Anorexia nervosa symptoms and hospital treatment. Anorexia nervosa: symptoms and treatment of mental disorder. What is anorexia nervosa: external signs

Anorexia nervosa is a severe mental disorder that is accompanied by an eating disorder motivated by the goals of losing weight or preventing excess weight. As a result, such a pathological desire to lose weight, accompanied by an all-consuming fear, leads to a loss of 30 to 60% of body weight. Many patients lose their criticality towards their condition, they do not notice obvious dystrophy, their metabolism is disrupted, diseases of various systems and organs arise, but it can be extremely difficult to convince them of the need for treatment from a specialist. Some patients are aware of their exhaustion, but their fear of eating food is so deep that they can no longer restore their appetite on their own.

In this article we will introduce you to the causes, risk factors, manifestations, consequences, methods of identifying and treating anorexia nervosa. This information will help you notice alarming symptoms of the disease in yourself or your loved ones, and you will make the right decision about the need to see a specialist.

Without treatment, anorexia nervosa leads to death in about 10-20% of patients. This condition is rightly called the disease of stereotypes, and more often it develops among the affluent segments of the population. According to statistics, the number of such patients has been increasing in recent years; almost 95% of patients are women. Approximately 80% of all anorexics are girls and young women 12-26 years old, and only 20% are men and women of more mature age (up to the period).

Causes and risk factors

Girls who are insecure and suffer from low self-esteem are more susceptible to anorexia nervosa.

The causes of anorexia nervosa are conventionally divided into biological, psychological and social. The following factors can lead to the occurrence of such a disease:

• genetic – the disease manifests itself under unfavorable conditions in carriers of certain genes (HTR2A, BDNF), which form a certain type of personality and contribute to the development of mental disorders;
• biological - obesity and early onset, dysfunction of neurotransmitters regulating eating behavior (serotonin, norepinephrine and dopamine) can deepen pathological disorders with anorexia;
• personal – the likelihood of developing a mental disorder increases among those belonging to the perfectionistic-obsessive personality type, suffering from feelings of inferiority and the need to meet certain standards and requirements, low self-esteem and uncertainty;
• family – the risk of anorexia increases among people in whose family someone suffers from the same disease, obesity, bulimia nervosa, depression, alcoholism and drug addiction;
• age - persons of adolescence and adolescence are most susceptible to desires to please the opposite sex or to imitate idols and stereotypes;
• cultural - living in industrialized cities increases the desire to meet the canons of beauty and success, expressed in a slim figure;
• stressful – physical, psychological, sexual violence or traumatic events (death of a close friend or relative, divorce, etc.) can contribute to the development of eating disorders;
• mental – a number of mental illnesses (for example, schizophrenia) may be accompanied by eating disorders.

Symptoms

Usually the disease begins with the patient having a delusional and obsessive thought that excess weight is the cause of all his troubles (unattractiveness, separation from a loved one, lack of demand in the profession, etc.). Next, the patient develops depression, which leads to severe and constantly progressive restriction of food. As a rule, patients try to carefully hide this from others (they throw away food secretly, give it to a pet, put part of their portion back into the pan, etc.).

Constant malnutrition and starvation leads to the appearance of another pathological deviation - at times he “breaks down” and begins to absorb large amounts of food. At the same time, he reproaches himself and comes up with ways to limit its absorption. To do this, the patient can artificially induce vomiting, take laxatives and perform enemas.

Against the background of changes occurring in the body due to malnutrition and metabolic disorders, patients with anorexia nervosa lose their criticality towards their condition. Even after they reach desired result in losing weight, it begins to seem unsatisfactory to them, and they set themselves new “tasks.”

As a rule, after about 1.5-2 years the patient loses 20% or more of his body weight and develops physical consequences anorexia nervosa – physiological abnormalities in work different systems and organs.

Mental disorders

Long-term malnutrition leads to a number of changes in the behavior and mental state of the patient:

• the patient’s denial of mental disorders and lack of criticality towards signs of exhaustion;
• constant feeling own fullness and the desire to lose weight more and more;
• changes in eating habits (eating in small portions, eating while standing);
• sudden passion for topics about food: collecting recipes, reading books on cooking, organizing delicious meals for relatives without the participation of the patient himself, excessive enthusiasm for diets;
• panic fear of extra pounds;
• the emergence of unreasonable grievances and anger;
• sleep disorders;
• depressive state: sadness, irritability, periods of euphoria followed by decreased activity;
• change in activity in the social environment and family: excessive sports training outside the home, reluctance to attend events that include meals (birthdays, corporate parties, etc.), limited communication with relatives and friends.

One of the characteristic signs of anorexia nervosa is the following reasoning from the patient: “My height is 168, and my weight is now 45 kilograms, but I want to weigh 35 kilograms.” Subsequently the numbers become smaller.

Any results in weight loss are regarded by the patient as a desired achievement, and gaining even a few kilograms is perceived as insufficient self-control and dissatisfaction with oneself. Even patients who are aware of their dystrophy often wear baggy clothes, hiding their thinness from others. In this way, they try to avoid having to explain themselves and enter into discussion with those who do not support their aspirations for far-fetched “ideal” standards.

One of the most dangerous manifestations of anorexia nervosa is the self-prescription of various hormonal drugs for weight loss. Such cases are very difficult to treat, and even forced treatment may be ineffective.

Mental disorders that occur with anorexia nervosa can cause suicide.

Physical disorders

Over time, prolonged malnutrition and starvation leads to severe metabolic disorders and the development of diseases of various systems and organs.

Initially, the patient experiences hormonal changes caused by decreased hormone production thyroid gland, estrogen and increased cortisol levels. They are manifested by the following symptoms:

• constant weakness (up to hungry fainting);
• menstrual irregularities (scanty periods, pain, delays and absence of menstruation, inability to conceive);
• decreased libido;
• muscle spasms;
• bradycardia;
• tendency to.

Subsequently, the following disturbances in the functioning of body systems occur:

• cardiovascular system - fainting, feeling cold, the occurrence of arrhythmias, which can cause;
• blood - signs, a decrease in the level of leukocytes, leading to increased susceptibility to infections;
• digestive system - functional dyspepsia, cramping pain in the stomach, peptic ulcer, chronic constipation, nausea, edema (bloating) of the abdominal cavity;
• skin and hair - dryness and swelling, yellow skin tone, dullness and hair loss, the appearance of vellus hair on the face and body, brittleness and splitting of nails;
• skeletal system and muscles - tendency to fractures and their long-term healing, tooth decay, swelling of joints, muscle atrophy;
• urinary system – tendency to,.

Some of the physical problems described above can be remedied by treating anorexia nervosa and restoring normal weight and nutrition, but some of them are irreversible.

Excessive enthusiasm for attempting to induce artificial vomiting and performing cleansing enemas can cause the following disorders:

• problems swallowing food and liquids;
• esophageal ruptures;
• weakening of the rectal wall;
• rectal prolapse.

Pregnancy and anorexia nervosa

Getting pregnant with anorexia is often difficult, but after treatment and weight gain, estrogen levels can be restored and conception occurs. Even after therapy, in the future a woman may experience the following problems associated with hormonal imbalance:

• difficulty in conceiving;
• increased risk of fetal malnutrition and the appearance of congenital malformations in the unborn child;
• increased risk of complications during pregnancy and childbirth;
• increased risk of relapse of anorexia due to stress that occurs in response to the news of pregnancy.

In severe forms of anorexia nervosa, even after treatment, the menstrual cycle does not return, and the woman cannot become pregnant on her own.

Stages of the disease

The initial stage of anorexia nervosa is characterized by the patient’s constant bad mood, her tendency to frequently weigh herself and measure body volume, and the desire to follow a strict diet.

The following stages are distinguished during anorexia nervosa:

1. Dysmorphomanic. The patient often has painful thoughts about his own inferiority associated with imaginary completeness. The mood becomes depressed and anxious. The patient can look at his reflection in the mirror for a long time, often weighs himself, measures the size of his waist, hips, etc. At this stage, he begins to make his first attempts to limit himself in food or searches for and follows an “ideal” diet.
2. Anorectic. The patient is already attempting persistent fasting and loses about 20-30% of his body weight. Such “successes” are perceived with euphoria and are accompanied by a desire to lose even more weight. The patient begins to exhaust himself with excessive physical activity, eats even less and tries in every possible way to convince both himself and others that he has no appetite. At this stage, he can no longer be critical of his exhaustion and underestimates its excessive degree. Fasting and lack of nutrients lead to the first signs of changes in physical condition: hypotension, bradycardia, fainting and weakness, menstrual irregularities and libido, dry skin, hair loss. Disturbances in metabolism and physiological functioning of organs are accompanied by active tissue breakdown and lead to even greater suppression of appetite.
3. Cachectic. At this stage, irreversible disorders occur caused by organ dystrophy. As a rule, this period begins 1.5-2 years after the first manifestations of anorexia nervosa, when the patient loses approximately 50% of his body weight. If left untreated, degenerative processes lead to the fading of the functions of all organs and the death of the patient.

Diagnostics

Many people with anorexia nervosa think that they are not sick or that they are able to control their illness on their own. That is why they rarely go to the doctor on their own. In such cases, the task of their relatives is to help their loved one understand the problem and resort to the services of a specialist.

Typically, to make a diagnosis, the doctor asks the patient several questions from a test developed in the UK:

• do you consider yourself fat;
• whether you keep your weight under control and what you eat;
• have you lost more than 5 kilograms recently;
• whether thoughts about food are dominant;
• Do you believe that you are fat if others say that you are thin?

Even two “yes” answers indicate the presence of eating disorders.

To confirm the diagnosis and determine the severity of anorexia nervosa, the patient is prescribed the following types of studies:

• calculation of body mass index (for example, the norm for women over 20 years old is 19-25, the risk threshold is 17.5);
• blood tests to detect anemia and electrolyte imbalances;
• blood tests to determine kidney and liver function;
• and sex hormones.

If necessary, examination of a patient with anorexia nervosa can be supplemented (to identify osteoporosis), ultrasound of various organs and (to identify diseases of internal organs).

Treatment

Treatment of anorexia nervosa is carried out by doctors of several specializations and can be carried out on an outpatient basis or in a hospital setting. The need for hospitalization of the patient is determined by the severity of the clinical picture. It is indicated in the following cases:

• decrease in body mass index by 30% below normal;
• progressive weight loss during outpatient therapy;
• heart rhythm disturbances;
• hypotension;
• hypokalemia;
• severe forms of depression;
• suicidal tendencies.

The main goal of treatment for anorexia nervosa is to restore weight and eating habits. An increase in body weight of 0.4-1 kg per week is desirable. In addition, therapy is aimed at eliminating mental and physical complications.

The most successful treatment tactics for such a disease is a combination of psychotherapy, family and conservative therapy. It is extremely important that the patient himself participates in this process and understands its necessity.

Even after treatment, some patients remain prone to repeated relapses diseases and need constant psychological support (especially during stressful periods of life). The following factors can complicate the recovery process and increase the risk of relapse:

• communication with friends, sports coaches and relatives who admire thinness and promote weight loss;
• lack of psychological support from close friends and family;
• the impossibility of overcoming the patient’s conviction that excessive thinness is the only way to combat obesity.

The treatment plan for anorexia nervosa is drawn up depending on the characteristics of the disease and the personality of the patient. Part complex therapy Several methods are included.

Lifestyle change

A patient with anorexia nervosa needs the following changes:

• regular and healthy eating;
• correct formation of the diet and menu preparation with the help of a nutritionist;
• getting rid of the habit of constantly weighing yourself;
• exclusion of exhausting physical activity for weight loss (only after the patient’s condition has normalized, the doctor can include physical therapy exercises in the treatment plan);
• increasing social activity;
• psychological support from friends and relatives.

Restoring normal nutrition and weight gain

This part of the treatment plan for anorexia nervosa is fundamental, as normalizing nutrition and weight helps restore both physical and mental health. In addition, these factors increase the effectiveness of psychotherapy.

To increase weight, the patient is prescribed a diet, the principle of which is aimed at gradually increasing the calorie content of the daily diet. Initially, it is recommended to consume 1000-1600 calories per day, and then the diet gradually expands to 2000-3500. Food should be taken 6-7 times a day in small portions.

In the early stages, the patient may experience anxiety, depression, and signs of fluid retention in the body that occur in response to increased body weight. Over time, as you gain weight, these symptoms decrease and disappear.

Parenteral and intravenous nutrition are not usually used to treat anorexia nervosa, as such methods may make it difficult to restore normal nutrition in the future and many patients perceive such methods as punishment and coercive treatment. However, in some difficult cases (categorical and prolonged refusal to eat, heart rhythm disturbances, bleeding from the mouth, etc.), such methods can be used temporarily to initially improve the patient’s condition.

Nutrition and supplementation

People with anorexia nervosa suffer from a lack of vitamins, minerals and nutrients. Their replenishment significantly improves the mental and physical condition of patients and therefore food should be nutritious and fortified.

If necessary, diet therapy is often supplemented by taking nutritional supplements. The following dietary supplements can be used for this:

• multivitamins (A, C, E) and supplements based on magnesium, zinc, calcium, copper, phosphorus and selenium;
• Omega-3, fish fat, eating fish (especially halibut and salmon);
• coenzyme Q10;
• 5-hydroxytryptophan;
• probiotics based on lactobacilli and acidophilus;
• creatine

Improve absorption useful substances And general state may follow the following recommendations:

• sufficient reception drinking water(up to 6-8 glasses per day);
• inclusion of high-quality sources of proteins in the diet: eggs, meat, dairy products, protein and vegetable shakes;
• quitting smoking and drinking alcohol;
• eliminating or significantly reducing the amount of caffeine-containing products;
• limiting refined sugars: sweets, sweet water etc.

Cognitive behavioral therapy

This method of treating patients with anorexia nervosa is the most effective. Using this technique, the patient learns to replace distorted thoughts and negative judgments with real and positive ways to solve problems.

Cognitive behavioral therapy consists of the fact that over the course of several months or six months the patient himself creates his own menu and includes in it foods that he had previously refused in every possible way. It tracks your diet and records unhealthy thoughts and reactions associated with food. In addition, he notes relapses that occur in the form of vomiting, taking laxatives and excessive physical exertion.

The patient periodically discusses these recordings with a cognitive psychotherapist and as a result may become aware of false and negative judgments about his weight. After such acceptance, the list of foods in the diet expands, and awareness of previously present problems allows him to get rid of ingrained false judgments. Subsequently, they are replaced with correct and realistic ones.

Family therapy

Family psychotherapy plays an important role in the complex treatment of anorexia nervosa. The patient needs to feel the support and understanding of friends and relatives.

The participation of parents, relatives and friends helps the patient cope with emerging difficulties. The doctor teaches them to develop the right tactics for dealing with him. In addition, family therapy is aimed at eliminating feelings of guilt and anxiety that arise among the patient’s loved ones and relatives.

Maudsley method

This tactic is a form of family therapy and can be used in the early stages of anorexia nervosa. The Maudsley method consists in the fact that in the first stages the patient’s parents take charge of menu planning and control the consumption of prepared dishes. Gradually, as correct judgments about nutrition are restored, the patient begins to make decisions about when and how much to eat. Treatment results are discussed weekly with a psychotherapist, who gives additional recommendations and evaluates the effectiveness of this technique.

Hypnotherapy

The use of hypnosis can be part of a comprehensive treatment for anorexia nervosa. Such sessions allow the patient to regain self-confidence and increase resistance to stressful situations, restore the correct perception of your appearance and weight. As a result, hypnotherapy can help you return to normal eating habits.

Drug therapy

Reception medicines for the treatment of anorexia nervosa is recommended only if it is impossible to eliminate existing problems using psychotherapeutic techniques and diet therapy. For this, the patient may be prescribed:

• antidepressants (Fluoxetine, Cyproheptadine, Chlorpromazine, etc.) – for the treatment of severe forms of depression, relief from anxiety and obsessive-compulsive disorders;
• atypical antipsychotics (Azenapine, Ziprasidone, Clozapine, Sertindole, etc.) – are used to reduce increased levels of anxiety.

In addition, drug treatment is complemented by symptomatic treatment of emerging complications of anorexia nervosa (gastritis, peptic ulcer, arrhythmias, etc.). When mental illnesses causing eating disorders are identified, treatment is prescribed.

Forecasts

The recovery process for a patient with anorexia nervosa can take about 4-7 years. Even after recovery, there is still a possibility of relapse of the disease.

According to various statistics, approximately 50-70% of patients fully recover from the disease, but 25% of patients fail to achieve such results. Sometimes, after treatment, uncontrolled overeating occurs, leading to weight gain and a number of other psychological problems.

The likelihood of death with anorexia nervosa depends on the stage of the disease, mental and physiological characteristics the patient's body. Death can be caused by natural causes (i.e., complications and diseases that arise) or may occur due to suicide.

Which doctor should I contact?

If you are extremely concerned about your weight, open or hidden from others, refusal to eat and sudden weight loss, you should consult a psychotherapist. When anorexia nervosa is detected, a nutritionist and a therapist are involved in the patient’s treatment process.

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Anorexia in men has its own characteristics:

• Anorexia in men is often associated with various mental disorders - schizophrenia, neuroses.
• Men don't talk about their desire to lose weight. They are more secretive, unlike women who constantly discuss ways to lose weight.
• Men are more purposeful, they firmly adhere to their promise to refuse certain foods. They are less likely to have eating disorders.
• A large percentage of sick men refuse food for ideological reasons. They are supporters of body cleansing, raw foodism, veganism, sun-eating or other nutritional systems.
• Anorexia affects not only young men who strive to meet the standards of beauty, but also men over 40 who are interested in methods of cleansing the body and various spiritual practices. You can often hear phrases from them that “food is an obstacle to mental development”, “refusing food prolongs life and purifies the spirit.”
• The character of patients is dominated by asthenic and schizoid traits, in contrast to women, who are characterized by hysterical traits.
• Delusional ideas about imaginary fatness sometimes serve as a distraction for a man. At the same time, he tends not to notice real physical defects, which sometimes disfigure his appearance.

Factors that provoke anorexia in men

• Growing up in a single-parent family in an overprotective atmosphere from the mother's side. The boy is afraid that as he gains weight, he will grow up and lose the love of his family. By remaining thin, he tries to avoid responsibility and hardships adult life. Such men continue to live with their parents into adulthood.
• Critical statements from others regarding excess weight. This can cause psychological trauma.
• Participation in certain sports, requiring strict control over body weight - sports dancing, ballet, running, jumping, figure skating.
• Professions related to show business– singers, actors, models. People employed in these professions sometimes pay excessive attention to their appearance, which causes thoughts about their own imperfections and excess weight.
• Self-punishment. Boys and men work themselves to the point of exhaustion, reducing the feeling of guilt for undiagnosed aggression towards the father or forbidden sexual desire.
• Schizophrenia in one of the parents, the tendency to which is inherited. There is a high risk of anorexia nervosa in young men whose parents suffered from anorexia, phobia, anxious depression, and psychosis.
• Homosexuality. In specialized publications, a cult of lean male bodies is created, which encourages young men to refuse food.

Manifestations of anorexia in men and women have many similarities. In 70% of patients, the onset of the disease occurs at the age of 10-14 years. If parents failed to notice and stop them, then the symptoms slowly increase.

• Painful attention to one's appearance.
• The tendency to eat normally once and then starve for weeks.
• Tendency to hide food. To convince relatives that the patient is “eating normally,” he may hide or throw away his portion of food.
• Decreased sexual interest and potency, which is analogous to female amenorrhea (lack of menstruation).
• Traditional methods of losing weight include refusing to eat, excessive exercise and vomiting, enemas, and colon therapy. However, morbid attachment to vomiting is less common than in women.
• Unmotivated aggression. Rude attitude towards close people, especially parents.
• Refusal to be photographed. Patients argue that their “fullness” is more noticeable in photographs.
• Hypochondria. A man is overly concerned about his health and suspects that he has serious illnesses. Natural sensations (especially the feeling of fullness in the stomach) seem painful to him.
• Changes in appearance appear after a few months - weight loss (up to 50% of body weight), dry skin, hair loss.
• The tendency to alcoholism is an attempt to cope with emotions and drown out thoughts about food and losing weight.

At first, losing weight causes euphoria. There is a lightness and a feeling of victory when the appetite has been curbed, which causes deep satisfaction in the patient. Over time, appetite disappears and the body's resources are depleted. Vigor is replaced by irritability and chronic fatigue. The way of thinking changes, delusional ideas are formed that cannot be corrected. The body becomes painfully thin, but the man continues to perceive himself as fat. Brain malnutrition affects the ability to think clearly and process information. Long-term abstinence from food leads to organic brain damage.

Men with anorexia do not perceive their condition as a problem. They do their best to justify fasting by cleansing the body and the desire for enlightenment. Their relatives often seek medical help. If this does not happen in time, then the man ends up in a hospital with cachexia (extreme exhaustion) or in a psychiatric hospital with an exacerbation of mental illness.

Treatment of anorexia in men includes psychotherapy, medication and reflexology. Taken together, these measures lead to recovery in over 80% of patients.

1. Psychotherapy- an obligatory component of treatment. It allows you to correct the patient’s thinking and helps eliminate psychological trauma that led to eating disorder. For anorexia in men, the following have proven effective:

• psychoanalysis;
• behavioral therapy;
• family psychotherapy with the patient's relatives.

2. Drug treatment. Medicines can only be prescribed by a doctor, and the dosage depends on the severity of the symptoms of the disease.

• Neuroleptics Clozapine and Olanzapine are used for the first 6 months of treatment. They promote weight gain and reduce delusions regarding obesity. The dose of the drug is determined individually. After reaching therapeutic effect it is gradually reduced. If an exacerbation occurs, the dose is increased to the initial dose.
• Atypical antipsychotics Risperidone and Risset eliminate the negative manifestations of the disease, but do not reduce performance or interfere with work and study. Take medications constantly or only when symptoms of the disease occur. Treatment with atypical drugs can last from 6 months to one and a half years.
• Vitamin preparations. B vitamins normalize the functioning of the nervous system, helping to eradicate the root cause of the disease. Vitamins A and E improve the production of hormones, promote the restoration of the skin and its appendages, as well as the mucous membranes of internal organs.

3. Reflexology(acupuncture). During sessions, reflex points are affected, which stimulates appetite and restores impaired metabolism.

4. Trainings on organizing healthy nutrition. Special training programs will help the patient create a menu in such a way that the body receives all the nutrients and does not experience discomfort.

5. Intravenous nutrition or feeding through a tube. These methods are used in cases of extreme exhaustion in patients who categorically refuse to eat.

Anorexia in a child, what to do?

Anorexia in children is a more common problem than is commonly believed. 30% of girls 9-11 years old limit themselves in food and adhere to a diet in order to lose weight. Every 10th person has a high risk of developing anorexia (in boys this figure is 4-6 times lower). However, in childhood the psyche is more susceptible to influence and in the early stages parents can help the child avoid the development of the disease while remaining slim.

Causes of anorexia in a child

• Parents feed the child, forcing him to eat too large portions. As a result, an aversion to food is formed.
• A monotonous diet that creates negative attitude to food.
• Past severe infectious diseases - diphtheria, hepatitis, tuberculosis.
• Psycho-emotional stress - sudden acclimatization, death of a loved one, parental divorce.
• The abundance of unhealthy and sweet foods in the diet disrupts digestion and metabolism.
• Excessive care and control on the part of parents. Often found in single-parent families, where a child is raised without a father by his mother and grandmother.
• Dissatisfaction with one's appearance, which is often based on parental criticism and peer ridicule.
• Hereditary predisposition to mental illness.

What are the signs of anorexia in a child?

• Eating disorders – refusal to eat or a certain set of foods (potatoes, cereals, meat, sweets).
• Physical signs include weight loss, dry skin, sunken eyes, dark circles under the eyes.
• Behavioral changes – sleep disturbances, irritability, frequent tantrums, decreased academic performance.

What to do if you notice signs of anorexia in a child?

• Make eating an enjoyable experience. Create comfort in the kitchen. While your child is eating, find a few minutes to sit next to him and ask him how the day went, what was the most pleasant event today.
• Start eating healthy as a family. For example, instead of pies, cook baked apples with cottage cheese; instead of frying potatoes or fish, bake them in foil. Focus not on the fact that this will make you lose weight, but that proper nutrition is the basis of beauty, health and vigor. Being slim is just a pleasant consequence healthy image life.
• Follow family rituals related to food. Bake meat according to your grandmother's recipe, marinate fish, as is customary in your family. Share these secrets with your child. Rituals make the child feel like he is part of a group and give him a sense of security.
• Go shopping together. Make a rule: everyone buys a new, preferably “healthy” product. It could be yogurt, an exotic fruit, a new type of cheese. Then you can try it at home and decide whose choice is better. This way you instill in your child the idea that healthy food brings pleasure.
• Don't insist on your own. Give your child a choice, strive for a compromise. This applies to all aspects of life. A child who is overly controlled in everything takes control of what is left to him - his food. Avoid categorical demands. If you think it's cold outside, don't shout at your daughter to put on a hat, but offer your child an acceptable choice: a headband, a hat, or a hood. The same applies to food. Ask what the child will like, offering a choice of 2-3 acceptable dishes. If your daughter flatly refuses dinner, move lunch to a later time.
• Involve your child in the cooking process. Watch cooking shows together, choose recipes on the Internet that you would like to try. There are a huge number of tasty and healthy low-calorie dishes that do not increase the risk of gaining weight.
• Encourage dancing and sports. Regular physical training increases appetite and promotes the production of endorphins - “happiness hormones”. It is advisable that the child exercise for his own pleasure, since professional activities aimed at winning competitions can provoke a desire to lose weight and cause anorexia and bulimia.
• Consult a cosmetologist or fitness trainer if the child is dissatisfied with his appearance and weight. Children often ignore the advice of their parents, but listen to the opinions of unfamiliar experts. Such specialists will help you create a proper nutrition program that improves skin condition and prevents excess weight gain.
• Listen carefully to your child. Avoid categorical judgments and do not deny the problem: “Don’t talk nonsense. Your weight is normal." Give reasons for your reasons. Together, calculate the ideal weight formula, find the minimum and maximum values for this age. Promise to help fight for beauty ideals and stick to your word. It is better to prepare a diet soup for your child than for a rebellious daughter to fundamentally skip a meal consisting of a high-calorie roast.
• Find areas where your child can self-actualize. He should feel successful, useful and indispensable. To generate interest in various activities, attend a variety of events with your child: exhibitions, dance group competitions and sports competitions. Encourage him to try his hand at a wide variety of sections and clubs. Give sincere praise for every small achievement. Then the teenager will take root in the idea that success and positive emotions can be associated not only with physical attractiveness. And new acquaintances and vivid impressions will distract you from thoughts about the imperfection of your body.
• Help your child receive complete and comprehensive information. If your child wants to stick to a diet, then find detailed instructions on this topic. Be sure to familiarize yourself with the contraindications and read about the dangers and consequences of this diet. For example, it has been proven that supporters of protein diets are at risk of cancer. The more your child knows, the better protected he will be. Thus, due to a lack of understanding of the full danger of the problem, many girls stubbornly search the Internet for advice on “how to get anorexia?” In their minds, this is not a serious mental illness, but easy way to beauty.

Remember that if over the course of 1-2 months you have not been able to correct your child’s eating behavior, then seek advice from a psychologist.

How to avoid relapse of anorexia?

Relapses of anorexia after treatment occur in 32% of patients. The most dangerous are the first six months, when patients are highly tempted to give up food and return to old habits and the same way of thinking. There is also a risk that in an attempt to suppress their appetite, such people will become addicted to alcohol or drug use. That is why relatives should pay maximum attention and try to fill their lives with new impressions.

How to avoid relapse of anorexia?

Scientists agree that anorexia is a chronic disease characterized by periods of calm and relapses. This food addiction is compared to diabetes mellitus: a person must constantly monitor his condition, follow preventive measures, and begin drug treatment when the first signs of the disease appear. This is the only way to stop the return of anorexia in time and prevent a relapse.

is a disease characterized by an eating disorder. Patients (mostly women) differ mental disorder expressed in a distorted perception of their own body, and even if they have normal weight indicators, they still strive lose weight and are very afraid completeness . This forces a person to sharply limit himself in nutrition.

In 95% of cases, women suffer from anorexia nervosa, and most often the first manifestations of the disease appear in adolescence . Less commonly, the disease manifests itself in adulthood . Anorexia affects representatives of wealthy segments of the population, usually young girls or unemployed young women, the number of cases in Western Europe is growing every day. By the way, the disease practically does not occur among the poor and among representatives of the black race. Mortality for this disorder is 10-20%.

Anorexia nervosa can be mild or severe and long-lasting. This disease was first described more than 200 years ago. Until the 1960s, this disease was very rare, but now its incidence is rapidly increasing.

Before severe weight loss is detected, patients are characterized as gentle, hardworking people, academically successful, with no signs of mental disorders. Most often, their families are prosperous and belong to the upper or middle strata of society. Such people may suffer from ridicule about their figure or. At the very beginning of the disease, a person worries about his obesity, and concerns about weight increase as the patient loses weight. And even if a person’s body is exhausted, he claims that he has... After symptoms appear exhaustion , parents usually seek help from a doctor. The examinations will reveal exchange And hormonal changes , characteristic of fasting, but the patients themselves deny the disease and do not want to be treated.

Symptoms of Anorexia Nervosa

Modern research points to the role personal factor in the disease anorexia nervosa. Patients usually suffer inflated pride , isolation , violations psychosexual development .

Usually the disease goes through 4 stages of its development.

The first stage of anorexia nervosa is primary , or dysmorphomaniac . At this stage, the patient begins to have thoughts about his inferiority, which is associated with ideas about himself as too full. Ideas about one’s excessive fatness are usually combined with criticism of one’s own appearance flaws (the shape of the nose, lips). The person is not at all interested in the opinions of others about his appearance. At this time, the patient is in a depressed, gloomy mood, and there is a condition anxiety , depression . There is a feeling that those around him are mocking him and examining him critically. During this period, the patient constantly weighs himself, tries to limit himself in food, but sometimes, unable to cope with hunger, 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 already decrease by 30%, and at the same time it can be felt. Such results are achieved by implementing strict diet , and, inspired by the first results, the person begins to tighten it even more. At this time, the patient loads himself with constant physical activity and sports exercises, increased activity and performance are observed, but signs appear hypotension due to decreased fluid in the body. This period is characterized by the appearance and dryness of the skin, blood vessels on the face may be damaged, menstrual cycle irregularities may be observed (), and in men it may decrease spermatogenesis , as well as sexual desire.

Often patients vomit after eating, take laxatives and, enemas are given in order to allegedly lose excess weight. Even if they weigh less than 40 kg, they still perceive themselves as “too fat”, and it is impossible to dissuade them, which is caused by brain malnutrition.

Frequently taking large doses laxative may lead to weakness sphincter , up to rectal prolapse. At first, artificially induced vomiting brings unpleasant sensations, however, with frequent use of this method, no unpleasant sensations arise; it is enough to just tilt the torso forward and press on the epigastric region.

This is often accompanied by when there is no feeling of satiety, when patients can absorb huge amounts of food and then induce vomiting. Pathology of eating behavior is formed, first - cooking large quantity food, “feeding” your loved ones, then chewing food and spitting it, and then induced vomiting.

Thoughts about food can become obsessive. The patient prepares food, sets the table, begins to eat the most delicious things, but cannot stop and eats everything in the house. Then induce vomiting and rinse the stomach with several liters of water. In order to lose weight more painfully, they can start smoking a lot, drink a lot of strong black coffee, and can take medications that reduce.

Products high in content are excluded from the diet carbohydrates And proteins , try to eat plant-based and dairy foods.

The next stage of anorexia nervosa is cachectic stage . At this stage, the patient’s weight decreases by 50%, and irreversible dystrophic disorders . The body, due to a lack of protein and a decrease in potassium levels, begins to swell. Appetite disappears and decreases acidity gastric juice , appear on the walls of the esophagus erosive lesions . Vomiting can occur reflexively after eating.

The skin of patients becomes dry, thins and peels, loses elasticity, hair and teeth fall out, and nails break. However, at the same time, hair growth on the face and body may occur. Decreases, as well as body temperature, are observed myocardial dystrophy , prolapse of internal organs, signs of anemia, the functions of the pancreas, as well as the secretion of growth hormone and others, may be impaired. At this stage, there may be a tendency to faint.

Changes in the cachectic stage are usually irreversible; such complications of anorexia nervosa can lead to death. The physical and work activity of patients decreases, heat and cold are poorly tolerated. They continue to refuse food and also claim that they are overweight, i.e. adequate perception of one’s body is impaired. It should be noted that due to a strong decrease in body weight and lack of fat, and due to a drop in estrogen levels, it can occur, which can lead to curvature of the limbs, as well as the back and severe pain.

Gradually, as cachexia increases, patients stop being active, spend more time on the couch, and begin to develop chronic nausea , muscle cramps , polyneuritis . Mental symptoms Anorexia nervosa at this stage - a depressive state, sometimes - aggressiveness, difficulty trying to concentrate, poor adaptation to the environment.

To recover from the state of cachexia, patients need medical supervision, because with the slightest weight gain, those suffering from anorexia nervosa again begin to use laxatives and induce vomiting after eating, perform heavy physical activity, but depression may develop again. Normalization of the menstrual cycle occurs no earlier than six months after treatment for anorexia nervosa is started. Before mental condition the patient is characterized frequent changes mood, hysteria, sometimes manifested dysmorphomanic moods . Within 2 years after the start of treatment, relapses of the disease are possible, which need to be treated in a hospital. This stage is called reduction of anorexia nervosa.

Sometimes there is also a type of disease in which a person refuses to eat not because of dissatisfaction with his appearance, but according to strange ideas that “food is not absorbed in the body,” “food spoils the skin,” etc. However, in such patients amenorrhea does not occur, and exhaustion does not reach cachexia.

There are also 2 types of eating behavior during illness. First type - restrictive , which is expressed in the fact that a person follows a strict diet and goes hungry. Second type - cleansing , which is additionally characterized by episodes of overeating and subsequent purging. In the same person, both types can appear at different times.

The causes of anorexia nervosa can be called biological factors, for example, heredity, i.e. if there was a disease in the family bulimia or obese , psychological, which are associated with immaturity of the psychosexual sphere, conflicts in the family and with friends, as well as social reasons (imitation of fashion, influence of the opinions of surrounding people, television, glossy magazines, etc.). Perhaps this is why young girls (young men - less often) are susceptible to anorexia nervosa, whose psyche has not yet strengthened, and their self-esteem is very high.

In our society, there is a widespread idea that without a slim, beautiful figure, one can succeed in school or professional activity impossible, so many girls control their weight, but only for some it turns into anorexia nervosa.

The emergence of anorexia nervosa is associated with recent fashion trends, and today it is a fairly common disease. According to recent studies, anorexia nervosa affects 1.2% of women and 0.29% of men, and more than 90% of them are young girls aged 12 to 23 years. The remaining 10% are men and women over 23 years of age.

Diagnosis of anorexia nervosa

A doctor diagnoses anorexia nervosa based on the following signs: if a person’s weight is 15% below the norm for his age, i.e. body mass index will be 17.5 or less. Typically, patients do not recognize the problem they have, are afraid of gaining weight, suffer from sleep disturbances, depressive disorders, unreasonable anxiety, anger, and sudden mood swings. Women experience menstrual irregularities, general weakness, heart .

A typical case of anorexia nervosa is a young girl whose weight loss is 15% or more. She is afraid of gaining weight, her periods have stopped, and she denies that she has an illness. Also in a hospital setting, the diagnosis of anorexia nervosa includes ECG , gastroscopy , esophagomanometry and other studies. With anorexia nervosa, significant hormonal changes occur, which manifest themselves in a decrease in the level of the thyroid gland. This happens while the level increases.

Treatment of Anorexia Nervosa

Most often, patients suffering from anorexia nervosa seek medical help before irreparable changes occur. In this case, recovery may occur spontaneously, i.e. even without the doctor's intervention.

In more complex cases, patients are brought to the hospital by relatives, and treatment of anorexia nervosa takes place in a hospital, with the help of drug therapy, psychological help the patient and his family members, as well as a gradual return to a normal diet and an increase in calorie intake.

Helps most patients hospital treatment. At the initial stage of treatment, force feeding is used, especially if the body weight has decreased by more than 40% compared to the initial one, and the patient stubbornly refuses help. That is, they carry out intravenous administration essential nutrients and glucose, or through a tube inserted into the stomach through the nose.

As a result of psychotherapy, the patient’s somatic condition will be improved, and medications are only an addition to the sessions. Treatment of anorexia nervosa can be divided into 2 stages. At the first stage, the main task of treatment is stop losing weight, and also bring the patient out of the state of cachexia. At the next stage, apply psychotherapy methods And medications.

Psychologists usually try to convince their patients that they need to take part in social life, study or work, and devote time to family. This is what will help them distract themselves from dissatisfaction with their body and fall ill with anorexia nervosa again. In addition, using cognitive psychology normal self-esteem is formed, which is not related to weight and body shape. Patients are taught to adequately perceive their appearance and control their behavior. A person suffering from the disease can keep a diary in which he will describe the environment in which he ate. Individual psychotherapy helps to establish contacts with the patient to clarify internal psychological reasons anorexia nervosa.

Methods of family psychotherapy can be effective if the disorder is observed in young children; in this case, due to changes in relationships in the family, the child’s attitude towards himself and his body also changes. By the way, the parents of many people suffering from anorexia nervosa work in the food industry or sell food products.

Medications are used as adjuncts in the treatment of anorexia nervosa. Antidepressant cyproheptadine used for weight gain, for agitated and compulsive behavior may be prescribed or chlorpromazine . helps reduce the number of relapses in those recovered from anorexia nervosa. Atypical antipsychotics affect the level of anxiety, reducing it, and increase body weight.

During treatment, patients are provided with all possible support, a calm and stable atmosphere is established around them, behavioral therapy techniques are used, where bed rest combined with health-improving physical exercises, which help increase bone density and also increase estrogen levels. An example of behavioral psychotherapy would be the following situation: if the patient has eaten everything that was offered to him or has gained weight, then he can receive some kind of encouragement, for example, a longer walk, etc.

Plays an important role in the treatment of anorexia diet. At the initial stage, food is not very high in calories, but gradually the calorie content increases. The diet is compiled according to special schemes to prevent the appearance of swelling , stomach lesions And intestines etc.

It should be noted that the mortality rate from complete exhaustion of the body, as a complication of anorexia nervosa, ranges from 5% to 10%, and in this case the person dies from infections . Sometimes, especially on late stages disease, patients may exhibit symptoms of anorexia nervosa as signs of mental disorders, as well as a tendency, although not often, to suicide .

The doctors

Medicines

From the story of anorexia

The essence of anorexia is perfectly conveyed in the old parable " Cured delirium" The ruler of the northern Iranian city of Ray was distinguished by melancholy, sadness and anorexia. He believed that he was a cow, not a man. He mooed like an animal, refused to eat human food, and demanded to be taken to the meadow to graze. He also wanted to be killed and his meat used. Because of this, only “skin and bones” remained of the ruler. Doctor Avicenna decided to help him. Arriving at the palace, he shouted: “ Where is this cow, I came to slaughter it!" He was taken to the master. Before carrying out his plan, Avicenna examined it like a butcher, for the presence of fat and meat. And Avicenna said: “This cow is not suitable for slaughter, she is too thin. Let her gain weight and then I will take her.” Encouraged by this, the ruler began to eat everything that was brought to him, gradually gained weight and recovered.

In 1689, Dr. Morton designated this disease as “ nervous consumption " At the beginning of the last century, the disease was classified as a manifestation, and then as a symptom. Later he was called Twiggy syndrome or Barbie , and only in 1988 the disease received the name “anorexia nervosa.”

Diet, nutrition for anorexia nervosa

List of sources

• Korkina M.V. Social factors and eating disorders. Chapter in the Manual of Social Psychiatry / Ed. T.B. Dmitrieva. - M.: Medical Information Agency, 2009.
• Stormy ME. Clinical psychotherapy. M.: Academic project, OPPL, 2000.
• Alexander F. Psychosomatic medicine / F. Alexander / Ed. S.L. Shishkina. - M.: Institute of General Humanitarian Research, 2006.

Anorexia nervosa- a severe form of mental disorder due to pathological dependence on one’s physical appearance.

The high degree of danger of the disease is due to the individual’s conscious refusal to eat.

Lizzie Velaxes - 28 kg with a height of 1.58 m

The primary task that those in the risk zone see before themselves is a maximum reduction in body weight until they are satisfied with their external data.

The female part of the population is more prone to manic fear of obesity. For them, the consequences of anorexia can cause disruptions in hormonal levels and subsequently lead to the development of symptoms of amenorrhea, that is, the complete disappearance of menstrual flow.

The initial signs of the disease most often appear in adolescence. The child’s psyche does not have the flexibility inherent in adults and is subject to any manifestations of influence from the environment that shapes it.

Falling under the influence of fashion trends about body slimness and beauty standards, children begin to have an incorrect attitude towards their body.

Mass media, the Internet, magazines - everyone shouts that attracting attention and becoming attractive is possible only if you carefully control your own weight and calories consumed. A huge number of “beauty recipes” and diets have been invented, the degree of harm of which can only be determined by a highly qualified medical professional.

Initial signs of the disease

Propaganda of the external over the internal introduces dangerous values ​​and ideals into the child’s not yet fully formed worldview, which can later lead to illness and mental disorders, including anorexia.

The mortality rate from the disease is extremely high. Only according to official data, every tenth case recorded by medicine is fatal. The number of patients who did not seek help cannot be diagnosed.

Causes of anorexia nervosa

Factors that can trigger anorexia nervosa include the following.

Stages and clinical picture

Medicine distinguishes four stages of development of anorexia nervosa.

Symptoms

Symptoms will help identify anorexia nervosa at any stage of development.

Features in behavior:

1. Obsessive thoughts about the need to lose weight, even if body weight is within or below normal. The process of realizing these aspirations does not lead to the expected results in emotional terms (feelings of joy, relief, satisfaction and increased self-esteem); the person continues to look for new opportunities to improve his appearance.
2. Extreme physical activity, often uncharacteristic for the patient. Sports activities and extreme loads for the body become a panacea for obsessive thoughts about being fat. Patients are in constant motion and exhaust themselves with work without feeling tired. This inevitably leads to disruption of biorhythms, leading to insomnia and hyperactive states. As the disease develops, physical strength declines, the patient becomes inactive and lethargic.
3. Constant refusal to eat family circle or with other people when using arguments about being full. It is these moments that can arouse suspicion among loved ones, and they will pay attention to other symptoms.
4. Ignoring existing problems, even if there are physical manifestations. Patients deliberately do not pay attention to their body, which signals them about deviations and already real manifestations of anorexia. A persistent reluctance to seek help may be associated with fear of judgment from loved ones or (if anorexia has not reached an advanced stage) with worries about their mental balance.

General symptoms:

• rapid weight loss (the figure can reach up to 30%);
• inadequate assessment of one’s body parameters;
• obesity phobias;
• manic thoughts about food;
• fasting, refusal of proper nutrition and eating in public places;
• adherence to diets; failure to comply with them causes the patient to feel dissatisfied with his volitional qualities;
• voluntary self-isolation, isolation, excessive soul-searching, irritability from any manifestations of communicative actions on the part of other people;
• lack of interest in the opposite sex, decreased libido;
• episodes of fainting and stable states of weakness.

Consequences of anorexia

Anorexia nervosa is a disease that affects the functioning of the entire body. The consequences may be irreversible.

1. Brain and nervous system: decreased brain activity, increased incidence of amnesia, panic attacks, aggression.
2. Hair: loss of color and intense hair loss.
3. Heart: arrhythmia, frequent pain, shortness of breath, tachycardia.
4. Blood: low hemoglobin.
5. Muscles and joints: deformation of muscle tissue, changes in posture, bone vulnerability.
6. Kidneys: urolithiasis, renal failure.
7. Gastrointestinal tract: stomach pain, constipation, gastritis, peptic ulcer.
8. Hormonal system: amenorrhea, infertility, impotence.
9. Skin and nails: peeling and dry skin, brittle nails.

Diagnosis of anorexia nervosa

Symptoms of anorexia are a good reason to seek help from a specialist. He will determine the diagnosis and prescribe treatment. Anorexia nervosa is diagnosed using the following methods:

1. Conducting a conversation with the patient in the presence of someone close, during which the doctor will identify disorders, determine whether there are symptoms and to what stage they belong.
2. Calculation of the degree of correspondence of the patient’s height to his body weight.
3. Carrying out biochemical tests.

Treatment of Anorexia Nervosa

The severity and stage of the disease largely determine the methods used in the treatment of anorexia. Anorexia nervosa must be treated in hospitals, under the supervision of highly qualified specialists and experienced psychologists. The patient is prescribed a diet specialized for his condition.

If the patient refuses to eat food on his own, parenteral nutrition is used - all the nutrients the body needs are administered through the venous system. The disease can be treated with medications or antidepressants.

Anorexia nervosa is a disease that primarily affects mental processes in human activity, so the rehabilitation program involves not only a return to good nutrition and restoration of stable weight, but also psychotherapeutic assistance.

It includes both family therapy (help from relatives and immediate circles) and group therapy (meeting people who have similar symptoms). Compliance with all conditions prescribed by doctors is an important step towards recovery and return to normal life. Be healthy!

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Anorexia is a disease manifested by an eating disorder caused by disorders of the neuropsychic sphere, in which the desire for losing weight and fear of completeness. Many doctors and scientists consider anorexia to be a mental disease with physical manifestations, since it is based on an eating disorder caused by constitutional features, the type of reactions of the nervous system and brain activity.

People suffering from anorexia lose weight by refusing to eat or eating only non-caloric foods, as well as tormenting themselves with heavy, long-term, daily physical activity, enemas, inducing vomiting after eating, or taking diuretics and fat burners.

As weight loss progresses and body weight becomes too low, a person develops various disorders menstrual cycle, muscle spasms, pale skin, arrhythmia and other pathologies of internal organs, the functioning of which is impaired due to lack of nutrients. In severe cases, changes in the structure and functioning of internal organs become irreversible, resulting in death.

Anorexia - general characteristics and types of disease

The term anorexia is derived from the Greek word "orexis", which is translated as appetite or desire to eat, and the prefix "an", which negates, that is, replaces the meaning of the main word with the opposite. Thus, an interlinear translation of the term "anorexia" means lack of desire to eat. This means that the very name of the disease encodes its main manifestation - refusal of food and reluctance to eat, which, accordingly, leads to severe and dramatic weight loss, up to extreme exhaustion and death.

Since anorexia is understood as a state of refusal of food of various origins, this term reflects only the most common feature several isolated diseases. And therefore, the strict medical definition of anorexia is rather vague, since it sounds like this: refusal of food in the presence of a physiological need for food, provoked by disruptions in the functioning of the food center in the brain.

Women are most susceptible to anorexia; in males, this disease is extremely rare. Currently, according to statistics from developed countries, the ratio of women to men suffering from anorexia is 10: 1. That is, for every ten women suffering from anorexia, there is only one man with the same disease. Such a predisposition and susceptibility to anorexia in females is explained by the peculiarities of the functioning of their nervous system, stronger emotionality and impressionability.

It should also be noted that anorexia, as a rule, develops in people with a high level of intelligence, sensitivity and certain personality characteristics, such as persistence in achieving goals, pedantry, punctuality, inertia, uncompromisingness, painful pride, etc.

The assumption that anorexia develops in people with hereditary predisposition to this disease has not been confirmed. However, it has been found that in people suffering from anorexia, the number of relatives with mental illness, character abnormalities (for example, despotism, etc.) or alcoholism reaches 17%, which is much higher than the population average.

The causes of anorexia are varied and include both a person’s own personal characteristics and the influence environment, the behavior of close people (primarily the mother) and certain stereotypes and attitudes existing in society.

Depending on the leading mechanism of development and the type of causative factor that provoked the disease, three types of anorexia are distinguished:

• Neurotic – caused by excessive stimulation of the cerebral cortex by strong emotions experienced, especially negative ones;
• Neurodynamic – caused by inhibition of the appetite center in the brain under the influence of stimuli of extreme strength of a non-emotional nature, for example, pain;
• Neuropsychiatric (also called nervous or cachexia) - caused by persistent volitional refusal to eat or a sharp limitation in the amount of food consumed, provoked by a mental disorder varying degrees severity and character.

Thus, it can be said that neurodynamic And neurotic anorexia are formed under the influence of irritants of extreme strength, but of a different nature. In anorexia neurotic, the influencing factors are emotions and experiences related to the psychological sphere. And with neurodynamic, the decisive role in the development of anorexia is played by not emotional, but, relatively speaking, “material” stimuli, such as pain, infrasound, etc.

Anorexia nervosa stands apart because it is provoked not so much by the impact of extreme force, but by an already developed and manifested mental disorder. This does not mean that anorexia develops only in people who have pronounced and severe mental illnesses, such as, for example, schizophrenia, manic-depressive psychosis, hypochondriacal syndrome, etc. After all, such mental disorders are relatively rare, and much more often psychiatrists are faced with so-called borderline disorders, which in the medical environment are classified as mental illnesses, but at the everyday level they are often considered simply characteristics of a person’s character. Yes, borderline mental disorders consider severe reactions to stress, short-term depressive reactions, dissociative disorder, neurasthenia, various phobias and variants of anxiety disorders, etc. It is against the background of borderline disorders that anorexia nervosa most often develops, which is the most severe, long-lasting and common.

Neurotic and neurodynamic anorexia are usually recognized by a person who actively asks for help and consults doctors, as a result of which their treatment does not present any particular difficulties and is successful in almost all cases.

And anorexia nervosa, like drug addiction, alcoholism, gambling addiction and other addictions, is not recognized by a person; he stubbornly believes that “everything is under control” and he does not need the help of doctors. A person suffering from anorexia nervosa does not want to eat; on the contrary, he is tormented by hunger quite severely, but by force of will he refuses food under any pretext. If for some reason a person had to eat something, then after a while he may induce vomiting. To enhance the effect of refusing food, those suffering from anorexia nervosa often torture themselves with physical exercise, take diuretics and laxatives, various “fat burners,” and also regularly induce vomiting after eating to empty the stomach.

In addition, this form of the disease is caused not only by the influence of external factors, but also by the characteristics of a person’s personality, and therefore its treatment presents the greatest difficulties, since it is necessary not only to adjust the process of eating, but also to correct the psyche, forming the correct worldview and eliminating false stereotypes and attitudes . This task is complex and complex, and therefore psychologists and psychotherapists play a huge role in the treatment of anorexia nervosa.

In addition to the indicated division of anorexia into three types, depending on the nature of the causative fact and the mechanism of development of the disease, there is another widely used classification. According to the second classification, Anorexia is divided into two types:

• Primary (true) anorexia;
• Secondary (nervosa) anorexia.

Primary anorexia caused by severe diseases or injuries, mainly of the brain, such as, for example, hypothalamic insufficiency, Kanner's syndrome, depression, schizophrenia, neuroses with a pronounced anxious or phobic component, malignant neoplasms any organ, the consequences of prolonged brain hypoxia or stroke, Addison's disease, hypopituitarism, poisoning, diabetes, etc. Accordingly, primary anorexia is provoked by some external factor that disrupts the functioning of the food center of the brain, as a result of which a person simply cannot eat normally, although he understands that this is necessary.

Secondary anorexia, or anorexia nervosa, is caused by a conscious refusal or limitation of the amount of food consumed, which is provoked by borderline mental disorders in combination with attitudes existing in society and relationships between close people. With secondary anorexia, it is not the diseases that cause eating disorders, but a volitional refusal to eat, associated with the desire to lose weight or change one’s appearance. That is, with secondary anorexia there are no diseases that interfere with appetite and normal eating behavior.

Secondary anorexia, in fact, fully corresponds to the neuropsychic mechanism of formation. And the primary one combines neurodynamic, neurotic, and anorexia caused by somatic, endocrine or other diseases. In the further text of the article we will call secondary anorexia nervous, since this is its name that is the most frequently used, widespread and, accordingly, understandable. We will call neurodynamic and neurotic anorexia primary or true, combining them into one type, since their course and principles of therapy are very similar.

Thus, taking into account all the signs and characteristics of various types of pathology, we can say that primary anorexia is a somatic disease (such as gastritis, duodenitis, coronary artery disease, etc.), and nervous anorexia is a mental one. Therefore, these two types of anorexia are quite different from each other.

Since anorexia nervosa is currently the most common and represents a big problem, we will consider this type of disease in as much detail as possible.

At the everyday level, it is quite simple to distinguish anorexia nervosa from primary. The fact is that people suffering from anorexia nervosa hide their illness and condition; they stubbornly refuse medical help, believing that everything is fine with them. They try not to advertise their refusal to eat, reducing its consumption by various methods, for example, discreetly transferring pieces from their plate to neighboring ones, throwing food in the trash or bags, ordering only light salads in cafes and restaurants, citing the fact that they are “not hungry.” etc. And people suffering from primary anorexia realize that they need help because they are trying to eat, but they are unable to do so. That is, if a person refuses the help of a doctor and stubbornly refuses to admit the existence of a problem, then we are talking about anorexia nervosa. If, on the contrary, a person actively seeks ways to eliminate the problem, turns to doctors and gets treatment, then we are talking about primary anorexia.

Photo of anorexia

These photographs show a woman suffering from anorexia.

These photographs show a girl before the development of the disease and in the advanced stage of anorexia.

Causes of anorexia

To avoid confusion, we will consider separately the causes of true and anorexia nervosa, since they differ significantly from each other.

Causes of true anorexia

Primary or true anorexia is always caused by some causative factor that depresses or disrupts the functioning of the food center in the brain. As a rule, such factors are various diseases of both the brain and internal organs.

So, the following diseases or conditions can be the causes of primary anorexia:

• Malignant tumors of any location;
• Diabetes mellitus type I;
• Addison's disease;
• Hypopituitarism;
• Chronic infectious diseases;
• Helminths affecting the intestines;
• Organ diseases digestive tract(gastritis, pancreatitis, hepatitis and cirrhosis of the liver, appendicitis);
• Chronic pain of any location and origin;
• Alcoholism or drug addiction;
• Depression;
• Poisoning with various poisons;
• Neuroses with an anxious or phobic component;
• Schizophrenia;
• Hypothalamic insufficiency;
• Kanner's syndrome;
• Sheehan syndrome (necrosis of the pituitary gland, provoked by large blood loss with vascular collapse in the postpartum period);
• Simmonds syndrome (necrosis of the pituitary gland caused by puerperal sepsis);
• Pernicious anemia;
• Severe vitamin deficiency;
• Temporal arteritis;
• Aneurysm of the intracranial branches of the internal carotid artery;
• Brain tumors;
• Radiation therapy of the nasopharynx;
• Neurosurgical operation;
• Brain injuries (for example, anorexia due to a fracture of the base of the skull, etc.);
• Chronic long-term renal failure;
• Prolonged coma;
• Increased body temperature for a long period of time;
• Dental diseases;
• Taking glucocorticoids (Dexamethasone, Prednisolone, etc.) or sex hormones, including oral contraceptives.

In addition, true anorexia can develop while taking medications that act on the central nervous system. nervous system, such as tranquilizers, antidepressants, sedatives, caffeine, etc. Anorexia is also provoked by the abuse of amphetamine and other narcotic substances.

In young children, anorexia can be triggered by persistent, constant overfeeding, as a result of which the child develops an aversion to eating because he feels unwell after eating.

Thus, primary anorexia can be triggered by various factors. However, it must be remembered that with these conditions or diseases, anorexia is not the main or leading syndrome; moreover, it may be completely absent. Therefore, the presence of any of the above causative factors in a person does not mean that he will necessarily develop anorexia, but its risk is higher compared to other people.

Causes of Anorexia Nervosa

This disease is caused by a number of causative factors that must be present in combination for a person to develop anorexia. Moreover, the nature of the causative factors that make up the general etiology of anorexia nervosa is different, since among them there are social, genetic, biological, personality characteristics, and age.

Currently allocated following reasons development of anorexia nervosa:

• Personality characteristics (the presence of such traits as punctuality, pedantry, will, stubbornness, diligence, accuracy, painful pride, inertia, rigidity, uncompromisingness, a tendency to overvalued and paranoid ideas);
• Frequent diseases of the digestive tract;
• Stereotypes regarding appearance that exist in the microenvironment and society (the cult of thinness, recognition of only slender girls as beautiful, weight requirements in the community of models, ballerinas, etc.);
• The difficult course of adolescence, in which there is a fear of growing up and future changes in the structure of the body;
• Unfavorable family situation (mainly the presence of overprotection from the mother);
• Specific body structure (thin and light bones, tall stature).

These reasons can provoke the development of anorexia nervosa only if they act in combination. Moreover, the most important triggering factor in the development of the disease is personality characteristics, when superimposed on any other reasons, anorexia develops. This means that a prerequisite for the development of the disease is a person’s personal characteristics. All other factors can provoke anorexia only if they overlap with personality characteristics. That is why anorexia nervosa is considered a psycho-social disease, the basis of which is the personality structure, and the triggering point is the characteristics of the social environment and microenvironment.

Overprotection on the part of the mother plays a huge role in the development of anorexia nervosa. Thus, it has now been proven that girls of transition, adolescence, who are faced with excessive care and control from their mother, are very susceptible to anorexia. The fact is that in adolescence, girls begin to realize themselves as a separate person, for which they need self-affirmation among their peers, which is done through the performance of certain actions that are considered independent, characteristic only of adults and therefore “cool.” However, actions that teenagers perceive as “cool” and which they need to assert themselves are often frowned upon by adults.

As a rule, in the absence of overprotection on the part of adults, adolescents perform any actions that allow them to assert themselves and gain “respect” and recognition among teenagers, after which they continue to develop normally mentally and form as a person. But girls under overprotection cannot perform these actions, and they need them for further personal growth, since they are independent and are interpreted as manifestations of their will and desires. After all, the child must leave the circle of “childish” parental instructions and prohibitions and begin his own, independent actions that will allow him to finally form and mature.

And girls suffering from excessive mothers’ care cannot afford to act independently, since adults are still trying to keep them in line with children’s prohibitions and boundaries. In such a situation, the teenager either decides to rebel and literally “breaks out” from the mother’s overprotection, or outwardly does not protest, restraining himself, but subconsciously looking for an area in which he can make independent decisions and, thereby, prove to himself that he adult.

As a result, the girl transfers the desire to express herself as an individual through independent actions to control over food, beginning to reduce the amount of food and stubbornly restraining her hunger urges. A teenager perceives his ability to control the amount of food he eats precisely as a sign of an adult and independent act that he is already capable of performing. Moreover, they are tormented by a feeling of hunger, but the ability to live a whole day without food, on the contrary, gives them strength and strengthens self-confidence, since the teenager feels that he was able to withstand the “test”, which means he is strong and mature, capable of managing his own life. life and desires. That is, refusing food is a way of replacing independent actions from other areas of life that adolescents cannot perform due to the excessive guardianship of mothers who control all their steps and believe that the child is still too small and needs to be protected as long as possible and that’s all. decide for him.

In fact, anorexia gives a mentally unstable teenager or adult the opportunity to feel psychologically accomplished because he can control his weight and what he eats. In other areas of life, the teenager turns out to be completely weak-willed, powerless and insolvent, but in refusing to eat, the opposite is true. And since this is the only area in which a person is wealthy, he stubbornly continues to starve in order to get psychological feeling success even at the risk of death. In some cases, people even enjoy the feeling of hunger, since the ability to endure it is their “talent”, which is absent in others, due to which a necessary personality feature appears, a kind of “zest”.

What is anorexia nervosa and what are its causes: comments from a nutritionist and psychologist - video

Clinical picture of the disease

The clinical picture of anorexia is very polymorphic and diverse, since the disease ultimately affects the functioning of many internal organs and systems. Thus, doctors divide the entire range of manifestations of anorexia into symptoms and signs.

Symptoms of anorexia are the subjective sensations experienced by a person suffering from this disease. Unfortunately, patients with anorexia not only do not share these sensations with others, but carefully hide them, because they stubbornly believe that everything is fine with them. But people who managed to recover, after their experience, told all their feelings in detail, thanks to which doctors were able to identify the symptoms of anorexia.

In addition to symptoms, doctors also identify signs of anorexia, which are understood as objective, visible changes in the human body that occur as a result of the disease. Signs, unlike symptoms, are objective manifestations and not subjective sensations, so they cannot be hidden from others, and often they are the ones that play a role vital role to make a diagnosis and determine the severity of the condition.

Symptoms and signs of anorexia are not static, that is, they may be present at some stages of the disease and absent at others, etc. It means that various signs and symptoms develop and appear during different periods of the course of anorexia. Usually their manifestation is determined by the degree of depletion of internal organs from a lack of nutrients, which, in turn, leads to disruption of the functioning of organs and systems and the corresponding clinical symptoms. Such disorders of the functioning of various organs and systems that arise against the background of the disease are often called complications or consequences of anorexia. The most common complications people suffering from anorexia experience are: hair loss, brittle nails, dry and thinning skin, susceptibility to infectious diseases, menstrual irregularities, up to complete cessation of menstruation, bradycardia, hypotension, muscle atrophy, etc.

The symptoms and signs of primary and anorexia nervosa are almost the same. However, with primary anorexia, the person is aware of his problem and is not afraid of food. The remaining changes in the body associated with a lack of nutrients are the same for any type of anorexia, so we will present the symptoms and signs of all types of disease together.

Anorexia - symptoms

Typical symptoms of anorexia include the following:

• Very low body weight, which decreases even more over time, that is, the process of losing weight does not stop, but continues, despite excess thinness;
• Refusal to get better and support normal weight bodies;
• Absolute confidence that the current very low body weight is normal;
• Fear of food and limiting food consumption by any means and under various pretexts;
• Fear of being overweight or overweight, reaching the point of phobia;
• Weakness, pain, spasms and cramps in the muscles;
• Feeling of discomfort after eating;
• Deterioration of blood circulation and microcirculation, which provokes a constant feeling of cold;
• The feeling that life events are not under control, that vigorous activity is impossible, that all efforts are in vain, etc.

Signs of anorexia

Signs of anorexia can be divided into several groups depending on which aspect of a person’s behavior they relate to (for example, eating, social interaction, etc.).

So, Signs of anorexia include the following changes in eating behavior:

• A persistent desire to lose weight and reduce the calorie content of the daily diet, despite very low body weight;
• Narrowing the range of interests and focusing attention only on issues of food and weight loss (a person talks and thinks only about weight loss, excess weight, calories, food, food combinations, their fat content, etc.);
• Fanatical counting of calories consumed and the desire to eat a little less every day than the previous one;
• Refusal to eat in public or a sharp decrease in the amount eaten, which is explained, at first glance, by objective reasons, such as “already full,” “had a big lunch,” “I don’t want to,” etc.;
• Ritual consumption of food chewing thoroughly each piece or, on the contrary, swallowing almost without chewing, putting very small portions on a plate, cutting food into very small pieces, etc.;
• Chewing food and then spitting it out, which carefully suppresses the feeling of hunger;
• Refusal to participate in any events where food consumption is expected, as a result of which the person becomes withdrawn, unsociable, unsociable, etc.

Besides, Signs of anorexia include the following behavioral characteristics:

• The desire to constantly perform heavy physical exercise (constant exhausting workouts for several hours a day, etc.);
• Choosing baggy clothes that should hide supposedly excess weight;
• Rigidity and fanaticism in defending one’s opinion, peremptory judgments and inflexible thinking;
• Tendency to solitude.

Also signs of anorexia are the following changes in various organs and systems or mental state:

• Depressed state;
• Depression;
• Apathy;
• Insomnia and other sleep disorders;
• Loss of performance and ability to concentrate;
• Complete “withdrawal”, fixation on one’s weight and problems;
• Constant dissatisfaction with your appearance and the speed of weight loss;
• Psychological instability (mood swings, irritability, etc.);
• Severing social ties with friends, colleagues, relatives and loved ones;
• Arrhythmia, bradycardia (heart rate less than 55 beats per minute), myocardial dystrophy and other cardiac disorders;
• A person does not believe that he is sick, but, on the contrary, believes that he is healthy and in good health. correct image life;
• Refusal from treatment, from going to the doctor, from consultation and assistance from specialists;
• Body weight is significantly below the age norm;
• General weakness, constant dizziness, frequent fainting;
• Growth of fine vellus hair throughout the body;
• Hair loss on the head, peeling and brittle nails;
• Dry, pale and sagging skin with blueness of the fingers and tip of the nose;
• Lack of libido, decreased sexual activity;
• Menstrual irregularities up to amenorrhea (complete cessation of menstruation);
• Hypotension (low blood pressure);
• Low body temperature (hypothermia);
• Cold hands and feet;
• Muscle atrophy and dystrophic changes in the structure of internal organs with the development of multiple organ failure (for example, renal, liver, cardiac, etc.);
• Edema;
• Hemorrhages;
• Severe disorders of water-salt metabolism;
• Gastroenterocolitis;
• Prolapse of internal organs.

For those suffering from anorexia, refusal to eat is usually due to an obsession and a desire to correct or prevent a defect in their full figure. It should be remembered that people hide their desire to lose weight, and therefore visible signs of anorexia in their behavior do not appear immediately. At first, the person refuses to eat food sporadically, which, naturally, does not cause any suspicion. Then all high-calorie foods are excluded and the number of meals during the day is reduced. When eating together, anorexic teenagers try to move pieces from their plate to others, or even hide or throw away the food. However, paradoxically, those suffering from anorexia willingly cook and literally “feed” other family members or loved ones.

An anorexic person refuses food with the help of powerful volitional efforts, because he has an appetite, he wants to eat, but is mortally afraid of gaining weight. If you force a person suffering from anorexia to eat, he will make various efforts to get rid of the food that has entered the body. To do this, he will induce vomiting, drink laxatives, give an enema, etc.

In addition, to achieve weight loss and “burn” calories, those suffering from anorexia try to constantly be on the move, exhausting themselves with workouts. For this they visit gym, do all the housework, try to walk a lot, and avoid just sitting or lying quietly.

As the anorexic becomes physically exhausted, depression and insomnia develop, which in the initial stages are manifested by irritability, anxiety, tension and difficulty falling asleep. In addition, the lack of nutrients leads to vitamin deficiency and dystrophic changes in internal organs that stop working normally.

Stages of anorexia

Anorexia nervosa occurs in three successive stages:

• Dysmorphomanic – at this stage, a person becomes dissatisfied with his own appearance and the associated feeling of his own inferiority and inferiority. A person is constantly depressed, anxious, looks at his reflection in the mirror for a long time, finding, in his opinion, terrible flaws that simply need to be corrected (for example, full legs, rounded cheeks, etc.). It is after realizing the need to correct deficiencies that a person begins to limit himself in food and look for various diets. This period lasts from 2 to 4 years.
• Anorectic- on at this stage a person begins to constantly starve, refusing food and constantly trying to make his daily ration minimal, as a result of which a fairly rapid and intense weight loss occurs by 20 - 50% of the original. That is, if a girl weighed 50 kg before the start of the anorectic stage, then by the end of it she will lose from 10 to 20 kg of weight. To enhance the effect of losing weight, patients at this stage begin to carry out grueling, long-term workouts, take laxatives and diuretics, do enemas and gastric lavages, etc. At this stage, bulimia often joins anorexia, since the person is simply unable to contain the terrible, painful hunger. In order not to “get fat,” after each meal or attack of bulimia, anorexics induce vomiting, wash out the stomach, give an enema, drink a laxative, etc. Due to loss of body weight, hypotension develops, interruptions in heart function, and impaired menstrual cycle, the skin becomes rough, flabby and dry, hair falls out, nails peel and break, etc. In severe cases, failure of an organ develops, for example, kidney, liver, heart or adrenal, which, as a rule, causes death. This stage lasts from 1 to 2 years.
• Cachectic– at this stage, the loss of body weight becomes critical (more than 50% of the norm), as a result of which irreversible degeneration of all internal organs begins. Swelling appears due to protein deficiency, any food ceases to be absorbed due to irreversible changes in the structure of the gastrointestinal tract, internal organs stop working normally and death occurs. The cachectic stage can last up to six months, but if urgent measures are not taken during this period and the person is not treated, the disease will end in death. Currently, about 20% of patients with anorexia die if they were not helped in a timely manner.

It must be remembered that these three stages are characteristic only of anorexia nervosa. True anorexia occurs in one stage, which corresponds to the cachectic stage for anorexia nervosa, since a person loses the ability to eat normally, abruptly, without any previous psychological deviations and dissatisfaction with his own appearance.

Weight with anorexia

A reliable sign of anorexia is weight that is at least 15% below normal for a person’s height and skeletal features. The simplest and most accurate assessment of a person’s weight according to height is body mass index (BMI). With anorexia, the body mass index (BMI is equal to body weight in kilograms divided by height squared, expressed in meters) does not exceed 17.5. Moreover, even if a person, under the supervision of doctors or loved ones, has gained weight, then after some time he will definitely lose weight again, that is, he will not be able to maintain the achieved normal weight.

Treatment of anorexia

Treatment of people suffering from true anorexia is aimed primarily at eliminating the causative factor and replenishing the lack of body weight. If the cause of anorexia can be eliminated, then, as a rule, patients successfully recover and return to normal life. To gain weight, a high-calorie diet is developed from easily digestible foods, which are prepared in a gentle manner (steamed, boiled, stewed), chopped well and given to the person in small portions every 2 to 3 hours. In addition, various vitamin preparations (primarily Carnitine and Cobalamide), protein and saline solutions are used.

Treatment of anorexia nervosa is much longer and more complex than true anorexia, since its development has a very powerful psychological component. Therefore, therapy for anorexia nervosa consists of properly selected psychotherapy, therapeutic nutrition and medications, the action of which is aimed at relieving and eliminating painful symptoms from various organs and systems, including the central nervous system. Besides, in mandatory They use general strengthening drugs, vitamins and protein solutions, which make it possible to replenish the deficiency of all nutrients in the body in the shortest possible time.

Psychotherapy for anorexia nervosa is aimed at reassessing values ​​and reorienting the personality to other aspects of life, as well as creating a different self-image that is perceived as beautiful (for example, instead of a thin girl, imagine a curvaceous beauty with rosy cheeks, plump breasts, luxurious hips, etc.) . The final result of treatment and the speed of complete recovery depend on the success of psychotherapy.

Medical nutrition is crushed soft semi-liquid or porridge-like food prepared from high-calorie, easily digestible foods with a high protein content (caviar, fish, lean meat, vegetables, fruits, cereals, dairy products, etc.). If an anorexic has protein edema, or does not digest protein foods well, then a protein solution (for example, Polyamine) should be administered intravenously and fed with light food. In severe cases, a person is fed parenterally for the first 2–3 weeks, that is, special nutrient solutions are administered intravenously. When body weight increases by 2 - 3 kg, you can stop parenteral nutrition and switch to eating in the usual way.

To prevent a person suffering from anorexia from vomiting after eating, it is necessary to inject 0.5 ml of a 0.1% Atropine solution subcutaneously 20–30 minutes before meals. After eating, it is necessary to monitor the patient for 2 hours so that he does not secretly induce vomiting or flush the stomach. A person should be fed 6–8 times a day, giving him food in small portions. It is advisable to put the person suffering from anorexia to bed after eating so that he can lie quietly or even sleep.

On average, therapeutic high-calorie nutrition is necessary for 7–9 weeks, after which the person can gradually be switched to regular foods prepared in the usual ways. However, the caloric content of the diet should remain high until the person gains normal body weight for his age and height.

An anorexic person will have to relearn how to relate to food normally, and not be afraid of foods. You will have to overcome the terrible thought in your own head that one piece of cake eaten will immediately lead to fat deposits in problem areas, etc.

In addition to therapeutic nutrition, during the treatment of anorexia, the person should definitely be given vitamin supplements and restoratives. The most effective vitamins in the initial stages of therapy are Carnitine and Cobalamide, which must be taken for 4 weeks. In addition, you can use any multivitamin complexes for a long period of time (0.5 - 1 year). As general tonics, it is recommended to use infusions or decoctions of rowan, calamus root, eleutherococcus or dandelion, plantain leaves, mint, lemon balm, etc.

Medicines in the treatment of anorexia nervosa are rarely used and only from the group of antidepressants to relieve painful sensations, alleviate the person’s condition and prevent relapse of the disease. So, , failure of various organs, etc.) the following famous people:

• Debbie Barham - British writer (died at 26 from a heart attack caused by irreversible damage to the heart muscle due to lack of nutrients);
• Christy Heinrich - American gymnast (died at age 22 from multiple organ failure);
• Lena Zavaroni - Scottish singer of Italian origin (died at age 36 from pneumonia);
• Karen Carpenter - American singer (died at age 33 from cardiac arrest caused by lack of nutrients);
• Luisel Ramos - Uruguayan fashion model (died at age 22 from heart attack caused by depletion of the heart muscle due to lack of nutrients);
• Eliana Ramos (sister Luisel) - Uruguayan fashion model (died at age 18 from cardiac arrest caused by lack of nutrients);
• Ana Carolina Reston - Brazilian model (died at the age of 22 from liver failure caused by irreversible damage to the structure of the liver caused by a lack of essential nutrients);
• Hila Elmaliah - Israeli model (died at 34 from numerous complications of internal organs caused by anorexia);
• Mayara Galvao Vieira - Brazilian model (died at the age of 14 from cardiac arrest due to anorexia);
• Isabelle Carot - French fashion model (died at the age of 28 from multiple organ failure caused by anorexia);
• Jeremy Glitzer - male fashion model (died at 38 from multiple organ failure due to anorexia);
• Peaches Geldof - British model and journalist (died at the age of 25 in her home under unclear circumstances).

In addition, the famous British singer Amy Winehouse suffered from anorexia nervosa, but she died at the age of 27 from a drug overdose.

Anorexia and bulimia

Bulimia is a variant of an eating disorder, the exact opposite of anorexia - it is constant uncontrolled overeating. Unfortunately, many people suffering from anorexia also experience bouts of bulimia, which literally overtake them during periods of starvation. Each episode of bulimia is accompanied by inducing vomiting, performing heavy physical exercise, taking laxatives, enemas and other actions aimed at removing food that has entered the body so that it cannot be absorbed.

As a rule, the causes and approaches to treatment for anorexia and bulimia are the same, since these diseases are two variants of different eating disorders. But the combination of anorexia with bulimia is more severe compared to isolated variants of eating disorders. Therefore, treatment of anorexia combined with bulimia is carried out according to the same principles as isolated bulimia.

Books about anorexia

Currently on the domestic market fiction The following books about anorexia are available, which are either autobiographical or based on true events:

• Justine "This morning I decided to stop eating." The book is autobiographical, it describes the life and suffering of a teenage girl who, having decided to become fashionably thin, began to limit herself in food, which ultimately led to the development of anorexia.
• Anastasia Kovrigina "38 kg. Life in 0 calorie mode." The book was written based on the diary of a girl who constantly dieted in pursuit of thinness. The work describes the experiences, torments and all aspects related to the period of a person’s life in which diets and calories were the main ones.
• Zabzalyuk Tatiana "Anorexia - being caught and surviving." The book is autobiographical, in which the author described the history of the emergence and development of anorexia, as well as the painful struggle with the disease and eventual recovery. The author gives advice on how not to become anorexic and how to get out of this terrible state if the disease does develop.

In addition, there are the following popular science books about anorexia, which tell about the nature, causes of the disease, as well as ways to cure it:

• Elena Romanova "Deadly diet. Stop anorexia." The book gives a detailed description of anorexia, provides different points of view on the causes of the disease, etc. The author illustrates the description of various aspects of the disease with excerpts from the diary of a girl, Anna Nikolaenko, who suffers from anorexia.
• I.K. Kupriyanova "When losing weight is dangerous. Anorexia nervosa is a disease of the 21st century." The book talks about the mechanisms of development of anorexia, the manifestations of the disease, and also gives advice on how to help those suffering from this disease. The book will be useful to parents, since the author describes how to build a system of education that will instill in the child the right attitude towards his appearance and food and, thereby, leveling the risk of anorexia.
• Bob Palmer "Understanding eating disoders". A book in English, intended for teenagers, published in collaboration with the British Medical Association. The book describes the causes and consequences of anorexia, provides recommendations on proper nutrition and maintaining normal body weight.
• Korkina M.V., Tsivilko M.A., Marilov V.V. "Anorexia nervosa." The book is scientific, it contains materials from studies of the disease, provides diagnostic algorithms, approaches to treatment and features of anorexia in men.

In addition, on the domestic book market there are several books dedicated to recovery from anorexia and starting a new life. A similar book on anorexia is the following:

• "Finding yourself. Stories of recovery." The book contains various real stories of recovery of people who suffered from anorexia or bulimia, told by them themselves.

Anorexia in children

Before use, you should consult a specialist.