What is Anorexia Nervosa?
When assessing eating disorders, one should take into account the cultural-specific features of food and drink, as well as religious restrictions (fasting). Although described cases where the exit from the post occurs through a subsequent episode of anorexia. In addition, in modern culture there remains a stricter restriction on food in women in accordance with the requirements of fashion and style.
Men with anorexia can be found among the patients of the sexopathologist, since they often complain about the loss of sexual desire and potency, women with anorexia – among the patients of gynecologists, because they often have amenorrhea.
Causes of Anorexia Nervous
The cause of anorexia nervosa is a violation of the identification period, mainly in girls aged 12-18 years. Another reason may be a decrease in the level of the hormones of the hypothalamus and pituitary as a result of a vascular or neoplastic cause. Behind the mask of anorexia nervosa, there may also be puberty depression. If anorexia is observed in prepubertal, then the sexual development of boys and girls slows down dramatically. Psychoanalysts believe that anorexia is caused by anxiety in the oral period. In addition, in an evolutionary sense, anorectica can be considered an altruist who leaves food for her family members. High levels of anxiety can also underlie anorexia.
Symptoms of Anorexia Nervous
In the history of patients note a decrease in self-esteem, they say that they are often teased by fat. Sometimes adolescents seek to achieve a particular Ego-ideal, for example, film actresses, singers. Looking at themselves in the mirror, they see a clear discrepancy between themselves and the ideal.
In late puberty with youthful love, anorexia can hide love without reciprocity, as well as depression.
Patients perceive themselves to be too fat, although sometimes they consider separate parts of their bodies to be thick (calves, cheeks, buttocks). They have an obsessive fear of becoming overwhelmed, so they can avoid parties, holidays, which can consume a lot of food and drink. They have an interest in studying the calorie content of food and avoiding fatty foods, so they often set up a stereotypical diet for themselves, fixing on one or two types of foods, more often fruits or vegetables. All this leads to a weight loss of more than 15% compared with the expected weight, there are secondary asthenia and a decrease in social success. Patients seek to reduce weight by exhausting gymnastic exercises. Characteristic are also amenorrhea in women and the loss of sexual desire in men.
Diagnosis of Anorexia Nervous
To make a diagnosis, all the following symptoms are necessary:
- Body weight is maintained at 15% lower than expected.
- Weight loss is associated with avoiding food, vomiting, taking laxatives, excessive gymnastics, the use of appetite suppressants, and diuretics.
- The horror of obesity becomes an overvalued idea and the patient considers only low weight permissible for himself.
- Amenorrhea in women and impotence in men.
- Delayed puberty.
In the clinic of atypical anorexia nervosa, there are isolated symptoms of anorexia, for example, dysmorphotic experiences or a significant weight loss as a result of dieting, as well as an increase in libido.
Differential diagnostics
Anorexia nervosa should be differentiated from depression, the organic lesion of the hypothalamic-pituitary system (Simons disease, Sheehan disease), as well as episodes of anorexia in hysterical individuals.
Depression, along with refusal to eat, are characterized by decreased mood, self-esteem, suicidal thoughts, motor and cognitive inhibition. However, there is evidence that the basis of “seasonal fluctuations in weight” and “evening cravings for carbohydrates, in particular for sweets,” is depression. Therefore, the differential diagnosis is often set ex juvantibus.
Sheehan’s disease occurs in girls in late puberty, is accompanied by cachexia, asthenia and passes after the first birth.
Simons disease begins in middle age, accompanied by psycho-endocrine syndrome, hallucinatory-paranoid psychosis and cachexia. In this case, weight loss with organic brain damage is often not accompanied by a decrease in appetite. Anorexia in hysterical personalities is transient and understandable in the context of a dissociative personality.
Treatment of Anorexia Nervous
For anorexia nervosa, treatment with antidepressants (fluoxetine in small doses, small doses of lithium with control of the amount of fluid drunk by the patient), as well as the use of benzodiazepine tranquilizers is indicated. However, the main methods are psychotherapy: cognitive therapy, psychoanalysis, gestalt therapy, behavioral therapy.