Anorexia Nervosa - Anorexia

Generality

Anorexia nervosa is a particularly severe eating disorder. Those affected are against a marked loss of weight, due to the morbid fear of gaining weight and a distorted view of their body image.

The triggering causes are unclear. In this regard, doctors have formulated various theories, which start from the assumption that, at the origin of anorexia nervosa, there is a set of biological, psychological and environmental factors.

The symptomatology of anorexia nervosa is very broad and depends mainly on the fear of gaining weight. This fear means that the patient does not feed properly and, for this reason, develops a series of problems linked to the absence of food.

The therapy includes psychotherapy treatments and interventions aimed at restoring normal body weight.

What is anorexia nervosa?

Anorexia nervosa, or simply anorexia, is a serious eating disorder which, in those affected, is a reason for:

excessive weight loss,
a strong fear of gaining weight
a distorted view of one's body image.

The anorexic subject, in fact, is very thin, constantly monitors his body weight, avoids eating and sees himself more "fat" than he actually is.

Anorexia nervosa disrupts a person's life, as the thought related to body weight interferes with any other daily activity, from school or work to interpersonal relationships.

Epidemiology

Anorexia nervosa is a purely female eating disorder, although, in recent years, it is spreading more and more even in the male population.

According to some estimates, relating to the Western world, women with anorexia nervosa would be between 9 and 43 per 1, 000 (ie between 0.9 and 4.3%); while, men with anorexia nervosa would be at most 3 per 1, 000 (ie about 0.3%).

In general, affected individuals are adolescents, aged between 14 and 17 years.

Causes

The precise causes of anorexia nervosa are unclear. According to doctors and experts in the field, a set of biological, psychological and environmental factors would contribute to its appearance.

BIOLOGICAL FACTORS

Based on some scientific findings, some researchers claim that the onset of anorexia nervosa is linked to a genetic predisposition .

In other words, they believe that the expression of certain genes is a factor favoring anorexia nervosa.

At the present time, the aforementioned theory still has some outstanding points, which only future research can definitively clarify.

PSYCHOLOGICAL FACTORS

By analyzing the psychological profile of people with anorexia nervosa, experts in the field of eating disorders have noticed that many sufferers have in common a certain type of character / behavior . For this reason, they thought that the appearance of anorexia nervosa is linked, in some way, to the personality and behavioral traits of an individual.

Going into the details of the aforementioned study, the persons predisposed to develop anorexia nervosa would be:

Those who have a marked tendency to suffer from anxiety or depression.
Those who have difficulty managing stress.
Those who are easily worried by thinking about the future or who are, for some reason, afraid.
The perfectionist subjects, who habitually set themselves rigorous goals and who are very demanding of themselves.
Particularly reserved individuals.
Those who have obsessions / compulsions or who suffer from the so-called obsessive-compulsive disorder.

ENVIRONMENTAL FACTORS

Premise: an environmental factor is any circumstance, event or habit that can affect the life of an individual to a certain extent.

According to the opinion of doctors and specialists in eating disorders, the most important environmental factor, associated with the appearance of anorexia nervosa, would be the media exposure to the "thin equal beauty" myth, typical of modern Western culture.

Moreover, if we consult any magazine or watch television, we have a high probability of running into advertisements that have women and men as protagonists, so often successful, with a dry body and no blemishes.

Besides the exaltation of the thinness made by the media, other environmental factors that seem to contribute, more or less markedly, to the development of anorexia nervosa are:

The practice of sports or work activities where it is important to have an extremely thin body. This is the case, for example, of those who do dance or artistic gymnastics or models and models that parade by profession. For all these individuals, weight control is a must.
Emotional stress that can sometimes result from the death of a loved one, a change of residence or school, the loss of work, the end of a couple's relationship, etc.
The anatomical changes that occur during puberty. During the years of puberty, the human body undergoes various modifications. If particularly evident, these modifications could represent a profound discomfort for some individuals, especially if the latter are the object of ridicule or particular attention by their peers.
This would explain, in part, why anorexia nervosa affects mainly young subjects.
Membership in the female sex. Compared to men, women pay more attention to body weight and this could be the reason why they are more prone to getting sick from anorexia nervosa.
The presence, in the family, of people with anorexia nervosa or other similar eating disorders. Situations of this kind could involve, emotionally, some family members and induce, in the latter, the development of problems of the same nature. In general, the subjects who are most impressed by the sight of a family member with anorexia nervosa are adolescents.
A poorly controlled weight loss diet.
Being victims of physical violence or sexual abuse. According to some studies, there is a certain correlation between episodes of this kind and anorexia nervosa.

Symptoms and Complications

To learn more: Symptoms Anorexia: how to recognize it?

Anorexia nervosa presents a series of physical symptoms and signs and a series of behavioral manifestations.

Physical symptoms and signs are the consequence of insufficient nutrition (physical symptoms), while behavioral manifestations depend on the fear of gaining weight and on the distorted view of one's body image (behavioral symptoms).

PHYSICAL SYMPTOMS

Inadequate nutrition leads to numerous physical consequences. In fact, it determines:

Weight loss. Generally, in patients with anorexia nervosa it is extreme.
Obvious thinness
Sense of recurrent fatigue. The sick feel it more when they begin to make movement.
Insomnia
Dizziness and vertigo
Bluish coloration of the fingers
Thinning, breakage and / or hair loss
Constipation
Absence of menstruation, in women
Lanugo, that is the appearance of a fine and soft hair in some parts of the body (for example the face)
Dry and / or yellowish skin
Cold intolerance
Heartbeat Abnormalities (Arrhythmias)
Hypotension
Dehydration
Osteoporosis
Edema in the arms and legs
Anomalies in the number of blood cells
Reduced libido, that is, poor sexual drive

BEHAVIORAL SYMPTOMS AND EMOTIONAL SPHERE

The fear of gaining weight and the conviction of being fat induce people suffering from anorexia nervosa to assume abnormal behaviors, aimed at weight loss.

These anomalous behaviors usually include:

The observance of a highly restrictive diet, if not a real fast . This, then, is what causes the above physical manifestations.
The exhausting and continuous practice of physical activity .
Self-induced vomiting, to eliminate the food taken and which the patient believes can induce weight gain. In general, this behavior is also associated with the intake of laxatives, diuretics, purgatives and other similar products.
The obsessive count of calories taken daily.

The fear of gaining weight and the idea of being fat strongly affect the life of a person suffering from anorexia nervosa. Indeed, the latter is generally a subject that:

He is concerned almost solely with food and measuring his body weight.
Skip canonical meals.
He is in a flat mood and lacks emotions.
It isolates itself from the social context and struggles to establish / maintain relationships with other people.
He is irritated or tends to get irritated easily.
Mind about everything about food, claiming to have eaten when, instead, it is not.
Mind on its weight.
Suffers from moments of depression.
He has suicidal tendencies (in the most serious cases).

WHEN TO REFER TO THE DOCTOR?

Generally, patients with anorexia nervosa tend to refuse any medical consultation and to avoid any treatment. In fact, they struggle to admit their problems.

To convince them otherwise, it is essential to support relatives and friends, who must insist, in all ways, on the importance of starting an ad hoc therapy.

Some patients are good at concealing the aforementioned symptoms and weaknesses and this could complicate the situation.

It is important to act promptly, because, due to prolonged fasting, the health conditions of the patients could worsen markedly, to the point of seriously endangering their lives.

COMPLICATIONS

Anorexia nervosa can have various complications, which can greatly affect the health and well-being of those affected.

Some of the most important complications are:

Anemia;
Heart problems, such as mitral valve prolapse, cardiac arrhythmias and heart failure;
Muscle problems (muscle atrophy) and / or bone (osteoporosis);
Sexual problems, such as infertility (in women) and erectile dysfunction (in men);
Circulatory problems, such as persistent hypotension;
Gastrointestinal problems (constipation, abdominal bloating, abdominal pain, etc.) with a persistent character;
Kidney damage;
Anomalies affecting the electrolytes present in the body. Generally, potassium, sodium and chlorine levels tend to change;
Damage to the brain and peripheral nerves;
Persistent depression and / or anxiety;
Personality disorders and obsessive-compulsive disorders;
Dependence on alcohol or other substances.

Diagnosis

Faced with a suspected case of anorexia nervosa, doctors generally resort to scrupulous physical examination, to some laboratory tests, to an evaluation of the psychological profile of the patient and to some instrumental tests for the evaluation of the health of certain organs vital (heart first).

Although they are not specific, these tests are very useful, as they usually allow to establish with precision what the current problem is.

For the purposes of a correct diagnosis of anorexia nervosa, it is also important to remember the importance of consulting the so-called Diagnostic and Statistical Manual of Mental Disorders (DSM).

The DSM is a collection of all the peculiar characteristics of known mental and mental illnesses, including the respective criteria required for diagnosis.

EXAMINATION OBJECTIVE

The objective examination consists mainly in the measurement of the so-called body mass index (or BMI).

The body mass index is a very significant parameter, on which doctors base most of the assessments concerning an individual's body weight.

In fact, it allows us to establish whether the patient is of normal weight, underweight, overweight, obese or severely obese.

Remembering that a person in normal weight has a body mass index of between 18.5 and 24.9, in order to talk about anorexia nervosa a person must have a BMI equal to and less than 17.5.

To complete the physical examination, the doctor observes the appearance of the skin, measures blood pressure and temperature, listens to the heart and checks the muscle tone with appropriate physical exercises.

BMI calculation

Enter the data in the following calculation form to get an evaluation of your body weight.

LABORATORY ANALYSIS

Laboratory analyzes generally include a complete blood count and an assessment of the level of the various electrolytes. All this allows the doctor to establish the health status of important organs, such as the liver, kidneys and thyroid.

ASSESSMENT OF THE PSYCHOLOGICAL PROFILE

The evaluation of the psychological profile is generally up to an expert in the field of mental and psychological illnesses.

Briefly, it consists of a questionnaire, in which the specialist asks the patient to describe his thoughts, habits and relationship with food.

INSTRUMENTAL EXAMINATIONS

The instrumental tests allow the doctor to know the severity of the anorexia nervosa in place, whether it resulted in complications or not.

In fact, they consist of tests, such as chest radiography and electrocardiogram, which clarify the functionality and health status of the patient's heart.

DIAGNOSIS ON THE BASIS OF DSM

According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual suffers from anorexia nervosa if:

It takes less food than its body needs to function at its best.
He has an extreme fear of gaining weight and assumes abnormal behavior, to avoid increasing his own body weight.
He has a distorted view of his body image, seeing himself fat and in need of losing weight.

Treatment

The treatment of anorexia nervosa is complex and requires the collaboration of specialists, such as dietitians, doctors experienced in eating disorders, psychiatrists and psychologists.

In fact, a person suffering from anorexia nervosa needs not only an ad hoc dietary plan, but also an adequate psychological support ( psychotherapy ).

In other words, the goal of therapy is to treat the body (ie the physical symptomatology) and, at the same time, also cure the mind (ie behavioral symptomatology).

As stated, it is important to act quickly and when the disease is in its early stages and has not yet led to the appearance of complications.

Fundamental point: the awareness of the patient of suffering from a serious illness, which requires treatment, is the starting point for achieving recovery.

Individuals with anorexia nervosa, who refuse their condition as patients, do not undergo any treatment or, in any case, struggle to regularly follow the intended therapeutic path.

WHERE IS THERAPY?

For most cases of anorexia nervosa, the treatment is ambulatory . This means that the patient receives all the necessary care, attending a specialized hospital daily and returning home at the end of each therapeutic session.

In other words, the patient has a schedule of appointments to follow, established by the team of doctors who took care of him. Outpatient treatments are very advantageous, because they prevent the patient from having the inconvenience of hospitalization.

The therapy foresees the hospital stay, when, according to the doctors' opinion, the illness is at an advanced or serious stage. In these situations, patients need continuous medical assistance.

PSYCHOTHERAPY

Psychotherapy for anorexia nervosa includes different types of treatments:

Cognitive-analytical therapy (or CAT ). It is based on the theory that certain mental disorders and certain behaviors, such as those that characterize anorexia nervosa, derive from particular experiences of a past life.
The therapist who practices the CAT has, as a goal, to remind the patient of past life events, which have triggered certain mental disorders and certain behaviors, and help him find a remedy for it.
Cognitive behavioral therapy . It consists in preparing the patient to recognize and dominate the so-called "distorted thoughts" - ie behavioral symptoms - induced by anorexia nervosa.
It includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of the domain techniques.
Interpersonal therapy . It is based on the idea that interpersonal relationships and the external world in general have a decisive influence on a person's mental health.
According to those who practice this type of psychotherapy, anorexia nervosa is due to feelings of low self-esteem, anxiety and insecurity, born as a result of a problematic relationship with other people.
The therapeutic goal is to discover which interpersonal relationships have given way to the development of the eating disorder and to remedy it.
Family therapy . It is a type of psychotherapy that affects the whole family of the patient.
Those who practice this type of treatment maintain that an individual can recover from a disorder such as anorexia nervosa, only if his family members (who spend a lot of time with him) know the characteristics of the disease.
Family therapy is particularly indicated for younger patients, who share the drama of anorexia nervosa with the family.

In general, psychotherapy lasts between 6 and 12 months .

RESTORE THE NORMAL BODY WEIGHT

To help the patient restore his normal body weight, he is a dietitian, who prepares an ad hoc diet, depending on the patient's health.

Clearly, the attending physician and the family must ensure that the patient follows this diet and feeds according to the indications of the specialist.

For more severe cases of anorexia nervosa, the administration of food occurs, at least for the first period, through a nasogastric tube .

Some basic steps of restoring normal body weight:

At the beginning, the quantities of food administered must be very small, as the patient's body is no longer used to receiving normal meals.
Food intake should be increased gradually, giving the body time to get used to digesting normal meals.
In general, outpatient treatments are aimed at making the patient earn 0.5 kilograms per week as a therapeutic goal.

For further information: Diet for Anorexia Nervosa »

ARE THERE DRUGS?

To learn more: Medications to treat anorexia

Despite numerous scientific research on the subject, at present there is no specific drug against anorexia nervosa.

However, it should be pointed out that, in some situations, psychotherapists prescribe antidepressants (selective serotonin reuptake inhibitors) or antipsychotics (olanzapine), to alleviate, respectively, any states of depression or anxiety.

Prognosis

For those with anorexia nervosa, the prognosis depends on several factors, some of which have already been mentioned.

Generally, they have greater hopes of healing those who undergo appropriate treatment in time, while those who are at an advanced stage of the eating disorder find it much more difficult to heal.

Today, the therapeutic solutions, on which a person with anorexia nervosa can count, are different and have shown, on more than one occasion, their good effectiveness.