of your condition. A diary will help you keep track of how you feel throughout the day, especially when you have trouble eating.

• You can use the “unboxing” technique to delve deeper into your feelings. For example, if one day you wrote in your diary that you felt “fine,” ask yourself what you might mean by “fine.” This will help you explore your feelings more deeply.

1. Talk to your doctor. Anorexia can lead to serious complications with health, for example, to anemia, loss bone tissue, diseases of the gastrointestinal tract, heart problems and even death. If you think you have anorexia, you should definitely consult your doctor to get the treatment you need to get better. Talk to your doctor about anorexia if you have any of the following symptoms:

   • Significant weight loss as a result of not eating
   • Fear of being fat, even if many people think you are too thin
   • Overindulgence in diet and exercise
   • Anxiety, mood swings, or hyperactivity
   • Sleep problems
   • Suppressed sexual desire
   • In women, irregular or absent periods
   • Men are over-indulgent strength training

2. Set achievable goals. Unrealistic goals will only create problems, as you will find it difficult to achieve them and you will want to give up early. It's best to aim low first and then aim higher when you reach the first milestones. If your goals are realistic, you will be able to balance them with other aspects of your life. it great way assess whether your goals are achievable. If your goal requires so much effort and time from you that you do not have time for leisure or any other obligations, then it is worth reconsidering.

   Avoid triggers. A trigger, or provoking factor, is something that upsets you and stimulates the activation of an eating disorder. If you identify your triggers, you can gain control over the situations and people that trigger your anorexia habits. Once you know who and what puts you under such stress, you can create a plan to deal with these factors in advance. Your triggers can be:

   • Tension in the family
   • Stressful situations at work
   • Images or events that awaken your complexes about the body
   • Certain Foods You Have a Hard Time Thinking About

3. Learn more about intuitive eating. Intuitive Eating is a nutritional system developed by nutritionist Evelyn Tribol and nutritionist Alice Resch. This system will help you learn to listen to your body's signals, such as when it tells you that you are hungry or full. It will also help you develop alternative coping mechanisms so you can comfort yourself without resorting to food. In addition, intuitive eating can help you:

   • Start seeing food as an enjoyable activity
   • Respect your body or your “genetic program”
   • Get rid of the food restriction mentality

4. Accept that bodies are different. There are a huge number of diverse and beautiful body types in the world. If you find it difficult to accept your body, look at all the vibrant body types that exist in the world to see how special and unique each one is. This diversity can be seen, for example, by visiting an art museum and appreciating classical paintings, when people valued physical data different from those that are valued now.

5. Use positive affirmations if you feel anorexia coming on. When you are stressed and want to turn to anorexic behavior to deal with the stress, use a mantra or positive affirmation to redirect your feelings. Be your own personal trainer.

   • For example, you might say to yourself, “I can feel bad, but still choose a new and healthy direction.”
   • You can also tell yourself the following: “This situation is difficult and uncomfortable, but this is only a temporary phenomenon.”

6. Ask your doctor about medications. Psychiatric treatment help manage the symptoms of anorexia on a daily basis. Antidepressants help keep good mood and prevent depression due to an eating disorder. Anti-anxiety medications can help relieve excessive anxiety and compulsive behavior. These medications can be especially helpful if you have both anxiety and depression at the same time, which is very common in people with eating disorders.

   Help from family and friends

   1. Ask for help. it important step on the road to recovery. Find a positive person in your environment whom you can trust and rely on. Seeking help for an eating disorder can be scary or embarrassing, but getting the support of a close friend, family member, religious counselor, school counselor, or work colleague is the first step to recovery for many people. Research shows that a sense of social connectedness is the most important factor in the process of recovery.

      • For example, if your nutritionist helped you create a meal plan, ask a friend or family member to help you stick to your plan.

Usually patients with anorexia are brought to the hospital by close relatives, so the patients themselves have no motive for treatment and do not understand how the diet they follow may end. And the end can be terrible - death or schizophrenia. Combining psychotherapy, home therapy and therapeutic treatment have the most favorable prognosis in the fight against anorexia nervosa.

Since this disease affects both the mind and the body, an integrated approach is needed. It is important to involve the patient in active participation in the ongoing treatment, because often patients with anorexia consider themselves absolutely healthy, have no desire to change and may stubbornly resist treatment. As a rule, the use of psychotherapy for patients with anorexia nervosa who have already manifested characteristic symptoms schizophrenia, is unsuccessful. In this case, a psychiatrist begins to treat them in a hospital with medications, where, in order to maintain their lives, they are forcibly given nutritional enemas and food is introduced through a tube.

Ambulatory treatment

Outpatient treatment of anorexia is carried out if secondary somatoendocrine disorders are not a threat to life, and includes three points:

• return to normal weight body;
• fostering healthy eating habits;
• adjustment of ideas about oneself and the world around.

The patient comes to the doctor extremely emaciated, and it is required to improve his physical condition as soon as possible. After a detailed examination by a therapist and obtaining the results of laboratory tests, an individual high-calorie diet with six meals a day is prescribed, which meets the requirements of the body of a particular patient, and insulin, which helps to increase appetite. Prescribed medicines to compensate for the lack of iron and zinc, vitamins and antidepressants.

With strict observance of all the doctor's recommendations and constant monitoring of relatives, the patient gradually begins to recover. Such a rehabilitation program allows you to gradually return to normal eating behavior. Restoration of weight is a sign of recovery only if the patient actually changed the distorted thoughts in the course of additional psychotherapeutic treatment. Because it suffers endocrine system, treatment should include hormone therapy. In the presence of amenorrhea, estrogen replacement drugs are prescribed, they must be taken after weight gain.

The use of medications is necessarily combined with psychotherapy, since anorexia nervosa has strong impact on the psyche, completely changing thoughts and, accordingly, behavior, which makes recovery extremely problematic, even if the patient receives proper help. Work is being done both with patients and with their loved ones in order to create a more prosperous "family climate", to ensure the correct treatment of anorexia at home and cure it. It is worth noting that the speed of recovery directly depends on the adequate response of relatives to the patient, their active participation in his treatment and adherence to a restorative diet. For best results, patients are advised that a slow rate of weight gain will be seen as a sign of a more severe course of the disease, and will require hospitalization in a psychiatric hospital, where their diet and behavior are more closely monitored.

How to deal with anorexia in a hospital

One of the forced methods of treatment is the placement of a person in a psychiatric hospital with complete isolation from all relatives. Hospital treatment is used in severe anorexia, when the patient is hospitalized in case of deep exhaustion and physical weakness, and the likelihood of death is high. The goal of primary therapy in a psychiatric hospital is to delay weight loss, get rid of the threat to life and bring the patient out of the state of cachexia.

At the initial stage of treatment in the clinic, all efforts are aimed at restoring work of cardio-vascular system, a diet is also prescribed in the form fractional nutrition, while taking into account the state of the gastrointestinal tract, liver and pancreas. To begin with, food is shown only in liquid fat-free form, then the introduction of fats into food is allowed. Then there is a gradual increase energy value diet up to average norm healthy adult. During the exit from cachexia, patients are prescribed a strict bed rest. Because anorexics are hyperactive, they are often monitored around the clock to avoid stimulated vomiting. As a result, they have a negative attitude towards the attending physician and medical staff, which is expressed in protest reactions, so they are prescribed small doses of tranquilizers.

Patients undergo hypnosis sessions and training autogenic training because they give greatest effect in this mental illness, and in combination with drug treatment and carefully observed food regimen lead to positive results. It is rational to have several people with such a diagnosis in the department at once, their effect on each other is noticeable already at the very beginning of therapy. If, before hospitalization, patients do not realize the severity of their condition and the incorrectness of dietary rules, then at the sight of the same dystrophics, they understand the need for treatment and begin to change their mind about their body, which makes it possible to quickly cure this pathology.

How to treat anorexia with folk remedies

It is impossible to treat anorexia nervosa only with folk remedies in any case. At the slightest suspicion of this disease, an immediate appeal to a specialist is required for accurate diagnosis and prompt first aid. The use of medicinal herbs is possible only to strengthen and increase the overall tone of the body during exhaustion. Also, folk remedies can increase appetite after adjusting the patient's psyche by a psychotherapist. Without fulfilling this condition, no decoctions and potions will help and the achievement positive result will simply be ruled out.

The main obstacle for family members of people suffering from anorexia is the awareness of the severity of the condition of their children, friends and relatives, why they adhere to a diet and from what source the disease comes from, because an eating disorder unconsciously occurs in patients with serious personality conflicts. It is important to know that your advice to ask for help can lead to an angry reaction and an outright refusal. In this case, the best way out is to change the rules of behavior in the family, because often family members, unnoticed by themselves, themselves contribute to the disease. For this reason, family therapy is one of the most effective styles of treatment, and it is desirable that the whole family be involved. It is necessary to learn to listen and try to understand your loved one, without any value judgments, instructions and prohibitions.


Only through respect and sensitivity is it possible to establish warm, trusting relationships. The opinion that anorexia can be cured on its own is deeply erroneous, because patients with eating disorders have no power over their behavior or over their lives, and alone they cannot get out of this condition. There is no need to shame and reproach them for following the “diet”, throwing away food or artificial vomiting, because they are already experiencing strong feelings of helplessness and persecution. Your support and acceptance is the best you can give to the patient.

Many have the opinion that anorexia is nonsense and a whim, that this problem is greatly inflated, but the emaciated body of the patient is a real reflection of the suffering of his “malnourished” soul.

- This is a mental disorder that belongs to the group of eating disorders, characterized by the rejection of the body image, the refusal of food, the creation of obstacles to its absorption and the stimulation of metabolism in order to reduce weight. The main symptoms are avoidance of food intake, restriction of portions, debilitating physical exercises, taking drugs that reduce appetite and speed up metabolism, weakness, apathy, irritability, physical ailments. Diagnosis includes clinical interview, 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 ancient Greek, the word "anorexia" means "absence of the urge to eat." Anorexia nervosa often accompanies schizophrenia, psychopathy, metabolic diseases, infections, and gastrointestinal diseases. May be a consequence of bulimia or precede it. The prevalence of anorexia is determined by economic, cultural and individual family factors. In European countries and in Russia, the epidemiological rate among women aged 15 to 45 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 total number sick. Anorexia is rare in 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 a group high risk there are girls from socially prosperous families who are distinguished by their striving for excellence and have a normal or increased BMI. Possible reasons diseases 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 likely to be disturbed in people with overweight body, 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. Important role in the development of the disease plays 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. ideals slim body promoted on different levels, forming among young people the desire to lose weight in any way.
• Stressful. Anorexia can be triggered by death loved one, sexual or physical abuse. In adolescence and young age, the cause is uncertainty about the future, the inability to achieve 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 about an imaginary or real defect - dysmorphophobia. Under the influence etiological factors obsessive, delusional thoughts about excess weight, own unattractiveness, ugliness are formed. Usually the image of the bodily "I" is distorted, in reality the weight of the patient corresponds to the norm or slightly exceeds it. Under the influence of obsessive thoughts, emotions and behavior change. Actions and thoughts are aimed at weight loss, achieving thinness.

Strict dietary restrictions are introduced, the food instinct and the instinct of self-preservation are inhibited. Nutrient deficiencies activate physiological defense mechanisms, metabolism slows down, secretion decreases digestive enzymes, bile acids and insulin. The process of digesting food at first causes discomfort. In the later stages of anorexia, digestion becomes impossible. There is a state of cachexia with the risk of death.

Classification

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

• Anorexia with monothematic dysmorphophobia. Classic variant diseases - the persistent idea of ​​\u200b\u200bweight loss is supported by appropriate behavior.
• Anorexia with periods of bulimia. Periods of fasting, severe restriction of food alternate with episodes of disinhibition, a decrease in focus, during which gluttony develops.
• Anorexia with bulimia and vomitomania. Starvation is periodically replaced by gluttony and subsequent provocation of vomiting.

Symptoms of anorexia

A mandatory symptom of the disease is a conscious restriction of the amount of food consumed. May appear in different forms. On the early stages 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 plentiful consumption. Later, they begin to avoid meeting with relatives and friends for dining table, find a reason not to attend family dinners and dinners, talk about supposedly an existing disease(gastritis, stomach ulcers, allergies), requiring a strict diet. On the late stage anorexia possible complete cessation nutrition.

To suppress appetite, patients resort to taking chemical substances. 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. It's an uncontrollable bout of consumption a large number 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.

Complications

Without psychotherapy and medical care anorexia leads to a variety of somatic diseases. Most often in young people there is a delay in growth and sexual development. Pathologies of the cardiovascular system are represented by severe arrhythmias, sudden cardiac arrest due to electrolyte deficiency in the myocardium. The skin of patients is dry, pale, pasty and edematous due to lack of proteins. Complications from digestive system are chronic constipation and spastic abdominal pain. Endocrine complications include hypothyroidism (hypothyroidism), secondary amenorrhea in women, and infertility. Bones become brittle, 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 different high level consistency 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 on 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 caused active actions the patient himself, and not 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, girls do not increase mammary glands, young men have juvenile genitalia.

Treatment of anorexia

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 conditions intensive care unit aimed at restoring physical health, forming an adequate opinion about own body, normalization of 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 the patient's choice. A positive perception of personality and body image is formed, anxiety is reduced, internal conflict. 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 is prescribed replacement therapy sex hormones. 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.

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 the prognosis is. Recovery often occurs with a comprehensive therapeutic approach, family support and the elimination of factors that provoke the disease. Prevention should be carried out at the level of the state, society and family. Propaganda needed healthy lifestyle life, sport, balanced nutrition and normal weight. It is important to maintain traditions in the family sharing food associated with positive emotions, teach children how to cook balanced meals, form a positive attitude towards appearance.

Anorexia in men has its own characteristics:

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

Factors that provoke anorexia in men

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

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

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

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

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

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

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

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

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

Anorexia in a child, what to do?

Causes of anorexia in a child

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

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

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

How to avoid relapse of anorexia?

How to avoid relapse of anorexia?

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