A whole group of psychogenic syndromes concerning food intake and utilization by the body is called eating disorders. The symptoms are different, but the causes are similar. The essence is the same – loss or gain in weight. How such conditions are diagnosed and treated, you will learn from the article.
- General information.
- Classification and symptoms.
- Prognosis and prevention.
Eating disorders are classified separately in the International Classification of Diseases. What they have in common is the striking difference between the physiological need for food and the patient’s desire, expressed as overeating or malnutrition. The peak of pathology development is puberty and adolescence. Eating disorders have a pronounced gender coloring: up to 95% of patients are girls and women.
Psychologically determined overeating according to the latest data is affiliated with the adipose tissue hormone leptin. These problems most often occur in well-to-do families with a high level of income and education. Not long ago, they were considered the prerogative of economically developed countries, but with the development of the Web and the ubiquity of information about everything has become the global “domain”.
Aside from gender coloring and age peaks, no endemicity, seasonality, or racial preferences have been identified in the diseases.
Triggers for eating disorders are physiological and psychological issues, and patients’ social relationships. The specific cause is determined by the physician. As a rule, it is a combination of several factors.
The main ones among them are:
- Emotional instability, low self-esteem, suggestibility and other psychological features. Adolescents are at risk.
- Eating habits of the family.
- Beauty ideals, where thinness is associated with success.
- Endocrine disorders.
- Mental illnesses: depression, bipolar disorder, schizophrenia, affect.
Pathological changes in eating disorders occur at the psychological and physiological level. First, an imbalance is formed between the need for food and its intake. The desire to eat determines the obsession, motives and behavior. In anorexia, the thought of losing weight prevails, in bulimia nervosa – the fear of being obese, in psychogenic overeating – the desire to relax.
Sometimes the ideas take on an unusual character: fear of only specific foods, for example. Following the psyche, the pathological process includes digestion with a violation of the process of food processing and assimilation. This leads to a lack of nutrients, vitamins, trace elements.
Classification and symptoms
Eating disorders are varied. The most popular have become separate nosologies, and rare ones continue to be investigated. These are: orthorexia nervosa, druncorexia, selective eating.
Today, they are distinguished:
- Anorexia nervosa with dominant weight loss by any means.
- Bulimia nervosa with bouts of overeating, feelings of guilt and artificial emptying of the digestive tube.
- Psychogenic overeating with gluttony to stress.
- Psychogenic vomiting with bouts of overeating against a background of emotional overload.
- Ingestion of inedible or inorganic material: clay, chalk, leaves.
- Psychogenic loss of appetite against a background of long-term depression, psychological trauma.
Signs of psychogenic anorexia include exhaustion, obsessive desire to lose weight, fear of weight gain, unwillingness to maintain a normal weight, distorted body image. Patients emphasize strict diets, eat once a day, and if they break such rules feel guilty. They artificially induce vomiting, take laxatives, diuretics. They have a distorted perception of their bodies and lose critical judgment. Patients consider themselves obese if they weigh absolutely normal or even slightly less than this. They are withdrawn, depressed, socially distant.
Bulimia exists in the form of episodes of uncontrolled gluttony, which is associated with a disturbance of the synthesis and perception by the hypothalamus of leptin, a hormone of fat cells. Overeating alone without other people’s eyes is followed by artificial release from the food eaten. no matter what it is: vomiting, enema, laxatives.
This is followed by a period of torturing the body with physical hyper-exertion, abuse of laxatives. Fear of fullness prevails over common sense. The cycle of overeating and purging is repeated several times a week. At the table together with friends, patients behave absolutely normally.
Psychological overeating is gluttony against the background of stress, overexertion. Patients do not feel satiety, which is also associated with the level of leptin in the blood, they eat to the discomfort in the stomach, nausea. They realize that they have lost control over their actions, but are powerless to restore it. The feeling of shame is a source of additional experience, which again provokes overeating.
Psychogenic vomiting is the result of a stressful external situation and internal feelings. It occurs spontaneously and is uncontrollable. The attitude to food is indifferent, appetite is absent, patients are reluctant to eat, skip meals. There is also an obvious connection with leptin, which controls the feeling of satiety.
The most serious complications associated with eating disorders relate to the digestive system: avitaminosis, mineral deficiencies, pathologies of the digestive organs. In second place are disorders of bone tissue: osteoporosis and osteopenia. Then come anemia, hypotension, asthenia, myotonia, stratified nails and dry skin. In severe cases, fatal outcome. Complications of psychogenic vomiting and bulimia include tonsillitis, chronic aspiration inflammation, destruction of tooth enamel, intestinal and kidney problems, dehydration.
The first evaluation of patients with eating disorders usually occurs one to three years after the onset of the disease. During this period, the patient seeks medical care for somatic symptoms: digestive disorders, weakness, chronic fatigue, weight loss. The diagnosis is made by a psychiatrist or psychotherapist with the participation of the therapeutic specialists.
Special techniques include:
- A conversation to elucidate the circumstances of the pathology, dietary habits, habits.
- Personality questionnaire, aimed at identifying character traits, emotional stability or lability, social problems, relations with others.
- Projective techniques – drawings and test interpretations, which give an opportunity to reveal the patient’s hidden fear of obesity.
The pathology is differentiated with various psychoneurological and somatic disorders. For this purpose, laboratory testing and instrumental examination are performed.
Therapy is complex, multidirectional. Special treatment aims at the correction of emotional and personal problems, the restoration of normal socialization, eating habits. At the same time, physiological problems that are provoked by improper nutrition are removed.
Medical care involves:
- Psychotherapeutic measures in individual and group order.
- Drug therapy to correct appetite and emotions: tranquilizers and antidepressants in dosages selected by the doctor.
- Rehabilitation period with consolidation of the results achieved in everyday life.
Prognosis and prevention
The prognosis correlates with the type of disorder and the timeliness of the initial treatment. It is favorable in the absence of severe concomitant pathology. Prevention assumes proper nutrition since childhood, acceptance of the body as it is in adolescence (body positivity), the ability to withstand stress, release emotional tension with sports activities, creativity, and the ability to calmly resolve arising conflicts.