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Disorders eating behavior often arise against the background of various psychological problems. IN Lately Anorexia nervosa has become increasingly common.

A feature of this disorder is that a person perceives his body in a distorted form. Psychotherapists and psychiatrists can tell you how to cure anorexia, but the outcome of treatment largely depends on the person himself, on his willpower and desire to be healthy.

The main signs and causes of anorexia

We can talk about the presence of a disorder such as anorexia when a person has long time there is an obsessive desire to lose weight. The patient considers himself fat, but in fact his weight is within the normal range. A person suffering from anorexia chooses a variety of methods for losing weight - this is increased exercise stress, exhausting diets or complete refusal to eat.

In addition to the pathological desire to lose weight, a sick person experiences:

• prolonged depression;
• sleep disorders, problems falling asleep;
• frequent outbursts of anger, irritability;
• strong touchiness.

An individual's habits and priorities change. All his thoughts and actions are connected only with the process of losing weight. He fanatically counts the calories of all the food he eats during the day. The fear of getting better gradually arises and intensifies. Excess weight turns into a nightmare for an anorexic. It leads to complete absence appetite and refusal to eat.

Anorexia nervosa negatively affects not only the psychological state of a person. Physical health also deteriorates significantly.

Experts distinguish three stages of development anorexia nervosa. The final cachectic stage is characterized by the failure of major organs and systems, which inevitably leads to the death of the patient.

Anyone can develop anorexia, but young girls are most susceptible to this disorder. First of all, this is due to the desire to meet the beauty standards accepted in the world today. However, eating disorders can occur in conjunction with other mental disorders, due to difficult relationships in the family or excessive demands on girls from the people around them.

Before starting treatment for anorexia, specialists conduct a thorough diagnosis and identify the causes of the disorder. There are cases where eating disorders were associated with dysfunction of neurotransmitters or a malfunction of the endocrine system.

Diagnosis of the disease

If you notice the first signs of anorexia in yourself or someone close to you, then you should immediately consult a doctor. It is often very difficult to persuade a patient to do this: such people deny the presence of the disease, they are prone to perfectionism, which means they are confident that they are quite capable of coping with their problems on their own.

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But in order to understand how to treat anorexia, it is necessary to conduct an examination and make an appropriate diagnosis. This can only be done by a qualified doctor specializing in the treatment of the relevant eating disorders.

Diagnosis begins with the exclusion of other diseases that have manifestations similar to anorexia. These include organic damage to the pituitary gland and hypothalamus, depression, as well as anorexic episodes in people with a hysteroid type of character.

The diagnosis of “anorexia nervosa” can be made if the patient has the following manifestations of the disease:

1. A decrease in the patient's body weight below normal by 15% or more.
2. Body mass index does not exceed 17.5.
3. Dramatic weight loss occurred as a result of the actions of the person himself. To do this, they used the most different ways: reception medicines, inducing vomiting and refusing to eat.
4. The perception of one's own body is distorted. The person sees himself as fat, disgusting and ugly.
5. There are disorders of the endocrine system.

During the diagnosis, the patient undergoes a detailed examination by doctors of various specialties. Girls will be referred for consultation to a gynecologist. With help computed tomography brain will be able to confirm the presence or absence of neoplasms that may affect the functioning of the food center. Blood and other body fluids will also be tested.

The doctor must not only make the correct diagnosis, but also identify the causes of its development in a particular case - treatment will be aimed primarily at eliminating them.

Principles of therapy

Coping with Anorexia Without Qualification medical care almost impossible. The work will be carried out in two directions. First of all, doctors will try to restore normal functioning internal organs and minimize the harm caused to the body by prolonged fasting. If the disease is in initial stage and the patient’s body weight has decreased by no more than 15%, then treatment can be carried out on an outpatient basis. With greater weight loss, hospitalization is carried out, since the patient’s life is in danger.

After stabilization physical health The patient enters the second stage of treatment, the basis of which is psychotherapy. Among the most effective techniques In the treatment of anorexia, the following areas can be distinguished:

• Behavioral therapy allows you to correct the perception of yourself and your body. The psychotherapist teaches the patient to independently identify specific negative thoughts, understand their absurdity and replace them with positively colored thoughts. As a result of such work on oneself, a person’s behavior changes. Under the guidance of a psychotherapist, he learns to solve daily problems, cope with stress and build correct eating behavior. For this purpose, the patient keeps a food diary, where he writes down everything that relates to the process of eating;
• Family psychotherapy is carried out with the goal of improving relationships between family members. Anorexia often develops precisely because of family problems. Excessive care and demandingness on the part of adults leads to children’s self-esteem decreasing and self-perception being distorted. This technique is most effective in correcting eating disorders in children and adolescents;
• Rehabilitation measures allow you to consolidate the results of treatment. Achieving sustainable results becomes possible with a combination of sports and the presence of reinforcing stimuli. Throughout the treatment, the patient should feel the support and care of loved ones;
• The development of a special nutrition system will allow you to gain the missing weight without health complications. During prolonged fasting, the human body reduces energy consumption, so you need to increase your daily diet gradually. At first, nutrition includes eating low-calorie foods, gradually energy value products is increasing. Nutritionists can offer several nutritional plans aimed at normalizing the weight and health of a person with anorexia.

If you ignore this disease, the person may die. Its most severe and terrible consequence is the failure of internal organs.

A set of measures aimed at treating anorexia may require a significant time investment. Full recovery may occur only several years after it was started. But even in this case, it is not always possible to normalize the functioning of internal organs, and the person becomes permanently disabled.

Therefore, prevention of this eating disorder is of great importance. Parents should teach their children to lead an active lifestyle and adhere to the rules rational nutrition. People with low self-esteem and lack of self-confidence need more attention and care from loved ones. If a person has excess weight, then you should not blame him too rudely for this, traumatize his psyche - such actions can lead to the development of eating disorders. Most effective method prevention of the development of anorexia is to help in the formation of a healthy and adequate self-esteem in a person.

Self-treatment of anorexia

People suffering from anorexia underestimate the severity of their condition and the danger similar behavior for good health. Therefore, attempts to recover on your own most often end in failure.

As the disease progresses, the sick person considers himself increasingly fat. Moreover, the more weight he loses, the more obese he seems to be. His self-esteem during this period directly depends on his ability to refuse food.

Most anorexics are natural perfectionists. Therefore, they believe that they can control their own lives. And if others try to help with treatment, then this is perceived by the patient as envy of his beauty and a desire to spoil his figure.

At self-treatment anorexia, the first stage should be awareness of the problem by the sick person. Only in this case can an anorexic agree to accept help and start eating right. But you still can’t do it without outside help.

It is important to draw up proper diet nutrition and start sticking to it. In addition, there is often a need to take medications, and only a doctor can make such prescriptions.

The diet of a person with anorexia must be structured based on the following rules:

1. At first, the diet should include low-calorie foods. There are two explanations for this. Firstly, an organism weakened by illness does not need large amounts of energy. Secondly, products with low content Anorexics consume calories with the least resistance. Thus, the process of establishing power supply will not cause additional psychological problems.
2. Portions of food consumed by the patient at a time should initially be small. The amount of food should be increased gradually as you recover.
3. To prevent the occurrence discomfort When eating, you should first consume foods in a grated porridge form.
4. It will also be necessary to establish and drinking regime. As a rule, the body of an anorexic person is severely dehydrated, which also aggravates the situation.

However, diet alone is not always enough for complete recovery. Without appropriate correction of a person’s mental state, a relapse of the disease is possible. Anorexia may return within a year or two if the person's internal problems are not resolved. An experienced psychologist or psychotherapist will help you do this.

Along with behavioral therapy individual psychotherapy should be carried out. The literature describes wide range psychotherapeutic methods - from psychoanalytic to cognitive behavioral therapy. In senior adolescence Psychodynamic therapy is especially indicated, which puts the current conflicts of this period of life, considered from the perspective of the biography and family history of the patient, at the center of therapeutic conversations.

Goal of therapy most often - to eliminate the patient’s sense of inferiority, increase self-esteem, and teach how to discuss conflicts that arise in the family. Further problems may be the processing of an increased desire for achievement, leading to restrictions in other areas not related to achieving success, an inability to view relationships other than from a competitive point of view, and pronounced perfectionistic attitudes that push aside all other areas of life. There are various kinds of expressed fears related to the sexual sphere, as well as difficulties in accepting the female role.

Feeling your own inability and insufficiency leads to the fact that autonomy and identity can only be expressed through rigidity and control over one's own body. In the process of psychodynamically oriented therapy, they try, together with the patient, to understand the way in which painful ideas arise, analyze their function in the clinical picture of the disease, and develop an alternative way of thinking and behavior. It should be borne in mind that the ability for retrospective observation is initially limited by the characteristics of adolescence.

Therapy should definitely be focused on current problems female patients; The point of application is not “looking into the mirror of the past,” but rather overcoming difficulties and opening up real paths for further development for the patient.

Cognitive models of psychotherapy for anorexia nervosa

Often in progress development sharply expressed, difficult to correct dysfunctional thoughts and beliefs arise that require targeted influence. Cognitive methods of psychotherapy have proven themselves in cases of pronounced tendencies towards a chronic course of the disease; however, they are also applicable for short-term therapy.

In the center cognitive therapy Dysfunctional ideas about appearance, nutrition and weight are addressed. Her methods are also suitable for the treatment of low self-esteem, feelings of inferiority, as well as deficient self-perception (Steinhausen).

From point of view behavioral analysis symptoms of anorexia are supported and enhanced by cognitive mechanisms: weight loss as a result of fasting means cognitive reinforcement of this behavior, as it convinces the patient of the effectiveness of her behavior and of her own independence and competence. A question from one of the patients: “What will remain for me if I give up fasting?” - puts this problem in the spotlight. An important point of application of therapy is the impaired self-concept of those suffering from anorexia. An excess of negative attitudes at the level of emotions, ideas about oneself and one’s own capabilities occurs regularly and, as with depression, is quite amenable to the influence of cognitive therapy (Beck).

Cognitive therapy in this case pursues following goals(Steinhausen): The patient must learn to register her own thoughts and make their perception clearer. She must be aware of the relationships between certain dysfunctional thoughts, misbehavior and emotions, analyze your beliefs and check their correctness, form realistic and adequate interpretations and gradually modify misconceptions.

An illustrative example of psychotherapy for anorexia nervosa

Many patients with anorexia They say: “Everyone thinks that thin people are more attractive and luckier.” This statement is tested in therapeutic conversation. The following questions are being asked.
Do most people really think thin people are more interesting?
Is there a linear relationship here - the less a person weighs, the more attractive he is?
Do all people share such views or only those who uncritically perceive fashion trends?
When using the words “interesting,” “desirable,” or “lucky,” do most people also think about being thin?

Such conversation makes the patient think about the problem of the ideal of thinness, about the correct perception of her body, about the female role and the meaning of physical attractiveness.

Family interventions for anorexia nervosa

Impact on family and environment are part of the standard repertoire of techniques used in the treatment of almost every patient with anorexia nervosa. Of course, explaining this disease solely as a symptom of obligate family dysfunction has proven insufficient (Vandereycken, Kog, Vandereycken). Activities aimed at the patient must be coordinated in time and content with interventions aimed at the family and environment. The drawing gives an idea of ​​the therapy process.

Parallel to patient-centered diagnostics, carried out simultaneously from the outset family diagnosis. The basis for further family-oriented work is detailed information to parents regarding the nature of the disease and the planned stages of therapy, as shown in the figure. Further family therapy has two main aspects: first of all, structured psychoeducational techniques are used with an emphasis on the way family members interact with each other and with the patient. Here, the point of application and the subject of discussion is information about the family obtained during this phase of inpatient treatment.

This therapeutic phase transitions into family therapy, " relationship-oriented" Her task is to clarify conflicts between the patient and parents. Data obtained from individual therapy can be used here. Thus, individual and family therapy are closely related to each other. During the outpatient observation phase, this dynamic of therapy is maintained, i.e., if possible, one conversational psychotherapy session per week, one family session per month.

There are very few controls research, empirically proving the effectiveness of family therapy for anorexia nervosa. Russell et al. (Russell et al.) note that family therapy is especially effective when treating young patients whose disease has not yet progressed to chronic form. Family therapy as the only method of treatment is indicated only for young patients who have become ill relatively recently. The prerequisites for this are the absence of severe family anomalies and the parents' attitude towards cooperation in the treatment process (Hall).

However, family connection- even if family therapy is not chosen as the main method - it is mandatory in the treatment of every patient with anorexia and is as important as patient-oriented interventions. Family-oriented methods for the treatment of anorexia contain elements of counseling, structuring the environment and clarification of relationships between family members.