Anorexia nervosa - Causes, Symptoms and Treatment .MF .
This disease occurs mainly in girls during puberty, at least - in young women and young men.It manifests an obsessive fear of unjustified overweight, forcing sharply limit the power, as well as a violation of an adequate perception of the body.
Anorexia nervosa - it is a disease, the main manifestation of a refusal of food associated with changes in the neuroendocrine system.
Symptoms of anorexia nervosa
can distinguish 4 stages of anorexia nervosa:
1) primary, initial .
lasts from 2 to 4 years.It is characterized by Dismorphomania syndrome - delusional or overvalued ideas of discontent own appearance, the idea of relationships, depression and lack of desire for an imaginary correction.Teenagers might not like any of their "correct figure" as a whole or parts of the body, "round cheeks", "fat belly", "rounded hips."The emergence of discontent own appearance coincides, as a rule, the real change in body shape, typical of adolescence.Thoughts about excessive fullness can be either overvalued
Ideas relationship with anorexia nervosa very rudimentary.The decisive in the formation of the syndrome is often a discrepancy between the patient, in his opinion, his own "ideal" - a literary hero or a person's inner circle with the desire to imitate him in everything and above all have a similar appearance to it and figure.The opinion of others on the exterior of the patient is much less important to him.However, the high sensitivity and vulnerability of adolescents causes that trigger the desire to "correct" physical disability become careless remarks of teachers, parents and peers.
affective disorders (mood disorders) - if this disease, also have features.Depressive disorders are generally less pronounced and more remote stages are closely related with the degree of effectiveness of the exterior of the correction carried out by patients.
Dismorphomania Among the features of anorexia nervosa should include the fact that the possibility of correcting the alleged or actual physical shortage lies in the hands of the patient, and it is always one way or another it sells.
2) anorectic stage begins with an active commitment to the correction of appearance and weight loss probation ends at 20-50% of the initial weight, the development of secondary somatoendokrinnyh shifts oligoamenorei (reduction of menstruation in girls) or amenorrhea (cessation of its total).
weight loss methods can be very varied and carefully hidden at the beginning of the correction of excessive fullness.Initially, most physical activity, active sports patients combined with limited amounts of food.By reducing the amount of food, patients initially exclude a number of foods rich in carbohydrates or proteins, and then begin to comply with the most severe diet and eat mostly dairy-vegetarian food.When dissatisfaction with body parts such as the abdomen, thigh, while patients with a strict diet to exhaustion engaged specially designed exercise - doing all standing, a lot of walking, reduces sleep, tightening the waist with belts or cords so that the food is "slowly absorbed."Exercises such as "plies - unbending" the rising weight loss is sometimes so intense that lead to skin injury in the sacrum, shoulder blades, along the spine, on the site of constriction waist.Hunger may not be available in the early days of limited food, but more pronounced enough in the early stages, which significantly interferes with the actual denial of food and requires that patients search for other ways to lose weight.These include the use of laxatives, often in very large doses, less use of enemas.These measures may lead to weakness of the sphincter, rectal prolapse, sometimes quite substantial.
Another very common way to lose weight with the severity of hunger is artificially induce vomiting.Choosing this method often is conscious character, although sometimes patients come to him by chance could not resist the desire to eat, they eat a lot of food at once, and then because of the fullness can not keep her.The resulting vomiting and lead patients to believe there is sufficient and quickly released from the food intake has not happened yet, with the help of artificial vomiting.Initially, some patients chew and then spit out the food, making room packages and banks with the chewed food.
In the earlier stages of the gag act is accompanied by characteristic autonomic manifestations and delivers patient discomfort.In the future, with frequent vomiting, this procedure is simplified: patient enough to make expectorant movement or just tilt the trunk, click on the epigastric region and all eaten food is thrown out without painful autonomic manifestations.Patients call it a "regurgitation."First they carefully compared the amount of food eaten and vomit, have resorted to repeated washing of the stomach - after the first vomiting, drinking 2-3 liters of water, in some cases, this is done with a probe.Artificially caused vomiting in some patients is inextricably linked with bouts of bulimia.Bulimia is an irresistible hunger, almost no satiety, while patients can absorb very large amounts of food, often even malosedobnoy.
Thus, the pathology of eating is formed in the following order: first, patients are shopping and "visually gorge", with the same purpose, strive to prepare meals, while experiencing great pleasure, lick leftovers with knives and spoons.A characteristic feature of these patients is often a desire to "zakarmlivat 'relatives, especially younger brothers and sisters.The next stage of the fight against hunger - it is chewing and spitting, then - artificially induce vomiting, in a number of observations in the future associated with bouts of bulimia.
whole day sick starving, constantly thinking about food, imagining all the nuances of the upcoming meal.Thus, the thought of food becoming intrusive.Having bought a lot of food, and sometimes stealing them, the patients returned home, lay the table, it is often beautifully served, and start eating the most delicious food to enjoy.However, they can not stop and eat all the food available in the house.The loss of a sense of measure, control of quality and quantity eaten is very characteristic of bulimia.Some patients currently harvested whole malosedobnoy cans of food to ensure "Jordania".Eating huge amounts of food, patients experience euphoria, they are vegetative reactions.Following this, they artificially induce vomiting, the stomach is washed with plenty of water.There comes a feeling of "bliss" extraordinary lightness throughout the body, supported by confidence in the fact that the body is completely free of food (light washings without a taste of the gastric juice).
Passive methods of weight loss should also include the use of a number of drugs that reduce appetite, as well as stimulants, especially sidnokarba.In order to lose weight many patients start to smoke, drink large quantities of black coffee, use diuretics.
important place in the clinical picture of the disease take hypochondriacal disorder.Secondary gastroenterokolity, omission of virtually all internal organs and especially gastroenteroptoz, developing as a result of restrictions in food or improper feeding behavior, accompanied by pain in the stomach and along the intestine after a meal, persistent constipation.There is a lock on the patients discomfort in the gastrointestinal tract.Typical for this phase of anorexia nervosa is due to the fear of food not only fear to get better, but also the possibility of occurrence of painful sensations in the epigastric region.By psychopathological disorders of this period are unique obsessive phenomenon.They are inextricably linked to dismorfomanicheskimi experiences and manifest themselves in the form of obsessive fear of food, wait for a strong sense of hunger, the need to induce vomiting and compulsive counting calories contained in the food eaten.
Despite significant weight loss in patients with virtually no physical weakness, they are very agile, activity, performance.The clinical picture of the disease in the anorectic stage often also includes autonomic dysfunction in the form of attacks of breathlessness, palpitations, dizziness, sweating reinforced that occur several hours after a meal .;
During this period of the disease in the clinical picture is dominated by somatoendokrinnye violations.After the occurrence of amenorrhea, weight loss significantly speeds up.Patients completely absent subcutaneous fat, growing degenerative changes in the skin, muscles, developing myocardial and there are bradycardia, hypotension, akrotsianoz, drop in body temperature and skin elasticity, reduces blood sugar levels, there are signs of anemia.Patients quickly freeze, there is increased fragility of nails, hair fall out, broken teeth.
a result of prolonged malnutrition, as well as (in some patients) special eating heavier clinical picture of gastritis and enterocolitis.At this stage, physical activity, typical of earlier stages of anorexia nervosa, is greatly reduced.The leading place in the clinical picture takes asthenic syndrome with prevalence adinamii and increased fatigability.
During severe cachexia patients completely lose their critical attitude to his condition and still continue to stubbornly refuse to eat.Being extremely exhausted, they often say that they have an overweight or are satisfied with their appearance.In other words, there is a delusional attitude toward their appearance, based on which, apparently, is a violation of the perception of their own body.
With increasing cachexia patients become immobile, lie around in bed, they have persistent constipation, significantly reduced blood pressure.Severe water and electrolyte shifts can lead to the development of painful muscle cramps, sometimes possible polyneuritis (nutritional polyneuritis) Such a condition without medical care can be fatal Usually in a state of severe cachexia, for health reasons, often by violent means, because patients do not realize the seriousness of their situation,they are hospitalized.
4) a step of reduction of anorexia nervosa.
During removal from cachexia leading position in the clinical picture belongs - asthenic symptoms, fear to get better, pathological fixation on the sensations from the gastrointestinal tract.With little weight gain again updated Dismorphomania appears the desire to "correct" appearance, increases depressive symptoms.With the improvement of physical condition of physical weakness quickly disappears, patients again become very mobile, eager to carry out complex exercise, may resort to high doses of laxatives, after feeding try to induce vomiting.All this requires careful monitoring of patients in the hospital.For 1-2 months with proper treatment, patients completely out of cachexia - picking from 9 to 15 kg, but the normalization of the menstrual cycle requires significantly more time (6 mes- 1 year from the start of intensive treatment).Until the restoration of menstruation mental condition characterized by mood instability, periodic updating dismorfomanicheskih phenomena, explosive, prone to hysterical forms of response.During the first 2 years of the possibility of expressing syndrome relapses requiring hospital treatment.This stage should be seen as a reduction of the syndrome.
Along with an exemplary embodiment of anorexia nervosa in clinical practice, there are varieties of this disease, with the symptoms of the most different from the typical predanorekticheskom on stage.It is primarily concerned with the reasons for refusal of food, which may be delusional reasons not related to the patient's appearance.Most often, this hypochondriacal delusions ( "not digested food" contained in food substances "violate the metabolism, spoil your skin" and so on. D.).Self-restraint in eating may be due to fear of choking food or fear of vomiting in a public place in the presence of recorded vomiting reaction.Despite the significant weight loss due to the restriction of food intake, these patients rarely comes amenorrhea.Depletion usually does not reach cachexia.However, in the more remote stages of the disease may be formed a special relationship to their appearance without the desire to get better, even though underweight.
Causes of anorexia nervosa
To form the syndrome of anorexia nervosa requires a number of conditions, both social and biological.Important role in the development of anorexia nervosa belongs to heredity, exogenous hazard in the first years of life, personality traits microsocial factors (role of the family).
Exhaustion, depression, stress, aversion to food.
Over the past 20 years in developed countries increased the number of patients with anorexia nervosa.With a frequency of 1 in 90 cases of anorexia occur among girls aged 16 years and older.
How is anorexia nervosa
disease is common among teenage girls who lose weight by at least 15% -40% of normal.The loss of body weight caused by the patient by avoiding food that is "complete".Patients cause vomiting, taking laxatives, doing a lot of exercise, use the means suppressing appetite or taking diuretics.distorted perception of their body, there is a fear of fatness, the patient finds himself only valid for low weight.At the same time develops exhaustion, poor tolerance of heat and cold, chilliness, reduced blood pressure, disappearing menstruation, stops the growth of the body, patients are aggressive, poorly oriented in the environment.
Treatment of anorexia nervosa
Most patients go to the doctor even before the development of severe malnutrition.In such cases, recovery can occur spontaneously without medical intervention.In severe cases, medical assistance includes mandatory inpatient treatment, the purpose of drug therapy, psychotherapy, the patient and family members, restoring normal diet gradually increasing caloric intake.
Schematically, the treatment can be divided into two stages:
I stage, aims to improve the physical condition, its purpose - to stop weight loss, to eliminate the threat to life, to bring the patient from a state of cachexia.
II stage involves treatment of the underlying diseases using pharmacological agents, and various methods of psychotherapy.Regularly patients should be reminded that the realization of their aspirations related to their studies, are interested in the work, the situation in the family and society, to a large extent depends on their own efforts in the fight against pathological fixation on their appearance and nutrition.They need to make clear that public benefit activity should distract them from concerns over the body and help avoid repeated weight loss.