Anorexia nervosa: what is it, stages of the disease

A disease based on exhaustion created artificially on the basis of a nervous disorder is called anorexia nervosa (anorexia nervosa). This pathology is accepted to allocate to a separate nosology, because everything associated with it, is beyond the boundaries of reason. You will learn more about the “plague” of the new millennium in this article. Affiliation with leptin, a hormone of fat cells, is obvious, but it is not at the head of the pathology.


  1. What it is.
  2. Criteria for the disorder.
  3. Triggers.
  4. Stages of development.
  5. Primary.
  6. Anorexic.
  7. Cachexia.
  8. Fading anorexia nervosa.
  9. Prognosis.

What it is

Anton Chekhov said that everything in a person should be beautiful: soul, body, thoughts and words. Who can argue with that? Keeping yourself in great shape is commendable. But no one has canceled the sense of proportion. Anorexia – beyond reason, but despite the clear awareness of all mankind, young people fall into its trap. Suffer neurogenic anorexia patients aged 10 to 40 years, mostly – women. There are several types of such a disorder, the causes of which vary, but anorexia nervosa – the most common variant. The essence is a mental imbalance of the patient’s life.

Anorexia nervosa was first spoken of in the 17th century, when the doctor R. Morton described the appearance of an 18-year-old female patient with poor appetite and digestive disorders. The girl’s condition could not be called other than depressed. She looked like a skeleton wrapped in skin. At the same time she absolutely refused to eat. The reason for her consulting a doctor was the fainting spells that had been bothering her for a couple of years. Morton referred to the condition as nervous consumption.

In Russia, the disease became known at the very end of the 19th century, thanks to pediatrician A.A. Kissel, who described a case of hysterical anorexia in an eleven-year-old girl.

Criteria for the disorder

The main visual sign of anorexia nervosa is a thinness that is conspicuous. It is not a slender, but a haggard body with lost proportions. Of course, not every thin person is anorexic, weight deficiency can be due to constitution (asthenic), somatic pathologies, severe infections and mental deviations from the norm. In other words, thinness alone is clearly not enough to make a diagnosis of anorexia nervosa.

There are a number of symptoms that help to clarify the presence of pathology:

  1. Weight deficiency of more than 15% of normal, weight retardation during puberty.
  2. Underweight is the result of the patient’s behavior, limiting the amount of food up to the complete refusal of food. At first only high-calorie foods are excluded, but gradually very severe restrictions are imposed.
  3. Application of pre-toxicating and detoxifying procedures: laxatives, diuretics, enemas, provocation of vomiting after a meal, use of appetite suppressants, physical hyperexertion.
  4. Constant fear of obesity.
  5. Disorder of the monthly cycle: absence of three menstrual periods in a row. Loss of libido.
  6. Delayed puberty, amenorrhea, underdevelopment of secondary sexual characteristics.
  7. Distorted perception of one’s own body.


The essence of anorexia nervosa is psychological. In the first place is stress.

Among the factors that provoke it special attention deserves:

  • physical or sexual abuse;
  • death of relatives and loved ones;
  • separation of parents in front of a child;
  • loss of a job, transition to a less creative and less paid job that does not meet a person’s needs.

Stress causes anxiety, instability. Sometimes a person feels like he or she has no control over his or her own life. In this case, controlling food becomes a substitute option. There is another side to the emerging disorder – it is the environment in which thinness is particularly respected and admired, while obesity is the opposite. This forces patients to resort to extreme measures.

A search for the answer to the question begins: why some people are able to hold themselves in check, not to loose, limiting their intake of food, and others – not. And the answer lies on the surface: it’s all about provoking factors.

It is primarily a question of the family environment. If one member of the family develops an eating disorder, the risk that others will also develop it increases. Girls are especially impressionable. Depressive moods of relatives, their addiction to alcohol and drugs aggravate the situation. In disharmonious families with difficult relationships, where misunderstanding, lying, indifference reigns – the most frequent cases of fatal anorexia. The reason is the complete absence of responsibility for the promise to eat normally, they are blindly believed, but no one is going to fulfill them.

Scientific studies have noted an interesting fact: in a large number of cases, people with anorexia nervosa lived together with a mother who overprotected her child. In this situation, the child lost the skill of psychological independence from the mother.

Since the time of growing up is also the time of formation of one’s own self, the formation of the child’s personality, anorexia nervosa in this period became an unconscious way of warding off the overprotective mother, the price being irrelevant. In this case, it is a way of self-destruction, especially of your body.

The desire for pathological thinness may have another reason: it may express an unconscious desire to maintain a connection with her father and mother. On a subconscious level, the girl is trying to stay small, not to turn into a mature woman, not to leave her parents’ house, to remain under her parents’ care. Another provoking factor of anorexia nervosa is age.

Most often the disease develops in adolescence or at most in women under the age of 40. Today there is a tendency to reduce the age of manifestation of anorexia nervosa: there are known cases where the disease affected girls 9 years old.

Separate attention is paid to personality traits, among which the most dangerous are:

  • excessive punctuality;
  • demanding, pushy, goal-oriented;
  • neatness;
  • a heightened sense of self-love;
  • low self-esteem;
  • unwillingness to bear responsibility;
  • constant comparison of oneself and others;
  • ignoring one’s own desires, living according to other people’s standards;
  • inability to cope with difficulties;
  • hysterical;
  • a lack of flexibility;
  • perfectionism.

There is also a hereditary predisposition. The serotonin and neurotrophic factor receptor genes are considered susceptible to anorexia nervosa. They are affiliated with leptin and control a person’s eating behavior. Concentrations of neurotransmitters also provoke the disease. Provocative factors, such as stress, and a certain personality, combined with expressive genes, may well become triggers in the formation of the pathology.

It is very frustrating that in a large number of cases of anorexia among adolescents, a silly remark by classmates about obesity, disproportionate figure, or an unpleasant nickname becomes the trigger for pathology.

Stages of development

There are four stages in the course of anorexia nervosa: primary, anorexic, cachexic, and the fading stage of anorexia nervosa.


It begins with the formation of the persistent idea of being overweight and lasts several years. Typical during this period is the phenomenon of dysmorphophobia – dissatisfaction with oneself in general and with specific parts of the body, their shape and proportions: the legs are fat, the sides are hanging, the cheeks are like Kolobok.

The patient becomes depressed and decides to get rid of these “flaws” by all means. In addition to being overweight, the concept of dysmorphophobia falls under and other imaginary flaws: a large or long nose, crooked legs, protruding ears. Such critical self-perception is typical for teenagers, therefore dysmorphophobia is formed most often during the period when the child’s body undergoes age-related changes in body proportions.

An adolescent chooses a role model and strives to match him or her. It does not matter who it is: a public figure or a school friend, a literary character or an acquaintance. At this stage, ideas and weight loss are carefully hidden. But there is a bad mood, up to depression, anxiety, physical disinhibition.


This stage is actually the process of losing weight. There are different ways of doing this. The main one is the denial of food. Initially, meals are skipped, only high-calorie foods are excluded, and calorie counting is begun, using special tables for each product. Over time, the diet becomes tougher, patients move only to plant foods, milk and its derivatives. Interestingly, at this stage, the appetite is preserved and patients on such a diet have a hard time: they have to resist hunger.

Inhibitions in the diet reach the point of absurdity. At the same time, patients with developing anorexic syndrome begin to feel dislike for their loved ones, for anyone of normal weight, and even more so for obese people. On the other hand, they actively cook different dishes, collect culinary recipes, watch cooking shows. Such patients enjoy licking spoons as they cook, eating with their eyes while strolling through markets and stores.

All thoughts of anorexic patients are about food. A person spends most of the day thinking about it. To forget about food, anorexics start drinking a lot of coffee, buying, drinking alcohol. Moreover, they take psycho-stimulants, the side effect of which is to block the feeling of hunger. When teenagers are forced to eat forcibly, they come up with thousands of different ways to get rid of food unnoticed: they throw up food, induce vomiting after every meal, take laxatives.

This is similar to bulimia, but it should not be confused with anorexia. With bulimia, the trouble is overeating and only then – getting rid of what has been eaten With anorexia – it’s the opposite, you can not allow the food to enter the body. Quite often there is a combination of the signs of both bulimia and anorexia, and the connecting link between them is considered leptin, which controls the appetite.

In the early stages of the disorder, anorexics do not practice vomiting after eating; instead, they put food in their mouths, chew, but do not swallow. Then they spit in silence. Sometimes there is no room in the anorexic’s room for bags of chewed food. Vomiting in anorexia is a conscious act, but sometimes it is involuntary. For example, when patients break down and overeat – the distended stomach cannot hold the food. At first, provoking vomiting is not easy, accompanied by severe discomfort.

Gradually the process becomes easier: just bend over and press on the epigastrium area – done! The empty stomach is as if regurgitated, as anorexics themselves say about it. Patients keep an eye on the amount of vomit, so that God forbid, they don’t leave extra volumes in the stomach. If they feel that regurgitation is not enough, they flush the stomach by drinking up to 3 liters of water. sometimes it comes to the probe.

Physical exertion requires special attention. Patients try to sit and lie down as little as possible, striving for constant movement. They work hard in the house: cleaning, ironing, cooking, being on their feet all the time. Teenagers can learn homework while standing on their feet or moving around the room, young mothers play with their children until they faint.

Anorexics, who have a distorted view of their bodies, overindulge in physical activity. Irrepressible physical activity often leads to injuries, the skin in the place of exposure is stretched, covered with cracks. Muscles are also traumatized.

Clothing is another problem. The waist is tightened with a corset, and wearing underwear is rejected so that it does not make you look fat. The psychological and emotional state of patients with anorexia nervosa is unstable. If they manage to get rid of extra pounds – it is a holiday, if not – bitter sorrow. Anxiety peaks at the moment of ingestion: every piece of food that enters the digestive system is a heavy burden on the soul.

Against the background of forming anorexia, patients become more egoistic, demanding of others for no reason. Often a real tyrant appears before the relatives. A distinctive feature of the disease is the prolonged maintenance of high physical activity against a background of exhaustion. In the second stage, patients lose up to 50% of their total body weight. Somatic or vegetative disorders also begin to develop, dysmenorrhea with subsequent amenorrhea becomes the norm.


While the first two stages of the disease are psychologically correlated, cachexia or emaciation is a change in the internal organs, sometimes completely irreversible. Fatty dystrophy causes muscles and bones to lose their strength and become brittle. Disorder of fat metabolism blocks the synthesis of leptin, which allows the cerebral structures to control the biochemical, energy processes in the body. As a result, the patient simply does not assimilate any food, and the cells and tissues that comprise them are deprived of nutrients. The result is complete exhaustion, asthenia, and lack of physical activity. This can cause a fatal outcome.

A severe consequence of lipodystrophy, which also provokes a fatal outcome, is myocardial dystrophy. That is, impairment of the contractile work of the heart with a drop in blood pressure and bradycardia. Body temperature is below normal, limbs are cyanotic. Somatics are primarily manifested in the digestive system. Because of the deficiency of visceral fat, the internal organs sink: gastroptosis by the type of nephroptosis.

This process is accompanied by pain syndrome during meals and after meals, with time pain appears before meals as well. Occur constipation, colitis, enteritis. A craving for laxatives provokes hemorrhoids, prolapse of the rectum. Apohecia nervosa causes decreased skin turgor, wrinkles, rough skin folds, hair loss, teeth crumbling. Vegetative disorders are manifested by dizziness, hyperhidrosis, shortness of breath, and heart rhythm disturbances.

In cachexia stage biochemical processes are blocked, water-electrolyte balance is disturbed. It is a terminal period associated with fatal outcome. Patients in cachexia require emergency hospitalization. On the physiological level, changes occur that affect the mental state of the person, depersonalization and derealization are observed. The own body is perceived erroneously, in practice a person is a skeleton covered with skin. There are known cases when girls with average height weighed 28 kg.

No strength to get out of bed. However, in the sick imagination prevails the idea that they have extra pounds and need to diet. In the “favorable” version, this is enough to reassure patients. They are satisfied with themselves. In reality, when admitted to the hospital, it is impossible to measure blood pressure, the volume of the arm does not allow, the cuff is not possible to fix. Weight loss is more than 50%. Disorientation of patients makes treatment difficult.

Fading anorexia nervosa

This is the final stage of suffering. With proper treatment, it is possible to correct the condition of patients in no more than six months, with the goal of gaining about 15 kg. It takes a year, at least, to normalize the period. Together with the balancing of the endocrine glands, the psychological state of patients is normalized in parallel. Taking into account the severity of the pathology and the prevailing symptomatology, the patient is treated in an outpatient or inpatient setting.

The goal of correction of anorexia nervosa is to restore the physiological functioning of the body, balancing the work of internal organs and systems. It is because of this, first resorted to general strengthening therapy with infusions, cardiopreparations, minerals, vitamin and mineral complexes. Appointed fractional feeding up to 7 times a day, sometimes resorting to the probing of food.

After the termination of the terminal phase of the pathology, restoration of physical parameters and health, the patient must necessarily undergo a course of restorative psychotherapy. In adolescence, in addition to individual psychotherapy sessions, family therapy is very effective.

Psychotherapy is the main method of treatment for anorexia nervosa. Its goal is to help the patient understand the root cause of the disorder, to teach the anorexic to perceive his body rationally, listening to its needs. Anorexia nervosa is not just a mental disorder, it is a threat to human life. The disease eats the patient from the inside, slowly but surely, affecting all levels of the body.

Maximum effectiveness in the correction of anorexia nervosa can be achieved with a treatment duration of at least six months. It is recommended to seek medical help at the first signs of pathology. Teenagers are in the zone of special attention. They need special attention and care more than others, but most importantly – understanding.


With timely and adequate therapy, the prognosis is favorable. Advanced forms of pathology are fraught with fatal outcome due to irreversible changes in internal organs.


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