Both anorexia and bulimia are considered mental illnesses, their nature remains obscure, like the nature of other mental illnesses, and they are also difficult to treat. Their incidence seems to be growing. From 2 to 5 percent of adolescents and young women suffer from anorexia nervosa; if untreated, mortality reaches almost 20 percent. It is believed that another 5 percent suffer from bulimia, but it almost does not give deaths. Women with disturbed eating habits can suffer from a number of disorders, ranging from cardiac disorders to amenorrhea, which stops menstruating, osteoporosis, in which there is a decrease in bone density, usually developing in women after menopause.
We give anorexia as an example. Doctors believe that in civilized countries, about 2-5% of girls and young women suffer from anorexia. And what is most sad - these figures are growing every year. Girls fall ill more often than boys; male to female ratio 1:10. Although in recent years, cases of the disease among men have become more frequent. Doctors say that overall the number of patients has increased in recent decades - they call it the “anorexic explosion in the population.”
Characterization of Anorexia and Bulimia
General characteristics of anorexia nervosa and bulimia nervosa. Clinical picture
Anorexia nervosa is a malnutrition in young women who develop a pronounced fear of overweight. With anorexia nervosa, this leads to a radical restriction of the use of high-calorie foods, as a result of which the depletion of the body develops. In patients with bulimia, excessive absorption of food is followed by arbitrary vomiting and excessive consumption of laxatives. These two states cannot always be separated quite clearly.
|Body weight control method||Food limit||Vomiting|
|Body weight for diagnosis||Markedly reduced||Close to normal|
|Amenorrhea||About 100%||About 50%|
|Cardiovascular changes (bradycardia, hypotension)||Common||Not peculiar|
|Hypothermia (hirsutism, dryness, carotinemia)||Often||Often|
|Somatic complications||Hypokalemia, cardiac arrhythmias||Hypokalemia, arrhythmias, aspiration of the contents of the stomach, rupture of the esophagus or stomach|
Note. These signs are characteristic of anorexia nervosa or bulimia, occurring in isolation. But sometimes mixed syndromes develop and anorexia can evolve into bulimia (bulimia rarely transforms into anorexia).
Diagnosis criteria for anorexia nervosa
- Beginning before the age of 25
- Anorexia with loss of body weight of at least 25% of the original
- A perverted attitude to the process of eating, food or body weight, forcing to overcome the feeling of hunger and neglect warnings, exhortations and threats
- Lack of organic disease that could be the cause of weight loss
- The absence of any other mental illness
- The presence of at least two of the following manifestations:
- lanugo (gun hair)
- bradycardia (heart rate at rest 60 in 1 min or less)
- periods of hyperactivity
- bulimia episodes
- vomiting (may be self-induced)
Since dysfunction of the hypothalamus (dysregulation of gonadotropins, partial diabetes insipidus, impaired thermoregulation) is characteristic of anorexia nervosa, most researchers are inclined to believe that there is a psychogenic cause. Interpersonal relationships among family members are usually inadequate; there is an intra-family pathological focus focused on foods and eating behavior. Anorexia nervosa usually occurs either before or shortly after puberty. Despite cachexia, patients deny the feeling of hunger, weight loss, fatigue. Often there is amenorrhea, which may precede anorexia. Subcutaneous fatty tissue is not detected, although the tissue of the mammary glands is practically unchanged. Enlarged parotid glands and edema can be accompanied by anemia, leukopenia, hypokalemia, hypoalbuminemia. Basal levels of LH and FSH are low, leading to amenorrhea. The menstrual cycle is restored as body weight normalizes.
Characterization of bulimia nervosa
Bulimia, a violation of eating behavior, characterized mainly by repeated bouts of gluttony, food"revelry". To avoid obesity, most patients with bulimia at the end of the"revels" resort to one way or another to cleanse the stomach, artificially inducing vomiting or taking laxatives and diuretics. Others use excessive physical activity or intermittent fasting. Like those suffering from anorexia nervosa (a very close disease), most patients with bulimia are young women, usually from older teens to over 30 years old.
The term “bulimia” comes from the Greek word for bull hunger. Although there are no exact statistics, it can be said that in recent years this disease is becoming more common and widespread in the USA, Canada, Great Britain, Australia, Japan and many other countries.
The cause of bulimia is unknown. However, most experts believe that this condition is due to many reasons, including hereditary, hormonal, psychological and social factors. Parents of patients, as a rule, belong to the upper layer of the middle class and are distinguished by their pretentiousness and high ambitions.
Most patients with bulimia look normal and healthy people, but are usually too demanding of themselves and others, prone to loneliness and depression. They tend to raise standards and underestimate self-esteem. Their life is almost entirely focused on food, their own figure and the need to hide their"mania" from others. Even while working or attending school, they usually shun society.
Depression, poor sleep, talk of suicide, excessive fear of getting fat, and feverish grocery shopping can testify to bulimia. Bulimia sufferers usually make “revels” about 11 times a week, but the frequency of such attacks varies from 1–2 per week to 4–5 per day.
Unlike anorexia, in which self-exhaustion ultimately becomes noticeable, people with bulimia can hide this disease for a long time, even many years, as their weight usually remains within normal limits (sometimes there may be a slight excess of body weight) , and periods of gluttony, followed by cleansing the body are kept secret.
The clinical symptoms of bulimia can be swelling of the glands on the face and neck, enamel erosion of the posterior surface of the teeth, facial hemorrhages, swelling of the salivary glands (a type of chipmunk), constant soreness in the throat, esophagitis, hiatal hernia.
All these signs are the result of artificially induced vomiting.
The uncontrolled use of laxatives often causes disorders of the gastrointestinal tract, including rectal bleeding, persistent diarrhea.
In this case, leaching of potassium and sodium from the body can occur, which leads to an imbalance in the electrolyte balance up to the development of dehydration, muscle cramps and ultimately can lead to cardiac arrest.
Other symptoms of bulimia are hair loss, icteric coloration of the skin, premature wrinkle formation, respiratory failure, severe weakness, muscle fatigue, and dizziness.
Bulimia can have dire health consequences. Frequent vomiting causes irritation of the pharynx and esophagus, as well as the destruction of tooth enamel with acid from the stomach. Sometimes there is a cessation of menstruation. The most serious consequences are associated with dehydration and loss of electrolytes (sodium and potassium) as a result of vomiting and diarrhea caused by laxatives. Repeated tinctures of the emetic root cause muscle weakness and have a cumulative effect on the heart, i.e. its growing damage, which can lead to its stop. Cases of rupture of the stomach due to overeating are described.
Bulimia treatment requires the combined efforts of doctors of different specialties. An important role is played, apparently, by individual psychotherapy; it should be carried out by a trustworthy specialist. Group therapy, which takes place in a warm and friendly atmosphere, can be equally beneficial.
Recovery usually occurs slowly. However, patients are treatable. Moreover, studies are currently underway that promise significant progress in the treatment of bulimia.
Possible causes of bulimia
The main causes of increased appetite:
- psychogenic (psychological);
Organic Causes of Bulimia:
Diabetes mellitus. Increased appetite is often a symptom of untreated diabetes, or is associated with low blood sugar as a harbinger of a complication of the disease (insulin shock).
Inflammatory lesions of the brain stem. Residual phenomenon of encephalitis. Often, bulimia in such cases is combined with dementia or diabetes insipidus.
Toxic brain damage.
Brain stem tumors. Often, increased appetite does not lead to the development of obesity.
Genetic diseases with damage to brain structures. When the central nervous system is affected, increased appetite is regarded as true bulimia.
Side effect of hormones of the adrenal cortex (prednisone, dexamethasone, etc.) - Itsenko-Cushing's syndrome. Along with increased appetite, there are other signs of excessive hormone activity (increased blood pressure, stretch marks on the abdomen and hips, changes in blood sugar, etc.).
Increased activity of thyroid hormones (hyperthyroidism).
Helminthic infestations, especially damage by tape worms.
Psychogenic causes of bulimia:
Violation of family relations. The development of gluttony in children can contribute to the conflict between the mother and the child. Often children begin to eat an exorbitant amount of food if they consider themselves abandoned, deprived of affection, deprived in comparison with other brothers and sisters.
Soul isolation. For example, a change in appetite may develop when a child is placed in a boarding school. For such a child, food is a source of positive emotions and “acquisitions,” a mechanism of protection against depression, and a cure for fear.
Bulimia nervosa. The causes and target setting are very similar to those with anorexia nervosa.
Social causes of bulimia:
- pretentiousness and high ambitions of parents;
- insufficient attention to the child in the family and children's team;
- one child in the family;
- long-term viewing of TV shows with constant “snacks” - chips, cracker, nuts, etc .;
- laziness and low physical activity;
- a change in the idea of a standard figure: from rounded female forms to the standard of a teenage woman.
Bulimia nervosa affects mainly girls. An aggravated feeling of hunger occurs, as a rule, once a day and is eliminated by eating high-calorie foods, followed by inducing vomiting. That is, bulimia nervosa is characterized by a cycle: food-vomiting. The goal of vomiting is to lose weight, become more elegant or get rid of obesity. Often girls use laxatives and diuretics for artificial bowel movements and weight loss, and are intensely engaged in physical exercises. However, body weight is steadily increasing and the vicious circle of “eating - vomiting - re-eating large amounts of food” on their own is not possible for children to break.
Characterization of Anorexia Nervosa
Anorexia nervosa, a disease characterized by weight loss, excessive fear of fullness, a distorted view of his appearance and deep metabolic and hormonal disorders. Loss of appetite, cessation of menstruation, increased physical activity, and sometimes increased appetite with vomiting artificially induced after eating, excessive concern for food and its preparation, bouts of gluttony and the desire for weight loss are also possible. Patients often stubbornly deny the presence of any food-related disorders.
Anorexia nervosa occurs mainly in teenage girls. Of every 18 patients, only one is a man. Until the 1960s, this disease was rare, but then its frequency, for unknown reasons, increased significantly. According to modern data, 1% of teenage girls suffer from anorexia nervosa.
Usually, the disease begins in early adolescence, but sometimes it can appear for the first time and much later - after 30 and even 40 years. Until weight loss is detected, anorexia patients are described as soft, enthusiastic, hardworking people with no clear signs of neuropsychiatric disorders. Almost always, their families are socially very successful and belong to the middle or upper strata of society. At school, such children are distinguished by excellent academic performance. Often they are a little overweight and because of the ridicule of their peers decide to stick to a diet, and when they start to lose weight, they deny it.
When exhaustion becomes apparent and relatives can no longer ignore this circumstance, you must finally consult a doctor. He must conduct a thorough examination to distinguish true anorexia from other somatic or mental illnesses (such as severe toxicosis, metabolic disorders, or profound impaired thinking with the formation of delirium), in which loss of appetite, weight loss, or both together are only secondary symptoms . At this stage, anorexia patients (in typical cases, adolescent girls) are characterized by hostility, depression, secrecy, and increased anxiety. They may complain of chilliness and constipation. Laboratory tests show signs of metabolic and hormonal changes characteristic of fasting. Despite the obvious danger associated with refusal to eat, patients do not want to change their behavior, have difficulty realizing their painful condition and stubbornly resist treatment. For example, a sick girl with a height of 173 cm and a weight of only 27 kg continues to consider herself full.
Marked weight loss, excessive weakness, dizziness, menstrual dysfunction, erosive and ulcerative lesions of the esophagus, enamel erosion of the inner surface of the teeth due to repeated vomiting, damage to the blood vessels on the face, and a decrease in heart rate and blood pressure are possible.
Thyroid dysfunction, secretion of growth hormone, as well as cortisol, gonadotropin and vasopressin are sometimes observed. With a prolonged course of anorexia nervosa, electrolyte imbalance due to potassium and sodium deficiency due to dehydration, muscle cramps and even cardiac arrest are possible.
If laxatives are used, then these disorders are further exacerbated by the loss of potassium.
Hypokalemia can cause arrhythmias, heart failure and is a threat to life.
In recent years, it has been shown that anorexia nervosa is not only a psychogenic problem. For example, it has been established that people suffering from diseases associated with eating disorders have a chemical imbalance similar to that observed in patients with depression.
It is also shown that in some cases, anorexia is a consequence of zinc deficiency.
Patients with anorexia nervosa may experience starvation complications. They may have moderate leukopenia and normocytic anemia; in addition, during a special examination, violations of endocrine functions can be detected with an increase in the content of adrenocorticotropic hormone and a shift in the hormonal pattern of the hypothalamic-pituitary axis to the pattern of the prepubertal period of life.
Such patients may develop various consequences of severe and prolonged vomiting. With repeated vomiting, so-called emetogenic disorders occur. Patients using large doses of laxatives to cleanse the gastrointestinal tract may develop particularly severe electrolyte abnormalities, in particular hypokalemia. Sometimes patients who take Ipecac may develop myopathy of the myocardium and skeletal muscle. And finally, in such patients, an increase in blood amylase concentration (usually saliva isoamylase) is not excluded.
Most anorexia patients benefit from inpatient or outpatient care. However, some still have chronic or prolonged eating disorders and body weight regulation. Mortality as a result of complete exhaustion reaches 5%, and the common cause of death is usually some common infection or irreversible metabolic disorders. A significant part of patients at a later age have obvious signs of psychosis, some (few) commit suicide.
The root cause of anorexia is unknown. However, it is believed that the main violations are associated with the initial sense of fear and the immaturity of the psychosexual sphere, which is accompanied by the rejection of any sexual activity and is the leading mechanism for the development of the disease. Patients' need to “control” their body indicates a latent fear of losing such control.
Numerous studies are currently underway aimed at elucidating the role of biological factors, hormonal or neurochemical, in the pathogenesis of this condition, but so far no such relationships have been found. Further studies are needed to clarify how common anorexia nervosa is. It remains, in particular, unclear why it is practically not found among the low-income strata of the population or among representatives of the black race.
Possible causes of anorexia
Who and why suffers from anorexia? Of course, most of the patients are girls aged about 14-28 years, who suffer mainly from the so-called anorexia nervosa. That is, they refuse food completely consciously, trying to reach the figure of a fashion model from a fashion magazine. But we will talk about this in the second part of the article.
Actually, the main causes of anorexia are diseases that, one way or another, affect the loss of appetite.
Here are just a few of them:
- Disorders of the endocrine system and metabolic disorders (insufficiency of the pituitary or hypotolamus function, lack of thyroid hormones, etc.)
- Digestive diseases (appendicitis, cirrhosis, gastritis, hepatitis)
- Diseases of the genitourinary system (e.g., chronic renal failure)
- Neurotic reactions and mental disorders (e.g. persistent anxiety, prolonged depression)
- Any chronic pain
- Poor oral hygiene
- An increase in body temperature (as a result of any disease)
Anorexia can be a consequence of taking or abusing certain medications. For example, this occurs when drugs of an unpleasant taste are used that suppress the function of the gastrointestinal tract or act on the central nervous system (for example, amphetamine, as in principle other psychostimulants, including caffeine), and some antibiotics
An increase in blood glucose as a result of intravenous infusion of solutions can also lead to anorexia.
Unfortunately, anorexia is found not only in adults, but also in very young children. It's just that the parents themselves are almost always to blame. Doctors found that anorexia in babies develops more often with forced feeding, violation of the rules of feeding. That is, interference with the child’s natural needs for food sooner or later leads to impaired appetite. And all these persuasion “a spoon for mom, a spoon for dad ...” often leads to the exact opposite result, when the child simply refuses to eat.
Psychological Characteristics of Nervous Eating Disorders
Psychological characteristics of risk groups
Most experts believe that there are a number of factors contributing to the development of eating disorders. Both researchers and clinicians are worried that the ideal woman is currently considered to be a very thin woman - with a figure unattainable for the vast majority, and this circumstance may increase the number of people at risk of contracting anorexia or bulimia. “Many women treat food as more than just a way to satisfy their hunger, they are terribly concerned about their weight,” says Lisa Silberstein, a private doctor. “Weight and food are a weak spot for many women.” Indeed, in a number of programs, there has been an increase in the number of older women among those who make careers seeking treatment for eating disorders. According to Dr. Silberstein, these are “super women” of the type “I want to be ...” who have adopted the opinion of society that in order to succeed, a woman must be fashionable, beautiful and wear the same size as a model."There are a number of studies that suggest that women who do everything to get close to such an ideal are at risk of acquiring an illness associated with malnutrition," she says."The image of a" superwoman"is an unattainable goal for them.
As well as attempts to become thin, like a model, when your genes dictate the opposite. “There are also biological differences that contribute,” says Dr. Silberstein. “At least the weight and body structure depend on the hereditary disposition. If a woman is prone to overweight, then her risk of getting sick increases because she can always feel somewhat full."
Researchers believe that one of the reasons why a very large number of diseases occur in adolescence is that at this time, when girls begin to notice boys, changes occur in their bodies associated with the deposition of more fat. Unfortunately, the natural ideal of the lines of the female body does not coincide with the accepted in our society. “Girls are programmed to increase body fat during puberty, and boys are programmed to increase lean body tissue, build muscle,” says Dr. Zilberstein. “At this age, boys' bodies become more like the bodies of adult men. A jump in growth is desirable for them."We conducted a study among college students to identify the causes of dissatisfaction with their bodies, and found that young men preferred to be more solid. This is completely excluded for women." Some researchers have suggested that anorexia is a way for young women to deny puberty. Probably, due to insufficiency of adipose tissue in patients with anorexia, menstruation does not occur and some secondary sexual characteristics are absent, for example, pubic hair. They seem to remain little girls. Their fear of fullness is essentially a fear of life. Other researchers point out that patients with anorexia or bulimia may seem like they are finally in control of their lives - or at least have found that they are able to control better than anything else. This is their greatest achievement on the road to excellence.
Although we are all subject to some degree to the influence of fashion quirks and public perceptions of how body weight should be, very few really suffer from anorexia and bulimia. Other factors may affect them. “There are people who are more vulnerable to cultural attitudes about how an ideal body should be. These are, for example, dancers and fashion models, ”says Dr. Silberstein. - Women who have an increased need for praise and are more dependent than usual on generally accepted standards are also at greater risk. The risk increases with a genetic predisposition to mental disorders, such as low self-esteem and depression."Studies have also shown that in some cases, but not always, there is an increased degree of family distress." In such families there is a higher incidence of other mental illnesses, including alcoholism and toxic mania, ”says Dr. Silberstein. In one study, 78 women with malnutrition found that 30 percent were sexually abused. However, when they dug deeper, expanding the concept of sexual abuse, this figure rose to 64 percent. Several other studies have reported that between one third and two thirds of women with eating disorders have been sexually abused in childhood or adolescence. A number of specialists, including Ph.D. Judith Rodin and Kathleen Pike (both of them from Yale University), turned to studying the relationship of the sick and their mothers. “These young women who have developed eating disorders are the daughters of the first generation of women who began to monitor weight,” Dr. Zil-Bershtein points out. In fact, a study conducted by Rodin and Pike showed that most often young women suffering from anorexia or bulimia were the daughters of mothers, overly concerned about their weight and encouraging the desire to lose weight with their daughters, because they found the daughters not attractive enough.
Psychological signs and features of the perception of the world in patients with anorexia nervosa and bulimia
Common to patients and anorexia, and bulimia is that they have a distorted view of their body. It does not matter how thin they are, they still consider themselves fat, although they know that by objective criteria they have low weight. Along with such a misconception, they deny the obvious. Many women with eating disorders refuse to admit that they are not okay, so it is difficult to treat them. “The degree of denial is very strong,” says Dr. Zilberstein. “Bulimia sufferers have continued to persist for years that the attacks of satisfying wolf hunger and the subsequent induction of vomiting are not associated with the disease, but simply a good way to lose weight.” In both anorexia patients and bulimia patients, controlling body weight becomes an important life goal. This for them, although unsuccessful, and in some cases life threatening, is a way to solve their problems. “Bulimi-ki, for example, often use food as a means of controlling their emotions,” says Dr. Silberstein. “For them, food can be a means to calm down and relieve stress. For many, food replaces company when they are alone.” Another reason why treatment is difficult is that treatment usually involves supplementation, which is painfully tolerated both physically and emotionally. Some centers use drugs to relieve the symptoms of indigestion and relieve the fear most women experience of weight gain using psychotherapy. In order to help women regain a more realistic picture of their body and reduce their sense of isolation and their own “abnormality,” which could make them deny that they are sick, they use group therapy.
Although women with eating disorders are usually immersed in caring for food and diet, many have little idea of the basics of good nutrition and need to be consulted by a specialist. They also have a poor understanding of what happens to them when they use food or a severe restriction in food to control - essentially, to relieve by starvation - deeply hidden feelings of anxiety and depression. “Often they need psychotherapy,” says Dr. Silberstein, “which should help them sort out their feelings.”
Clinicians have found that antidepressants may be helpful in treating eating disorders, especially for bulimia; For the treatment of women who, after satisfying the attacks of wolf hunger, induce vomiting, they increasingly use fluoxetine, which is marketed under the name Prozac. No one can tell how it works, but fluoxetine, used to treat everything from depression to compulsive and compulsive conditions, regulates the content of serotonin in the brain, the chemical responsible for mood changes that suppresses appetite. A doctor with amenorrhea patients can recommend estrogen replacement therapy to prevent an early decrease in bone density.
In some cases, family therapy is needed because the family, as Dr. Zilberstein says, continues to influence in a way that contributes to the progression of the disease. Depending on the condition, a woman can be treated on an outpatient basis or in a hospital. Even after successful treatment, residual effects are observed, although a woman who has been treated for an illness related to malnutrition may still experience some difficulties.
Psychological problems of patients suffering from anorexia nervosa and bulimia
In Western society, many — mostly women — feel as though they have been on a diet throughout their adult life, or have a short break between diets. Is it possible to be a woman in Western society and not fight for my weight? Who is responsible for social standards and pressure affecting such a huge number of women?
Distorted thinking in people with anorexia also manifests itself in poorly adapted to real life attitudes and improper self-perception. They often say to themselves:"I have to become perfect at all costs,""I will become better if I put myself in hardships" and"I will not feel guilty if I stop eating."
Anorexia sufferers experience various psychological problems. The experiments - the participants in them were people of normal weight who started to follow a half-starvation diet - showed that psychological problems result from starvation. People with this disorder often become depressed and have low self-esteem; someone starts having trouble sleeping, others are obsessed with obsessions. Such people can set firm cooking rules. In one study, subjects with anorexia and people with other obsessions got equally high scores when evaluating their degree of compulsiveness. In addition, those suffering from anorexia nervosa tend to strive for perfection in everything.
In one study, people look at their own photos through a lens and adjust it until they see, in their opinion, the real dimensions of their body. Deviations from the real image (left photo) can reach from minus 20% (middle photo) to plus 20% (right photo).
The number of young men with serious eating disorders is growing, and more and more of them are trying to get rid of this disorder. However, men make up only 5-10% of the total number having similar problems. The reasons for such gender differences are not entirely clear.
One possible explanation is that men and women are subjected to different social and cultural pressures. Thus, when conducting a survey, it was found that when college students are asked to describe the ideal male body, they usually speak of a"courageous, strong and broad-shouldered man", and when asked to describe the ideal female body - about a"slender girl with a slight shortage weight." Although the emphasis on a muscular, strong and athletic body, ideal for men, reduces the likelihood of mental disorders in men associated with the nutrition process, it can create other problems - for example, abuse of steroids or weight gain by increasing muscle mass.
The reason that women are more prone to mental disorders may also be that when trying to lose weight, men and women resort to different methods. According to clinical observations, in order to lose weight, men are more zealous in performing physical exercises, and women go on a diet. And a person who adheres to a strict diet is more likely to have nutrition problems.
Mental disorders associated with eating are diagnosed in men with greater difficulty than in women. Many of the men simply do not admit that they may have traditionally “female problems”. In addition, often in such cases, it is difficult for the doctor to identify the disorder due to the absence of obvious symptoms. The absence of menstruation is an obvious sign of anorexia in women, cannot be an indicator in men. And it’s much harder to test the male reproductive system — for example, test your testosterone levels.
Men who develop these disorders often have the same goals as women. Some of them, for example, admit that they would like to have not a strong, muscular figure with broad shoulders, but a"perfect, slender figure" close to the ideal figure of a woman. In many cases, however, the causes of the onset of the disorder are different for men and women. In men, for example, they are more often than in women caused by the needs of work or sport. According to one study, 37% of men with malnutrition had a job or were engaged in a sport for which weight control was very important, while in women this figure reached only 13%. The most common serious eating disorders are among jockeys, wrestlers, swimmers and bodybuilders. Jockeys usually spend about four hours in a sauna before racing, losing up to 7 pounds of weight; they can also limit food intake, take mild laxatives and diuretics, and force vomiting. Wrestlers also usually limit their food intake three days before the competition,"make weight", often losing from 2 to 12% of the mass. Some run around wearing several layers of warm or rubber clothing to lose up to 5 pounds of weight before weighing.
While most women with a disturbed diet are constantly worried about weight problems, jockeys and wrestlers tend to worry about it only during the sports season. After the competition, they begin to eat and drink hard to gain strength for training, and again remember the weight only before the next control weigh-in. These seasonal cycles of weight loss and recovery are harmful to the body, as this changes the athlete's metabolic activity, which directly affects his health.
The increase in the number of men with impaired diet attracts the attention of researchers, they are trying to understand what role gender differences and similarities play here and what factors influence in each case.
Diagnosis and treatment of anorexia nervosa and bulimia
Diagnosis of Nervous Eating Disorders
The film industry has brought to our life certain ideals of beauty: the desire to have a slim figure, to be sure to look like top models and pop stars. Not surprisingly, young girls who have not yet found their place in life and have not achieved their desired goals blame their appearance for everything. A sharp change in image in the form of dropped kilograms may seem to be the answer to all questions. Unfortunately, exhausting diets will eventually lead to a disease that will control every minute, every step of its victim. As a result of scientific research, it was noted that the risk of developing bulimia and anorexia is not associated with social status, income, profession, education and the nature of the victim. Psychologists note that women with a low level of self-esteem are most susceptible to the disease. They are impulsive and often complain of a lack of control over their lives. Scientists point to the large role of the hereditary factor in the occurrence of the disease.
Patients with this diagnosis usually have various phobias, panic attacks, fear, and a tendency to alcoholism. 50% of these women suffer from constant depression.
According to the data obtained, the likelihood of becoming a victim of a nervous breakdown in nutrition increases 2.2 times in women suffering from depression; 2.4 times - phobias; the likelihood of aggressive development of the disease increases 3.2 times in patients with alcohol dependence.
A correct diagnosis should be made even before the onset of the disease as an inevitable fact. The doctor must respond to any deviations associated with weight control: an obsessive desire to lose weight, exhausting workouts, painful perception of his body. It is not necessary to wait for more serious symptoms of a sharp weight loss, cessation of menstruation, exhaustion, severe and chronic fatigue, stopping or slowing down sexual development, and an increased risk of osteoporosis.
In addition to obvious symptoms, there are those that are almost impossible to diagnose until the following symptoms appear: a lack of vitamins, minerals, proteins and calories, the balance of which determines the development of a young body.
Often, when making a diagnosis, doctors are guided by general ideas about the disease, the so-called"myths". Consider the most rooted ones.
- In fact, people suffering from bulimia, anorexia nervosa and bouts of gluttony can be both complete and “chips”. The diagnosis has nothing to do with the size and body weight, the diagnosis follows from behavior and self-esteem.
- People suffering from such diseases are often accused of weak will, however, in reality, they are trying to solve the problem on their own, without outside help, although the latter will be necessary for them in the recovery process.
Despite the fact that these diseases are associated exclusively with women, 35% of the victims are men, 10% of them are middle-aged and 25% are children with a diagnosis of bulimia and anorexia nervosa.
The listed diseases are quite serious and dangerous, they can not be treated only as a consequence of one of the types of diets. 15% of patients diagnosed with"anorexia" die from a lack of food and essential elements for the body, approximately 1000 women die from anorexia or bulimia annually. One in ten illnesses results in suicide, heart attack, or exhaustion.
Diagnostic criteria for patients with bulimia nervosa
- Recurrent episodes of absorption of a huge amount of food, which are characterized by:
- the use of a very large number of products, much larger than those absorbed by most people over the same period of time and under similar circumstances;
- lack of control over food during this episode.
- Periodically arising unusual behavior, the desire to prevent weight gain through non-standard measures. For example, patients self-induce vomiting, in excess use laxatives, diuretics, cleansing enemas or other therapeutic measures, conduct fasting courses, and perform excessive physical exercises.
- The frequency of episodes of uncontrolled absorption of food and the above features of behavior is on average at least 2 times a week and lasts for 3 months.
- The shape and weight of the body exert an excessive influence on self-esteem of behavior.
- These disorders do not occur during episodes of anorexia nervosa.
Although some scientists believe that patients with bulimia nervosa are very similar to patients with anorexia nervosa, nevertheless, the former have less body shape, they have a slightly greater choice of treatment, and they are easier to treat.
Other signs of bulimia nervosa
Bulimia nervosa, like anorexia, occurs much more often in young women. Bulimia nervosa is more common, and according to various authors, it can be detected in 1-3% of all teenage girls and young women.
A characteristic feature of bulimia nervosa is that patients try to hide their irrepressible appetite or behavioral patterns, which usually appear during stressful situations. As a rule, it is not possible to detect vomiting in such patients, because patients can restrain it until they enter the toilet or bathroom. Although vomiting is the most characteristic compensatory reaction of the body and occurs in 80-90% of cases, approximately 1/3 of patients use laxatives to alleviate the condition.
Patients with bulimia nervosa have very big problems in establishing contacts with other people; unlike patients with anorexia nervosa, they often have a dependency on any substance, especially alcohol. In% of these patients, concomitant personality changes join.
With an objective examination, it is rarely possible to detect any obvious pathological changes. Patients with bulimia nervosa, as a rule, do not have nutritional disorders, they have a healthy appearance, and other people who are familiar with the patients well, even members of their families, sometimes may not know anything about their disease. An objective examination in patients with repeated vomiting reveals the same disorders as in patients with anorexia nervosa.
Methods for the treatment of nervous disorders of nutrition
The healing process is complex and painful. First of all, it is necessary to step over fear and insecurity in seeking help. Fighting alone is a lot harder.
Tips of American specialists:
- Eat whole foods, in particular grains or beans. The more refined foods we eat, the more we are hungry. It is not necessary to suffer from bulimia to realize this. Avoiding such products, you can get rid of dependence on them.
- Decide for yourself that you really want change. If someone decides for you, it will be very easy to sabotage the treatment.
- Appreciate your body. You do not have to be like others - stay yourself.
- Try changing your behavior yourself. Experts say that for many women it is very difficult, almost impossible. However, some do. The easiest way is for those who suffer from anorexia or bulimia for only a short time.
- Tune in to success. If you have bulimia, eat regularly. Severe hunger is a natural cause of gluttony, regardless of the presence or absence of bulimia.
- Consult a therapist. Find a specialist with whom you will feel comfortable. If you are in a good mood, your chances of recovery will increase.
- Try to contact a clinic specializing in the treatment of patients with eating disorders. Call there and ask what is the essence of their treatment program, how experienced are their specialists and what is the effectiveness of their treatment methods.
- 8. Have a physical examination, focusing the attention of doctors on your condition. You may suffer from a lack of vitamins and minerals. Specialists with extensive experience in treating diseases like yours are more likely to determine what you need.
In cases of extreme exhaustion, hospitalization and force-feeding may be required to save patients' lives. Psychotropic drugs - tranquilizers or antidepressants - seem to give only a short-term effect. Many doctors use family therapy, individual psychoanalysis, behavioral therapy and endocrine treatment as the main methods of treatment, all of which have approximately equal effectiveness. Currently, it is believed that the best results are given by a combined approach using some or all of the listed treatments.
Psychotherapy should be aimed at identifying the motives, feelings and aspirations of patients. The psychotherapist or the psychotherapeutic group must persistently and consistently, but extremely carefully, develop self-confidence and desire for healing in patients. Family therapy can help resolve basic family difficulties, for example, confused relationships between family members, excessive care and severity in relation to the patient, his inability to get out of conflict situations.
Due to the diverse and severe course of anorexia nervosa, it is necessary for experienced doctors to treat such patients in specialized centers. In this case, treatment must necessarily be multifactorial. Conservative treatment is aimed at restoring body weight and correcting metabolic disorders. Strictly speaking, patients with moderate (65-80% of ideal body weight) and severe (less than 65% of ideal body weight) weight disorders or a low prognostic nutritional index should be hospitalized in a clinic where they are prescribed special nutritional supplements with appropriate supplements .
It is imperative for such patients to apply psychological treatment - both independently and in combination:
- with behavioral therapy, for example, the development of various conditioned reflexes;
- with cognitive (cognitive) therapy, for example, assessment and study of distortions of thought processes;
- with family counseling;
- with pharmacological treatment, for example, the use of chlorpromazine or antidepressants.
As a rule, anorexia nervosa is caused by various psychosocial causes (for example, problems in the family, at work, etc.)
In those cases where no organic causes of anorexia nervosa were found, and the insufficient functioning of the thyroid gland, adrenal glands and sex glands (amenorrhea, irregular periods) are just a consequence of malnutrition, it is first necessary to exclude in the differential diagnosis hyperthyroidism, tuberculosis, malignant tumors, especially in genitourinary area.
The basis of the treatment of anorexia nervosa is the elimination of conflict situations (psychotherapy with the direct participation of family members) and the gradual bringing of the routine of life into a normal state.
Bulimia nervosa proceeds differently. Sometimes it takes a chronic course, sometimes relapsing, with various intervals of remission. The long course of the disease is not described.
Patients with bulimia nervosa are treated on an outpatient basis. The course of treatment includes both cognitive therapy (recognition of abnormal patient behavior) and therapy aimed at directly correcting abnormal behavior. Antidepressants are useful as part of complex therapy, and not as the only treatment.
Often, experts unfamiliar with bulimia nervosa themselves provoke this disorder in the patient, saying:"How can you eat like that? We must pull ourselves together! ” But after all, the disease just implies that a person is simply not able to pull himself together without outside help.
We believe that any correction of excess weight should be supervised by several doctors - nutritionists, endocrinologists, and, of course, psychotherapists. And, first of all, it is the therapist who should be responsible for the treatment, since only he can determine what kind of weight loss in the mental plan will be safe for each individual person. If there are symptoms of bulimia nervosa, then first you need to cure this disorder. To do this, we use a special program, which consists of a series of sequential psychological exercises. Their goal is to teach a person how to get out of difficult life situations without loss, to release the inner “I” and help to more fully realize it in practice. After working with us, a person ceases to avoid conflict situations and begins to look for new ways to relieve stress besides eating and smoking.
Typically, the program includes from 5 to 8 lessons, which are held for 2 months, followed by a one-year follow-up of the patient. The principle is that a person heals himself, and a psychoanalyst acts as a kind of coach to help a person develop and realize internal capabilities. And most importantly, what a person managed to achieve himself, no one will be able to take away from him. As it becomes part of himself, his inner being. In other words, a stable result and a complete lack of desire to “jam” your problems.
Psychological assistance for eating disorders consists of two parts or approaches: body-oriented therapy and psychoanalysis. Each of the approaches is a separate lesson, designed for 1-1.5 hours.
The idea of body-oriented therapy is as follows: all our thoughts, desires, dissatisfaction, etc. bear the imprint on our body. That is, if ever there has been dissatisfaction, fear, anger, anger, irritation, stress - all this is reflected on our body with certain blocks or clamps. Developing our body, or liberating it, we remove these blocks one by one. Simultaneously with the removal of blocks, the reverse process occurs at the mental level - we remove the stereotypes of stressful behavior in our minds, which are entrenched in us along with fear, anger, etc.
Classes in body-oriented therapy are composed of two blocks. Each block lasts 30-40 minutes (depending on the condition of the person).
The first block - in this case, these are body-building exercises, which are based on the Chinese health-improving gymnastics tai chi chuan. The second block consists of meditation practices, mainly relaxing, balancing, harmonizing, and most importantly - betraying self-confidence.
Psychological counseling is built on the canons of psychoanalysis and involves the identification of underlying motives for behavior that led to disorders.
Simultaneous work of two methods is supposed. Since in this case the maximum study of two levels at once is achieved: conscious and unconscious.
In the media there are many materials about anorexia and bulimia. One of the reasons for the growth of public interest is the tragic outcome that these diseases can have. In 1982, the nation was shocked by the death of Karen Carpenter, a popular singer and TV show host. The prevalence of such problems among teenage girls and young women is also of serious concern.
Practitioners now understand that the similarities between anorexia and bulimia can be as important as the differences between them. So, those suffering from anorexia, making sure of weight loss, can begin to overeat and some of them, thus, can develop bulimia. Conversely, people with bulimia sometimes develop anorexia.
The number of people prone to anorexia and bulimia is growing incredibly: thinness is becoming an obsession with a national idea. People tend to lose as many kilograms as possible and as a result reach a dangerous edge. Two nutritional schemes are possible here: restriction of consumed products and gluttony with subsequent cleansing of the stomach.
The main features of anorexia nervosa and bulimia are the desire for thinness, fear of weight gain, a biased attitude to food, cognitive disorders, psychological and health problems, including the absence of menstrual cycles.