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Anorexia nervosa - A disease characterized by an eating disorder. Patients (predominantly women) differ mental disorder Expressed in a distorted perception of their own body, and even if they have normal levels of weight, you still tend to slim and very afraid completeness . It causes a person to sharply limit yourself to food.
In 95% of women suffer from anorexia nervosa, and often the first manifestation of the disease appear in adolescence . Less disease manifests itself in adulthood . Anorexia affects representatives of segments of the population, usually young girls or young women unemployed, the number of cases in Western Europe is growing every day. By the way, almost no disease is found among the poor and among the black race. Mortality in this disorder is 10-20%.
Anorexia nervosa can pass both mild and in severe and prolonged. This disease was first described over 200 years ago. Until the 1960s, the disease is very rare, its incidence is now growing rapidly.
Until it finds a strong weight loss, patients are characterized as soft, hard-working people, successful academically, with no signs of mental illness. Most often, their families, wealthy and belong to the upper and middle strata of society. Such people may suffer ridicule about their shape or overweight . At the beginning of disease a person is experiencing because of its completeness, and concern about weight increases as the patient loses weight. And even if a person has exhausted body, he claims that he obesity . After the appearance of symptoms depletion Parents usually seek medical advice. When surveys are identified exchange and hormonal changes Characteristic of fasting, but they deny patients the disease and does not want to be treated.
Symptoms of anorexia nervosa
Current studies indicate the role personal factor in the disease anorexia nervosa. Typically, patients suffer inflated self-esteem . insularity , Violations psychosexual development .
Typically, the disease goes through four stages of development.
The first step is anorexia nervosa primary Or dismorfomanichesky . At this stage the patient has thoughts of inferiority, which is associated with the notions of themselves as too fat. Performances of his excessive fullness usually combined with criticism of their own deficiencies appearance (shape of the nose, lips). The opinion of others about his appearance a person absolutely not interested. At this time, the patient depressed, sullen mood, there is a state anxiety . depression . There is a feeling that others scoff at him, considering his mission. During this period, the patient is constantly weighed, trying to limit yourself to food, but sometimes unable to cope with hunger and begins to eat at night. This period can last from 2 to 4 years.
The second stage of the disease - anorectic . During this period the patient's weight can be reduced already at 30%, and wherein there is euphoria . These results are achieved through the implementation of strict diet And, encouraged by the first results, the person begins to tighten further. At this time, the patient loads itself regular physical exercise and sports exercise, there is increased activity, performance, but there are signs of hypotension due to a decrease in the body fluid. This period is characterized by the appearance alopecia and dryness of the skin, blood vessels may be damaged on the face can be observed menstrual disorders ( amenorrhea ), And men may be reduced spermatogenesis As well as libido.
Often patients induce vomiting after eating accepted laxatives and diuretic drugs , Put an enema to relieve supposedly overweight. Even if they weigh less than 40 kg, they are still aware of being "too fat" and reassure them it is impossible, owing to malnutrition brain .
Often taking high doses laxative can lead to weakness sphincter Up to rectal prolapse. Please artificially induce vomiting brings discomfort, but with frequent use of this method, there is no discomfort, it is enough to just tilt your body forward and click on the epigastric region.
Often this is accompanied by a bulimia When there is no feeling of fullness when patients can absorb huge amounts of food and then induce vomiting. Formed pathological eating behavior, first - cooking large amounts of food, "zakarmlivanie" their loved ones, then - chewing food and spitting it, and then - induce vomiting.
Thoughts of food can become obsessive. The patient prepares food, serves the table, begins to eat the most delicious, but can not stop eating, and all that is in the house. After that cause vomiting and stomach was washed with several liters of water. In order to lose weight, patients may begin to smoke a lot, drink a lot of strong black coffee, can receive drugs, anorectic .
Excluded from the diet foods high carbohydrates and proteins They try to eat vegetarian and dairy foods.
The next step is anorexia nervosa cachectic stage . At this stage, the patient's weight is reduced by 50%, starting irreversible degenerative disorders . The organism, due to lack of protein and reducing potassium level starts to swell. Appetite disappears reduced gastric acidity , Appear on the walls of the esophagus erosive lesions . Vomiting may occur reflex after meals.
The skin of patients becomes dry, scaly and thinner, loses its elasticity, the hair falls out and the teeth, broken nails. However, at the same time can be observed hair growth on the face and body. Lowers blood pressure, as well as body temperature, there is myocardial dystrophy , Prolapse of internal organs, symptoms of anemia can disrupt pancreatic function and secretion of growth hormone, and others. At this point you may receive a tendency to faint.
Changes cachectic stage is usually irreversible, such complications of anorexia nervosa can lead to death. Physical and occupational activity of patients is reduced, poorly tolerated the heat and cold. They continue to refuse food, also claim that they are overweight, that is, violated the adequate perception of the body. It should be noted that due to the strong decrease in body weight and lack of fat, and because of the drop in estrogen levels may occur osteoporosis Which could lead to distortion of the limbs and back and severe pain.
Gradually, with the growth of cachexia, patients are no longer active, spend more time on the couch, they begin chronic constipation . nausea . muscle cramps . polyneuritis . Mental symptoms of anorexia nervosa at this stage - depression, sometimes - aggressiveness, difficulty in trying to focus, poor adaptation to the environment.
To display the status of cachexia, the patients need medical supervision, as at the slightest weight gain anorexia nervosa again beginning to use laxatives and vomit after eating, to perform heavy physical exertion, but again may develop depression. Normalization of the menstrual cycle does not begin earlier than six months after treatment started anorexia nervosa. Prior to that, the mental state of the patient is characterized by frequent changes of mood, hysteria, sometimes manifesting dismorfomanicheskim moods . Over 2 years after the start of treatment relapses of the disease to be treated in hospital. This stage is called the reduction of anorexia nervosa.
Sometimes there and this kind of disease in which a person refuses to eat, not because of dissatisfaction with their appearance, but according to the strange ideas that "food is not digested in the body", "food spoils the skin", etc. However, in such patients amenorrhea It does not occur, but does not reach the depletion of cachexia.
Also released 2 types of eating behavior with the disease. The first type - restrictive Which is reflected in the fact that the person complies with a strict diet, starving. The second type - cathartic Characterized by an additional and binge and subsequent purification. At one and the same person, both types can be shown at different times.
The causes of anorexia nervosa can be called biological factors such as heredity, ie If the family were a disease bulimia or obesity Psychological, which are related to the immaturity of psychosexual sphere, conflicts with family and friends, as well as social reasons (imitation fashion influence people's opinion, TV, magazines, etc.). Maybe that's why, anorexia susceptible young women (young men - rarely), whose mind is not yet matured, and self-esteem is very overpriced.
In our society, it spreads the idea that without a coherent beautiful figure to succeed in their studies or professional activities can not be, so many women control their weight, but for some it turns into anorexia nervosa.
The emergence of anorexia nervosa is associated with the fashion trends of recent times, and today it is a fairly common disease. According to recent studies, anorexia nervosa are ill 1, 2, and 0% of women, 29% men and 90% of them are young girls between the ages of 12 to 23 years. The remaining 10% - men and women older than 23 years.
Diagnosis of anorexia nervosa
Doctors diagnose anorexia nervosa on the following grounds: if a person weight of 15% below of the rules of his age, that is, BMI will be 17, 5 or less. Typically, patients do not recognize their existing problem, afraid of gaining weight, suffer from sleep disorders, depressive disorders, anxiety unreasonable, anger, mood swings. Do women have menstrual disorders, general weakness, cardiac arrhythmia .
A typical case of the disease anorexia nervosa is a young girl whose weight loss was 15% and more. She is afraid of gaining weight, she stopped menstruating, and she denies in his illness. Also in the hospital diagnosis of anorexia nervosa vkluchaet ECG . gastroscopy . esophageal motility study and other studies. When anorexia nervosa are significant hormonal changes, which are shown to reduce the levels of thyroid hormones. This occurs while increasing the level of Cortisol .
Treatment for anorexia nervosa
Most often, patients suffering from anorexia nervosa, seek medical help before the fatal change. In this case, recovery can occur spontaneously, ie Even without the intervention of a doctor.
In more complex cases, patients bring family members to the hospital, and treatment of anorexia nervosa takes place in a hospital, with the help of medication, psychological support to the patient and his family members, as well as a gradual return to normal diet and increase caloric intake.
Most patients helps inpatient treatment. At the initial stage of treatment used force-feeding, especially if the body weight decreased by more than 40% compared with the original, and the patient stubbornly refuses help ,. That is carried intravenous essential nutrients and glucose, or through a tube inserted into the stomach through the nose.
As a result of somatic therapy will improve the patient's condition and medication are only a supplement to the session. Treatment of anorexia nervosa can be divided into two stages. At the first stage the primary goal of treatment - stop losing weight And bring the patient out of cachexia. In the next stage applied therapies and medications .
Psychologists usually try to convince their patients that they need to participate in social life, engage in studies or work, to give time to his family. That is what will help them to escape from their body dissatisfaction and again ill anorexia nervosa. In addition, using Cognitive Psychology formed a normal self-esteem, which is not related to weight and body shape. Patients are taught to perceive their appearance, and to control their behavior. Suffering from a disease can keep a diary in which he will describe the environment in which he took food. Individual psychotherapy helps to establish contacts with the patient, to determine the internal psychological causes of anorexia nervosa.
Methods of family therapy can be effective, if the disorder occurs in young children, in this case, due to changes in family relations and changes the child's attitude to himself and his body. By the way, the parents of so many who suffer from anorexia nervosa, are working in the food industry and trade in food products.
Medications used in the treatment of anorexia nervosa as aids. Antidepressant cyproheptadine used to increase the weight, when excited, and compulsive behavior can be assigned olanzapine or chlorpromazine . Fluoxetine reduces the number of relapses have recovered from anorexia nervosa. Atypical antipsychotics affect the level of anxiety, reducing its and increase body weight.
During treatment, patients provide full support, is set around the calm and stable atmosphere, using techniques of behavioral therapy where bed rest combined with improving physical exercises that help to increase bone density and improve the level of estrogen. An example of behavioral therapy may be such a situation, if the patient has eaten all he offered, or by typing in the title, then he can get some encouragement, for example, a long walk, etc.
An important role in the treatment of anorexia plays diet . The initial stage of a very high-calorie food is not, but gradually increases calorie. The diet is made under the special scheme, to prevent the emergence of edema . lesions of the stomach and bowel etc.
It should be noted that the death rate from full exhaustion as anorexia nervosa complications ranges from 5% to 10%, and in this case, a person dies from the body trapped infection . Sometimes, especially in the later stages of the disease, patients may manifest symptoms of anorexia nervosa as signs of mental disorders, as well as a tendency, although not often, suicide .
From the history of anorexia
The essence of anorexia perfectly transferred to the old parable " Cured nonsense ". Lord North Iranian city of Rey different melancholy, sadness and anorexia. He thought that he - a cow, not a man. He bellowed like an animal refused to eat human food, and demanded to be taken to graze in the meadow. He also wanted to kill him and used his meat. Because of this, from the lord were only "skin and bones". Doctor Avicenna I decided to help him. Arriving at the palace, he shouted: " Where is this cow, I came to kill it! ". He was taken to the master. Before making plans, Avicenna examined him as a butcher, the presence of fat and meat. Avicenna said: "This cow is not necessary for the slaughterhouse, it is too thin. Let her gain weight, and then I'll take it. " Encouraged by this, the master began to eat everything that brought him gradually gained weight and recovered.
In 1689, Dr. Morton has designated this disease as " nervous consumption ". At the beginning of the last century, the disease ranked as the manifestations Schizophrenia And then to diseases of the endocrine system . Later it was called Twiggy syndrome or Barbie And only in 1988, the disease was called "anorexia nervosa".
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