Eating Disorders Anorexia Nervosa (Anorexia)

Anorexia nervosa is the most common psychiatric eating disorder

The most commonly diagnosed eating disorder is anorexia nervosa. Mostly, girls get into puberty and young women. In Germany, every 100th to 200th girl between the ages of 15 and 19 is now affected. But also in boys and men more and more anorexia nervosa and other eating disorders are detected. Patients suffer from a mental disorder that reduces food intake to a minimum and leads to severe underweight. Without therapeutic help, anorexia nervosa often leads to malnutrition or even life-threatening malnutrition. Anorexia is the highest mortality rate of all mental eating disorders. Almost every fifth person dies as a result of anorexia or suicide. This underlines the importance of appropriate and as early as possible treatment, which usually includes psychotherapy and nutritional advice.

contents

• Anorexia nervosa is the most common psychiatric eating disorder
• definition
• Symptoms - Most important feature is underweight
• Causes - Diet means the beginning of anorexia?
• diagnosis
• treatment
• Naturopathic treatment of anorexia nervosa
• Current state of research

definition

Anorexia nervosa, also called anorexia nervosa, describes a mental eating and body disorder. The Greek origin of the term anorexia nervosa means "neurotic loss of appetite", but describes the disease only very inaccurate. Rather than an anorexia there is a morbid need for weight loss. Anorexia is when the body mass index (BMI) is below 17.5, or the actual body weight is 15% below the expected weight, and the underweight itself is induced. Psychological causes lead to a disturbed body perception, so that anorexics believe despite their underweight to be fat and thus for fear of gaining weight greatly reduce food intake or even refuse at times completely.

Anorexia nervosa is the most common eating disorder, often with life-threatening consequences of malnutrition. (Image: Nomad_Soul / fotolia.com)

The clinical picture of anorexia varies a lot depending on the individual, but typically sufferers are almost exclusively concerned with eating, nutrition and body weight. If anorexia occurs in isolation, it is called a restrictive anorexia nervosa. If sufferers are suffering from a mixed form and also show hallmarks of the so-called bulimia (bulimia nervosa), this is called the purging type. In principle, however, bulimia is to be distinguished from anorexia. Persons suffering from bulimia are usually of normal weight, as opposed to anorexia. In a bulimia, the disturbed eating behavior is mainly in cravings with binge eating, usually followed by self-induced vomiting and the abuse of laxatives. In addition to the mixed form, anorexia nervosa can also turn into bulimia or, more rarely, follow from bulimia.

Often, the term anorexia is also used for anorexia, but anorexia nervosa is not synonymous with this term. Anorexia is a general lack of appetite without a causal relationship. Furthermore, even earlier names for anorexia nervosa are used, such as Anorexia hysterica or anorexia mentalis.

Symptoms - Most important feature is underweight

The main criterion of anorexia is underweight or a body weight that is at least 15% below the expected weight, and is caused by the reduction or refusal of food intake by the sufferer himself. If one looks more closely at the anorexia nervosa as a mental illness and its symptoms, then there are many, even individual, signs of an incipient or already existing anorexia. The underlying body disorder causes those suffering from anorexia nervosa to perceive as too thick, although usually already an underweight exists. Even with complete exhaustion (cachexia) this disturbed perception persists.

Anorexics feel too fat due to a body disorder, despite underweight and actual conditions are perceived wrong. (Image: Des / fotolia.com)

One's own body perception is disturbed in such a way that signals and actual states are not perceived or are perceived wrongly. For example, starvation or fatigue are barely noticed in anorexia. The pain of self-injury by cutting ("scratching") or burning the skin is perceived by some sufferers as the only way to feel their body.

Anorexics are often very performance oriented and suffer from fear of failure. Your own success and self-confidence increasingly depend only on the control of your own weight. Although anorexics avoid food, you are constantly thinking about their diet. Likewise, sufferers reject their body, but concentrate in thinking and acting entirely on their own body weight. Typical behavioral changes in anorexics are often characterized by a panic anxiety to gain weight. Patients therefore control their body weight very precisely, sometimes several times a day. They focus on counting calories and know my food and its nutritional value well. Only very specific and mainly low-fat foods are eaten, this is often a misuse of appetite suppressants and laxatives. Due to as little rest and sometimes also extreme sports activities, weight gain should be prevented. If there are additional symptoms of bulimia, it is also deliberately and self-induced vomiting after eating.

It is usually shown in the affected little insight, so signs and symptoms are denied or downplayed. Frequently an anorexia develops conspicuous eating habits or wayward eating rituals. Not infrequently, the hunger sensation is suppressed by an increased drinking of water. Many who suffer from anorexia nervosa no longer participate in eating together and hide their own eating habits. On the other hand, it is not uncommon that the anorexic cook in the circle of friends and relatives and intensively deal with the food preparation. The change in behavior can also affect the social life to the extent that sufferers only have little contact with other people and no longer pursue their own interests.

Due to the low weight and a persistent malnutrition many body functions are negatively influenced. This often leads to a hormonal regulatory disorder on the axis of hypothalamus, pituitary and gonads. This may be manifested in men and women suffering from anorexia due to irregular or absent menstruation (amenorrhea), leading to a loss of potency in men. Also, infertility and a loss of libido may be associated with the disease. If the disease begins before puberty, it can also lead to growth disorders and a lack of development of breast or infantile genitalia. Also, the growth of a Lanugobehaarung is often reported.

The panic fear of gaining weight drives the anorexia sufferers into a veritable control over their body weight. (Image: Ralf Geithe / fotolia.com)

Sequelae of anorexia

Other symptoms of altered or slowed metabolism in anorexia nervosa include hair loss, decreased body temperature (hypothermia), low blood pressure (hypotension) and slow heart rate (bradycardia). Protein deficiency can cause water retention (edema), frequent vomiting and laxative abuse lead to internal dehydration and loss of electrolytes. There is an increased susceptibility to infection and in later stages, depression or even suicidal tendencies may be added.

After a long time with anorexia, some sufferers suffer permanently from long-term consequences, which can affect, among other things, the cardiovascular system, the organ functions or the condition of the blood. Known are, for example, osteoporosis, renal insufficiency, anemia, cardiac arrhythmia, infertility, constipation or chronic constipation.

Causes - Diet means the beginning of anorexia?

An eating disorder does not happen overnight. First signs may be dissatisfaction with one's weight and eating habits and resulting weight-loss behavior, such as dieting or fasting.

Puberty often plays a role in the development of anorexia. Due to various psychological, social and biological factors, sufferers are often initially dissatisfied with their own weight. (Image: terovesalainen / fotolia.com)

However, anorexia is usually caused by various factors, with psychic, social and biological causes coming together. Often, puberty plays an important role in the development of anorexia. Stressful situations, high performance demands and physical changes, together with other factors, can be the cause for the development of an eating disorder. Typical causes include:

• Problems in the family,
• Genetic factors,
• Lack of self-esteem and other personal factors,
• Social constraints and role expectations,
• Performance requirements (for example in competitive sports),
• mobbing,
• Beauty and slimming ideals,
• Abuse or abuse.

diagnosis

Since those affected often do not consider themselves ill, it often happens that people from the family and friends are the first to seek professional help. In case of a suspected eating disorder, it is advisable to seek medical advice or to contact counseling centers who are familiar with this topic and know how to deal with those affected in a sensitive and empathetic manner.

During a medical examination, the person concerned, possibly also together with relatives or caregivers, is asked about eating behavior and body perception. In the discussions (partly according to given questionnaires), as far as possible all symptoms, factors and individual aspects of a possible anorexia nervosa should be queried in order to capture the most accurate possible clinical picture. In addition, there is also a physical examination at the u.a. the exact body weight is determined. Based on the BMI percentile curves in minors or the BMI in adults, the physical condition of the patients is defined. In addition, further examinations may take place to rule out that an underweight has physical causes, e.g. a hyperthyroidism. It is also important to recognize possible physical consequences of anorexia early and to treat it if possible.

treatment

Anorexia is a serious eating disorder and can even be life threatening. About 15% of people suffering from anorexia nervosa die as a result of physical injury or suicide. Anorexia is the deadliest form of all eating disorders. Only about 50% of all anorexic sufferers can be completely cured, often there are serious physical sequelae back.

The main criterion for a successful treatment is a precise diagnosis as well as the insight and acceptance of the patients about their own illness. Without your own desire for treatment and help, therapy has little chance of success. But this is missing in most sufferers. Therefore, a stationary therapy is often sought to remove those affected for a long time from the usual environment and also to remove possible causes.

Sufferers often do not see themselves as ill, but understanding their own condition is fundamental to the successful treatment of anorexia. (Image: Photographee.eu/fotolia.com)

An anorexia must be treated on an outpatient or inpatient basis?

The form of treatment depends on the individual severity and severity of anorexia. If the disease is still in its infancy and there are neither severe malnutrition nor other psychiatric illnesses, treatment can be outpatient. However, if the weight loss is already too strong or there are aggravating side effects of anorexia nervosa is usually a hospital therapy necessary.

Various treatment concepts are used for eating disorders. In order to offer as complete and complete a therapy as possible, physical and psychological treatments are often combined. An outpatient therapy can be combined with a phased inpatient therapy. An integral part of the treatment of anorexia is personalized psychotherapy. This can take the form of individual, group or family therapy. Recent forms of psychotherapy have proven to be particularly effective in the focal psychodynamic approach. This therapy focuses on the processing of emotions. Patients are specifically prepared for everyday life after the end of therapy. Overall, focal psychodynamic therapy provides significantly better results than the previous standard treatment, as reported in 2014 in the journal The Lancet.

It is important that every therapy is based on a sound knowledge of eating disorders and anorexia. In a (combined) inpatient therapy a clinic for psychosomatic medicine and psychotherapy with special expertise on eating disorders should be visited. Through additional nutritional counseling, the affected people learn to eat healthily and eat again without fear. Participation in self-help groups can support the healing and also antidepressants or estrogens find in the therapy application.

At the beginning of the diagnosis of anorexia are usually medical and therapeutic discussions. An important component of the various treatment concepts for eating disorders is later an individually adapted psychotherapy. (Image: Photographee.eu/fotolia.com)

The aim of the treatment of anorexia is initially (continuous) weight gain. As part of an increase in weight, it can lead to a so-called Refeeding syndrome. By resuming a normal diet after a prolonged starvation period, associated changes in mineral metabolism can suddenly produce severe symptoms of heart failure with edema. This too can be life threatening.

In addition to the urgent task of raising and stabilizing the body weight of anorexics, it is also important to compensate for possible deficiencies. Those affected must learn to eat normally and regularly and to correctly perceive the signals of their body.

Last chance for anorexia: force-feeding

If the therapies are unsuccessful and if the underweight is life-threatening or suicidal, hospitalization may be necessary without patient consent. Once all options have been exhausted, force-feeding is the ultimate lifesaving measure.

Naturopathic treatment of anorexia nervosa

Since anorexia is a serious illness that can be life-threatening and its cause is made up of many individual factors, the treatment is very complex and must always be supervised by a doctor. Self-therapy is not possible.
Homeopathy is often used in addition to psychotherapy and further medical treatment of the patient. But as diverse as the symptoms of anorexia, are the possibilities of additional homeopathic treatment. One agent which is often used is sodium muriaticum (common salt), which causes u.a. A stabilization of the predominantly young sufferers and thus better chances of success of a psychotherapy should be achieved.

Current state of research

Relatively little is known about anorexia nervosa, so there is often too much time between incipient anorexia and treatment.

Only recently, an international research group led by the Medical Faculty of the University of Duisburg-Essen (UDE) in Germany showed that anorexia nervosa is not only caused by mental illness. The research showed: A specific gene provokes eating disorder anorexia nervosa. Anorexia can therefore also be innate. This opens the way for new forms of therapy and also changes the perspective on anorexic patients. The results of this study have been published in the journal The American Journal of Psychiatry.

Further research indicates that susceptibility to anorexia is already present in the womb, according to a journal article in Nature Communications. (jvs, cs; Updated on 04.07.2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

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