Anorexia: an eating disorder

A psychological disorder belonging to a group of eating disorders affiliated with the fat cell hormone leptin is called anorexia. A characteristic sign of the pathology is dissatisfaction with your body and a desire at all costs, up to the refusal of food to stimulate your metabolism in order to lose weight. What are the main symptoms of the disease, its diagnosis and correction, you will learn from the article.

Contents:

1. General information.
2. Etiopathogenesis.
3. Classification and symptoms.
4. Complications.
5. Diagnosis.
6. Treatment.
7. Prognosis and prevention.

General Information

Anorexia is translated from the ancient Greek as “absence of urge to eat”. If the pathology has a nervous genesis, it is considered a separate form of eating disorder that accompanies metabolic disorders and mental disorders, as well as – infections and diseases of the digestive tube. Anorexia may be a consequence of bulimia or may provoke it. The prevalence of the disease is correlated with economic, cultural, national and family factors.

In Europe and Russia, the prevalence of anorexia in women aged 15 to 45 years reaches 0.5%. The global rates are equal to 0.3% to 4.3%. Statistically, the peak incidence occurs between the ages of 15 and 20 years, and accounts for about 40% of all patients. Men practically do not suffer from anorexia.

Etiopathogenesis

Anorexia is polyetiological and polymorphic. Its development requires a combination of several provoking moments: biological, psychological, micro- and macrosocial. The risk group includes girls from the socially well-off environment, striving for perfection in everything, but most importantly, dissatisfied with their obesity, who consider even a normal weight according to BMI to be great.

The triggers of pathology can be divided into several groups:

1. An inherited predisposition defined by several gene mutations that control the neurochemical factors of eating disorders. The serotonin-associated NTR2A gene and the BDNF gene, affiliated through the hypothalamus with leptin, have been sufficiently studied. There is genetic determinism of certain character traits that predispose to the disease.
2. Biological provocateurs, which are correlated with overweight, obesity, early onset of menstruation. The bottom line is dysfunction of neurotransmitters like dopamine and hypersynthesis of leptin, the hormone responsible for feeling full.
3. Microsocial factors play a large role in the formation of the pathology: the attitude of relatives and friends to extra pounds, thinness, and eating habits. Anorexia flourishes where attitudes toward food are disparaging, and food restriction is encouraged.
4. Personality – patients with the obsessive-compulsive personality type are a priori prone to the disorder. The desire for slimness, starvation, and hyperexertion are supported by low self-esteem and perfectionism, anxiety and insecurity, and hypochondria.
5. Cultural aspects also play an important role: there are countries where thinness is elevated to the rank of beauty, which forms in young people a desire to follow a style icon by all means.
6. Stress most often becomes a trigger for anorexia: the death of family members or loved ones, physical trauma, sexual abuse, uncertainty about the future, despair at not being able to achieve what they want. In all of these cases, weight loss is a substitute for failed self-actualization or an attempt to forget grief.

The key to the formation of anorexia is the painful perception of one’s body, imagined or existing defects – dysmorphophobia. Under the influence of triggers there are obsessive ideas, negative thoughts about extra pounds, obesity, own unattractiveness, even ugliness. This is usually a distorted image of the bodily self. In fact, the weight is normal or slightly higher, but under the influence of negativity, the patient’s emotions and behavior change, and thinness becomes the meaning of life.

The patient begins to practice severe dietary restriction, and the instinct for self-preservation is blocked. Metabolism slows down, synthesis of digestive tract enzymes, pancreatic hormone and bile acids is reduced. The process of utilization of the food lump causes discomfort, and then the digestion of food is simply blocked. Cachexia is formed with the risk of death.

Classification and symptoms

The course of anorexia is staged. In the first stage, which is called the initial stage, slowly but surely, the patient’s interests change. The idea of beauty, attractiveness becomes delusional, and this lasts for several years. Then comes the turn of the active anorexia stage, which is typified by a great desire to lose weight, which forms the corresponding behavior. In the final, cachectic stage, exhaustion occurs, critical thinking is lost, and the risk of death is real.

Depending on the clinic there are three types of anorexia:

1. With monothematic dysmorphophobia, or the classic version of the disorder, when the idea of weight loss is anchored by appropriate behavior.
2. With periods of bulimia, when hunger alternates with periods of disinhibition, in which gluttony develops.
3. With bulimia and vomitomania, when hunger alternates with gluttony followed by vomiting.

The main sign of pathology is a conscious minimization of the amount of food that comes into the body. This is possible in different ways. First, patients deceive their loved ones about their feeling of satiety: this is a real duel with leptin on a psychological level. They chew food for a long time, creating the illusion of eating a large amount of food.

Later, they begin to dine alone so that relatives don’t see how much is eaten during the meal, they avoid family gatherings and holidays for various reasons, they think up gastritis, ulcers, allergies, which require compliance with severe restrictions. In the late phase of suffering, eating may be stopped completely.

Chemicals are used to suppress appetite: psychostimulants, antidepressants, tonics, coffee and tea. As a result, addiction and addictive behavior are formed. Another way to lose weight inherent in anorexia is to stimulate the metabolism: exhausting workouts, saunas and baths, wearing layered clothing to increase sweating.

To keep food from being absorbed, vomiting is induced after eating it. At first mechanically, but then it becomes a reflex, and every meal is accompanied by similar symptoms. Sometimes diuretics, laxatives are taken to lose weight. It comes to the point of absurdity, it also becomes a reflex: when you take a pill, you have urine or stool, when you don’t take it, you don’t urinate or defecate.

A common eating disorder is an eating binge or excess: an uncontrolled binge of consuming large quantities of food in a short period of time. Patients do not choose their food, do not enjoy the taste of the food, and do not regulate its volume; they simply get full alone in order to relieve accumulated tension. After a bout of gluttony there is guilt, self-loathing, depression, and even suicidal thoughts.

Complications

Without psychotherapeutic and drug support, anorexia contributes to the development of many somatic pathologies, stunted growth and sexual development. On the side of the heart and blood vessels there are severe heart rhythm disorders up to cardiac arrest due to electrolyte deficiency in the myocardium. Patients’ skin becomes dry and pale, pastose due to protein deficiency.

The digestive system is affected by constipation, spastic abdominal pain. Endocrine complications are represented by hypothyroidism, secondary amenorrhea, infertility. Bones become brittle, fractures often occur, osteoporosis and osteopenia are formed. Continuous intake of psychoactive drugs, depressive state provoke suicides (about 20%).

Diagnosis

Anorexia has clear signs and it is not difficult to diagnose the pathology clinically.

But given the dissimulation of patients – the deliberate withholding of symptoms – five basic signs are necessary:

1. Body weight deficit of at least 15%, BMI of 17, 5 points, etc.
2. Weight loss is related to the patient’s own active actions, not to concomitant pathology.
3. Obsession or dysmorphobia: patient’s dissatisfaction with his/her body, inadequate assessment of weight and appearance, fear of obesity and desire to reduce weight.
4. Endocrine dysfunction on the hypothalamic-pituitary-gonadal axis, with the development of amenorrhea in women and loss of libido and potency in men.
5. Delay in puberty – absence of secondary sexual characteristics in puberty or their late formation.

The differential diagnosis is made with chronic diseases that provoke exhaustion and intestinal disorders, as well as with severe depression.

Treatment

The correction of anorexia is corrected by the severity of the pathology, its causes, the patient’s age, and his mental and physical condition. Treatment can be at the level of an outpatient clinic or inpatient care, up to and including resuscitation. The essence is the restoration of somatic health, the formation of an adequate view of one’s own body, the balancing of the diet.

Comprehensive patient support consists of three components:

1. Diet therapy, when the doctor tells the patient and his relatives about the importance of sufficient intake of proteins, fats and carbohydrates, explaining the consequences of starvation. The daily menu correcting anorexia is prepared taking into account the patient’s taste, and the caloric content of the diet is increased gradually. In severe cases, food is first fed with intravenous glucose solutions, then with nutritional mixtures, only at the end of the course of treatment – normal food.
2. Psychotherapeutic help, in which the most effective is a conversation with the discussion of the features of the disease, possible consequences, the presence of a choice of further behavior of the patient. It is important to form a correct perception of one’s body, minimize anxiety, and resolve internal conflict. At the stage of behavioral correction, techniques are mastered that are designed to restore normal eating habits and the normal perception of food.
3. Medications, among which sex hormones and H1-histaminoblockers are considered the most important in puberty. The former are used for replacement therapy, the latter for weight gain. Neuroleptics eliminate motor agitation and help weight gain, antidepressants level depression, SSRIs (selective serotonin reuptake inhibitors) are used to reduce the risk of relapse in patients with restored nutrition and weight gain.

Prognosis and prevention

The outcome of anorexia correlates with the timeliness of treatment: the earlier it is begun, the better. In other words, the more favorable the prognosis. Recovery is possible with a comprehensive approach to therapy, family support and elimination of triggers of pathological changes. Prevention is the prerogative of the integrated efforts of the state and the family. A healthy lifestyle, sports, a balanced diet, and control of a normal weight are necessary. Joint family lunches and dinners with positive emotions are very useful. Even more important is the formation of children and adolescents the right attitude to their appearance, which today promotes a whole trend in cosmetology – body positivity.