Now no one will argue that mental health most directly affects physical health. But it is difficult to imagine such a direct connection between these two concepts as in the case of the consequences mental disorders, called " eating disorders».
What are eating disorders?
Eating disorders or eating disorders are deviations from normal eating behavior. Normality means regular healthy eating, which does not cause any physical or psychological discomfort in humans. But in the case of eating disorders, the emphasis shifts either to cutting down your diet or to exaggerating its increase. At the same time, it is worth distinguishing between such concepts as “dietary nutrition” and “eating disorders”.
The goal of the diet is to restore health; ideally, it should always be prescribed by a nutritionist, and some restrictions in the diet only contribute to recovery and sometimes weight loss. If we talk about eating disorders, then we should mean, firstly, unauthorized operations uncontrolled by doctors to change one’s normal diet, which ultimately lead not to recovery, but to a significant deterioration in a person’s health, and sometimes to death, because the body urgently needs balanced diet for normal life, otherwise you should expect trouble.
Let's talk in more detail about the main typical cases of eating disorders.
– pathological behavior in which a person specifically refuses to eat, driven by dominant desires for thinness and fear of gaining weight. Often, the actual state of affairs regarding the weight of an anorectic does not correspond to his ideas about himself, that is, the patient himself thinks that he is too fat, while in reality his weight can hardly be called sufficient for life.
Psychological symptoms of anorexia are: intrusive thoughts about one’s own fatness, denial of the presence of a problem in the area of nutrition, violation of eating methods (cutting food into small pieces, eating while standing), depression, poor control over emotions, change social behavior(avoidance, seclusion, sudden change of priorities and interests).
Physical symptoms of anorexia: problems with the menstrual cycle (amenorrhea - absence of menstruation, algomenorrhea - painful menstruation), cardiac arrhythmia, constant weakness, feeling cold and inability to warm up, muscle spasms.
The consequences of anorexia are dire. In pursuit of the modern ideal of beauty, which is expressed in emphasized thinness, anorexics forget about the other components. As a result, patients begin to look terrifying: due to insufficient intake nutrients the skin becomes dry and pale, hair falls out on the head and small hair appears on the face and back, numerous swelling appears, the structure of the nails is disrupted, and all this against the background of progressive dystrophy in the form of a skeleton protruding under the skin.
But all this cannot be compared with the danger of death of patients. According to statistics, if anorexia is not treated, every tenth patient dies. Death can occur as a result of a malfunction of the heart, due to a general inhibition of all body functions, or due to.
Bulimia nervosa– an eating disorder, manifested in the inability to control one’s appetite, is expressed in periodic bouts of painful hunger, which is very difficult to satisfy.
People with bulimia experience an obsessive desire to eat, even if they do not feel hungry. Often this behavior leads to obesity, but this is not a necessary indicator, since many patients, driven by a sense of guilt, prefer to empty the stomach of food by inducing vomiting. The patterns in which patients with bulimia act can be different, but basically the disease manifests itself in an attack-like desire to eat (sudden manifestation of increased appetite), in nighttime overeating (hunger increases at night) or in the constant incessant absorption of food.
The mental symptoms of bulimia are similar to mental symptoms anorexia, but the physical symptoms are different. If a bulimic, subject to ravenous hunger, does not stop eating, then the natural and least of the consequences will be obesity. However, if the patient prefers to empty the stomach after each meal, the situation gets worse.
Firstly, bulimics, like anorectics, try to hide their behavior for as long as possible, if in the latter it manifests itself quite quickly (relatives notice that the person does not eat anything), then in the former it is possible to hide their condition for a relatively long time, because with the help of vomiting the weight is kept in a stable state within the normal range and the person often demonstrates a good appetite, which does not prevent him, however, from flushing what he eats down the drain after a while. Therefore, loved ones may not even realize that there is a person next to them who is in dire need of help. After all, after some time and as a result of such manipulations with your body, your health fails.
Secondly, vomit contains gastric juice, which consists of hydrochloric acid and some other digestive agents. These substances, when regularly inducing vomiting, destroy the delicate walls of the esophagus, which is not at all intended for such an effect, becoming the causes of ulcerations. The oral cavity also suffers, tooth enamel is destroyed and there is a real risk of tooth loss. We should not forget that those who use such a “weight control method” for bulimia, just like anorectics, do not receive enough good nutrition, because the food simply does not have time to be digested, which in the future threatens exactly the same problems with physical health and death.
In addition to these two types of eating disorders, researchers have identified many others. For example, orthorexia (obsessive desire to eat only the right healthy food), selective eating disorder (when a person necessarily strives to eat only certain foods, avoiding all others and also new unfamiliar foods), eating inedible things, obsessive-compulsive overeating (when eating is caused by obsessive desire to be safe and plays the role of a “ritual” when ).
Founder and director of the Eating Disorders Clinic, psychologist, expert on eating disorders, author of methods for treating anorexia, bulimia, and compulsive overeating.
Treatment of Eating Disorders and the Path to Recovery
How to Overcome an Eating Disorder and Regain Your Self-Confidence
Many patients being treated for anorexia and bulimia are convinced that they will never be able to become happy, that they will constantly be forced to go on strict diets in order to be slim and beautiful, that they will never get rid of suffering, pain, constant fatigue from race for a thin and athletic figure. But it is not so. The main thing to remember is that nothing is impossible and that everything is in your hands.The help of a qualified therapist, a specialist in eating disorders, support from loved ones and work on yourself can save you from depressive thoughts, destructive methods of losing weight, and help you get rid of food addiction and regain self-confidence, happiness and pleasure in life.
How to get rid of an eating disorder, where to start?
First of all, you need to find the strength within yourself to admit that there is a problem. This can be difficult, especially if you still believe (somewhere deep down) that losing weight through bulimia or anorexia is the key to success, happiness and self-confidence. Even if you “intellectually” understand that this is not at all true, it may be difficult for you to break old habits.
The good news is that if you are serious about change and are willing to ask for help, you will succeed. But it is important to understand that for full recovery It is not enough to simply “forget” about unhealthy eating behavior. You will have to “get acquainted” again with the girl who is hiding behind these bad habits, thoughts about losing weight and the desire for the “ideal picture”.
Final recovery is only possible if you learn:
- Listen to your feelings.
- Feel your body.
- Accept yourself.
- Love yourself.
You may feel that you are unable to cope with this task. But remember - you are not alone. Qualified specialists are always ready to help you, you just need to take the first step!
Step One: Get Help
You may be scared and terribly embarrassed to approach strangers about such an issue, but if you really want to get rid of your addiction, you must overcome your fear. The main thing is to find someone who can really support you and listen without judging or criticizing you. This could be a close friend or family member, or someone you trust. You may feel more comfortable discussing this problem with a therapist or psychologist.
How to confess to your interlocutor about your illness?
There are no clear rules regarding how to tell someone you are sick about your illness. But pay attention to the time and place - ideally, no one should rush or interrupt you.
Where to start the conversation. This is perhaps the most difficult thing. You can simply say: “I need to confess something very important to you. It’s very difficult for me to talk about this, so I will be very grateful if you let me talk and listen to me carefully.” After this, you can talk about how your disease arose, how it all began; about your experiences, feelings, new habits, and how your eating disorder has changed your life.
Be patient. Your friend or family member will probably have a very emotional reaction to your confession. They may be shocked, amazed, confused, upset and even annoyed. It is possible that they will not even know how to properly respond to your confession. Let them digest what they heard. Try to describe the specific features of your eating disorder in as much detail as possible.
Explain how exactly your interlocutor can support you. For example, say that he can periodically check on your well-being, ask if you have sought help from a specialist, help you create a healthy meal plan, etc.
Today, patients have access to many various options treatment, but it is very important to find exactly the approach or course of procedures that best suits you.
- Find a highly specialized specialist in the field eating disorders
- The selected specialist must have a higher education in the specialization “psychotherapy” or “medicine”, as well as a higher education in the field of psychology and sufficient experience in the treatment of eating disorders
- You should not contact gastroenterologists, psychiatrists, neurologists, or nutritionists at the first stage of treatment for an eating disorder. All these specialists should be contacted already at the stage of an eating disorder. Our Clinic employs all the necessary specialists for successful completion recovery stage.
Step 2: Create a long-term treatment plan
Once you have addressed your health issues, your personal “treatment team” can create a long-term treatment plan for your eating disorder. It may consist of:
Individual or group psychotherapy. Working with an eating disorder specialist is necessary to uncover the underlying issues that led to the eating disorder. A specialist will help you restore your self-esteem, and also teach you how to react correctly to stress and emotional experiences. Each specialist has his own treatment methods, so it is important to discuss with him in advance what results you expect from the course of treatment.
Family therapy. Family therapy can help you and your family members understand how an eating disorder affects your relationships and how family problems may trigger the development of of this disease and also prevent it from healing. You will relearn how to contact each other, respect and support each other...
Inpatient treatment. In rare cases, you may need hospitalization and inpatient treatment. In most cases, inpatient treatment is required for severe anorexia and severe bulimia. You will be under the supervision of specialists 24 hours a day, which will significantly increase your chances of recovery. As soon as doctors are sure that your condition is stable, you can continue treatment at home.
Step 3: Learn Self-Help Strategies
When entrusting the solution to the problem to specialists, do not forget that your personal contribution to treatment is no less important. The faster you figure out what exactly led to you developing an eating disorder, and the faster you learn “healthy” ways to solve this problem, the faster you will get better.
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How to overcome Anorexia and Bulimia: what you can do and what you should avoid |
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How to Build a Healthy Relationship with Food
While food itself is not the problem, building a healthy relationship with it is essential to your recovery. Many patients find it very difficult to control their behavior when it comes to food - they often first severely limit their diet, and then suddenly break down and begin to uncontrollably absorb everything that comes to hand. Your task is to find the optimal balance.
Forget about strict nutrition rules. Severe food restrictions and constant monitoring of everything you eat during the day can trigger the development of an eating disorder. That's why it's so important to replace them with healthy ones. eating habits. For example, if you constantly limit yourself to sweets, try to soften this “rule” at least a little. You can occasionally allow yourself to eat ice cream or a cookie.
Stop dieting. The more you restrict yourself from food, the more likely you are to think about it constantly and even become obsessed with it. So instead of focusing on what you "shouldn't" eat, focus on nutritious foods that will give you energy and vitality. Think of food as fuel for your body. Your body knows very well when it needs to replenish its energy reserves. Listen to him. Eat only when you are truly hungry, and stop eating as soon as you feel full.
Stick to a regular eating schedule. You may be in the habit of skipping certain meals or long time there is nothing. But remember that when you for a long time don’t eat anything, all your thoughts become only about food. To avoid this, be sure to eat something every 3-4 hours. Plan your main meals and snacks in advance and don't skip them!
Learn to listen to your body. If you have an eating disorder, you've likely learned to ignore the hunger and satiety signals your body sends. You may not even recognize them anymore. Your job is to relearn how to respond to these natural signals so that you can plan your meals according to your physiological needs.
Learn to accept and love yourself for who you are.
When you base your self-worth solely on your appearance, you forget about your other qualities, accomplishments, and abilities that make you attractive. Think about your friends and family members. Do they love you for the way you look? Chances are, your appearance ranks low on the list of things they love about you, and you probably rate them on roughly the same scale of values. So why is your appearance so important to yourself?
Paying too much attention to how you look can lead to low self-esteem and loss of self-confidence. But you can learn to perceive yourself in a positive, “harmonious” way:
Make a list of your positive qualities. Think about all the things you like about yourself. Smart? Good? Creative? Faithful? Cheerful? What do people around you consider your good qualities? List your talents, skills, and accomplishments. Also think about the negative qualities YOU DON'T HAVE.
Focus on what you like about your body. Instead of looking for flaws when you look in the mirror, evaluate what you like about your appearance. If you find yourself distracted by “imperfections,” remind yourself that no one is perfect. Even supermodels have their photos retouched.
Stop thinking about yourself in a negative way. As soon as you notice that you are again starting to think negatively, harshly criticize yourself, judge, or feel guilty, stop. Ask yourself, do you have any real basis for such judgments? How can you refute them? Remember, your belief in something is not a guarantee of truth.
Dress for yourself, not for others. You should be comfortable in the clothes you wear. Choose clothes that highlight your personality and make you feel comfortable and confident.
Get rid of fashion magazines. Even if you know that all the photos in these magazines are completely photoshopped, they can still develop insecurity and feelings of inferiority in you. It's best to stay away from them until you're sure they're not damaging your self-esteem.
Pamper your body. Instead of treating your body like an enemy, look at it as something valuable. Treat yourself to a massage, manicure, facial, candlelit bath, or scented lotion or perfume that you like.
Lead an active lifestyle. Movement is essential for your mental and physical well-being. It's best if it's outdoor training.
Tips for Preventing Eating Disorders
Treatment for eating disorders is a long process. It is very important to maintain the achieved results to avoid relapse of the disease.
How to prevent the return of an eating disorder?
Gather a “support group” around you. Surround yourself with people who support you and want to see you healthy and happy. Avoid people who drain your energy, encourage disordered eating, or make you feel bad. Avoid hanging out with friends who always comment on your weight changes. All these comments are given not from good intentions, but from envy.
Fill your life with something positive. Make time for things that bring you joy and satisfaction. Try something you've always wanted to do, learn something new, pick up a hobby. The healthier your life becomes, the less you will think about food and losing weight.
You need to know the enemy by sight. Decide under what conditions the likelihood of relapse is highest - during the holidays, during the exam session or during the “swimsuit season”? Identify the most hazardous factors and develop an “action plan.” For example, during these times, you may want to see your eating disorder specialist more often or ask for additional emotional support from your family and friends.
Avoid internet sites that promote unhealthy body image behavior. Avoid information resources that advertise and encourage anorexia and bulimia. Behind these sites are people who are trying to justify their unhealthy attitudes towards their bodies and diet. The “support” they offer is dangerous and will only hinder your recovery.
Follow yours strictly individual plan treatment. Don't skip appointments with an eating disorder specialist or other parts of your treatment, even if you notice improvements. Strictly follow all recommendations developed by your “treating team”.
Thinness to the point of protruding bones, the gym and diets as the only meaning of life, or uncontrolled raids on the refrigerator in the consciousness of society have become entrenched as a choice of people and an indicator of willpower. This does not seem to be a problem: those who are exhausted simply have to start eating, and those who want to be slim-stop overeating. The solution seems logical if you don’t know that these people have eating disorders. There are many myths and misunderstandings about eating disorders, and they contribute to the increase in the number of cases. the site explains what it really is and what the dangers of such disorders are.
What is RPP?
Eating disorders (ED)-This is a group of eating disorder syndromes that are considered mental disorders. There are many types of these disorders, but the most famous-these are anorexia, bulimia and compulsive or psychogenic overeating. In addition, these disorders can occur together or replace each other throughout a person’s life.
Anorexia-psychopathological fear of obesity and sagging figure, which becomes an obsession. Under the influence of this obsession, people lose weight, and set their limit too low-this happens due to distorted perception own body. Weight becomes less physiological norm, appear accompanying illnesses: hormonal, metabolic and organ dysfunction.
Bulimia-a disorder with binge eating and severe weight control anxiety. Patients develop their own style of eating and overeating: when after eating, vomiting is caused or laxatives and diuretics are used. Bulimia often occurs in patients after anorexia goes into remission.
Compulsive or psychogenic overeating-a disorder that manifests itself as binge eating. Control over food intake is lost: people eat large amounts of food without feeling hungry, during times of severe stress, or simply in a short period of time. Binge eating disorder is accompanied or replaced by feelings of guilt, loneliness, shame, anxiety and self-loathing.
There are no exact statistics on the incidence of eating disorders: comprehensive treatment of these diseases began not so long ago, and few turn to specialists about this.. The survey involved 237 people who experienced eating disorders. The majority of respondents (42%) experienced anorexia, another 17%- bulimia, 21% - a combination of anorexia and bulimia. 6% suffered from loss of appetite and compulsive overeating-4%. Alternating attacks of anorexia, bulimia and overeating-4%, all listed at once- 6%.
Who suffers from eating disorder?
Anorexia and bulimia are called women's diseases, because this disorder mainly affects teenage girls and young women; it is rare in men. The survey site showed the same distribution: 97% of those with eating disorders- female.
Moreover, the vast majority (80.2%) fell ill with eating disorder between the ages of 10 and 18 years. 16% of respondents were between 18 and 25 years old. A very small number of respondents were over 25 years old.
Why is eating disorder dangerous?
The most common disorder-anorexia. Patients with anorexia bring themselves to extreme exhaustion: every tenth patient dies from this. If we add to this the young age of the sick, the situation becomes even more tense. The body at the age of 10-18 years is formed: internal organs, bones, muscles grow, hormonal changes occur, the psyche experiences enormous stress. It is difficult for the body to cope with exhaustion in such conditions. Intense emotional background, desire to fit into"beauty standards, difficulties with establishing relationships in a team, first loves-this is fertile ground for the development of eating disorders. Distrust of elders, fear that they will laugh, shame that they couldn’t cope, which prevents them from asking for help, and the inability to turn to a specialist on their own reduce the chances of recovery.
Not everyone can cope with the disease on their own. It’s not only about physical exhaustion, but also about the emotional state of the sick, because eating disorder-these are mental disorders. We asked respondents to choose what feelings and emotions they experienced due to illness. Of the 237 people, more than half chose all the options offered: fear, loneliness, anxiety, apathy and indifference, the desire to die and shame. Also 31 people chose the option"Other" . They described what they experienced:
- hopelessness, feeling that I can't change anything
- helplessness, feeling that everything is going to hell
- hatred of yourself and your body
- anger and anger at yourself and others
- fear for health and future
- joy and pride in one’s supposed success and willpower
- that I am like this - unworthy of existence
- panic attacks, horror, hysterics
- loss of control over yourself, your body and your life
- hatred for those who talked about food
- an unbearable desire to be needed by at least someone.
In addition, some health problems due to eating disorders are permanent. The whole body suffers from exhaustion. The stomach often “stands up” and cannot digest food. If patients used diuretics and laxatives, especially antidepressants such as fluoxetine, then the kidneys, liver, and heart fail. Teeth crumble and fall out.
Another danger is that it is not known whether eating disorder can be completely cured. Many achieve long-term remission, but then some events become a trigger that starts everything all over again. Reducing the number of attacks-already big success in the fight against eating disorders.
What causes eating disorder?
Patients with eating disorder told the site what caused the onset of their disorders. The stories are varied, but the vast majority talk about humiliation by classmates, friends and family, as well as stereotypes in society:"beauty standardsin Instagram photos, the popularity of thinness, and the romanticization of mental disorders. But some stories are really scary:
"My dad abused me, and I decided I didn't deserve food. That's how I punished myself."
“I have latent schizophrenia. Eating disorder is a consequence of the disease. I refused to eat because of voices that suggested that I was ugly and fat.”
“After the death of a loved one, anorexia appeared, and then, due to restrictions, bulimia.”
“From early childhood, I was told about the “harmfulness” of this or that food, I constantly heard “a girl should be thin”, “you need to be thinner”. My mother has an eating disorder, now I am recovering myself and helping her. I ignored, but such statements are still were equally deposited in the subconscious. The whole process was triggered by a person’s statement that I was “fat.” Click. And now I consider myself fat, now I don’t like myself, now I believe everything “bad” that they tell me about my figure."
“15 years is the age when the body begins to change, body weight increases. In six months I gained a little weight: from 46-48 to 54 kg. Well, my friends considered it their duty to say so. I found a scale at home and was convinced of this. I decided , that there is nothing better than mf (eat a little). But everything could not end so well, and for the third year now I have been suffering from bulimia. I feel that this is why I will die soon..."
“No one has ever loved me. Even myself. I don’t know what the reason is, maybe it’s the color of my skin or my facial features: I’m half Iranian. When I got tired of it, I started losing weight and working out... Gym for 5 hours, Japanese diet. I lost weight, but couldn’t get the last 5 kg off - and I started vomiting. Overeating and vomiting. I’ve had bulimia for 10 years.”
How to determine that you or a loved one may have an eating disorder
From the outside, you can notice if a person’s behavior has changed. Refusal of food or excessive consumption of it, fanatical burning of calories-a reason to wonder if everything is okay.
In addition, the Clark Institute of Psychiatry developed the Eating Attitudes Test (EAT). The test is intended for screening: it does not accurately determine the presence of the disorder, but it does reveal the possibility of it or a tendency towards it. A version of the EAT-26 test is used, which has 26 questions, and sometimes with a second part of another 5 questions. The test is freely distributed and can be used and passed by anyone. On the Internet, EAT-26 can be completed, for example, atpsychologists' websites .
Another way - Check your body mass index (BMI). This is important if you notice that a person is rapidly losing or gaining weight. There are many methods for determining BMI, but the simplest and most accurate is the Quetelet index. It is calculated according to the formula:
I = mh²,
Where:
- m is body weight in kilograms;
- h - height in meters.
For example, a person’s weight = 70 kg, height = 168 cm. The body mass index in this case is calculated as follows:
BMI = 70: (1.68 × 1.68) = 24.8
Now BMI needs to be checked against the table of values:
In our example, BMI is included in the normal value. It is also important to take into account that weight is individual and depends on many indicators: the skeletal system, development muscular system, gender, condition of internal organs. But if you check how a person’s BMI has changed, you can understand whether it’s worth sounding the alarm. Especially if it happened suddenly.
But more important - observe and talk with a person. RPP-it is a mental disorder that may not immediately affect the physical body. You just need to be more attentive to your loved ones and yourself. It is better to sound the alarm and find out that everything is fine than to leave a person alone with a disease that often wins. If you suspect something is wrong, it is best to immediately contact a specialist. On early stages Therapy with a psychologist helps if everything is neglected-go to a psychotherapist. It is very important not to leave sick people unattended.
You are not alone and you can handle it: what do people with eating disorders wish each other?
the site asked survey participants to talk about their feelings and give advice to those who are struggling. We quote some of them on condition of anonymity.
“Don’t start. I almost died several times, my heart couldn’t stand it... Sick organs and excess weight, despite all attempts. Seek help wherever you can. At one time I was stopped by my relatives who lived with me. Now there is no one. Move in with your mom, dad, sister, let them watch you like you’re a suicide. Because in reality it is unconscious suicide."
“I want to say that this type of mental disorder is terrible. It destroys you completely, and you don’t resist, on the contrary, you only praise your illness, pushing yourself even closer to the abyss. You really deserve a happy and wonderful life without the drives and thoughts that kill your mind and body. Love yourself and stop blaming food and the number on the scale for everything. Understand that you are beautiful and you don’t need hunger to read a lot, move and find out exactly what you did during periods of strict diets, trying to take your mind off the taboo food. I will even say more: to truly enjoy self-development and life in general, food MUST BE in your stomach. Foods give us energy, strength for new goals, it stops your hustle on a weekday, lifts your spirits - and this okay, stop thinking that enjoying your mother’s delicious dinner is disgusting. And that’s why she’s good. And therefore you shouldn’t renounce her in the direction of an imaginary “ideal.” Forget about it. Start again, but without hunger!"
“When I was too thin, they took pictures of me on the street and pointed the finger at me. I liked being thin, but it was a constant weakness, the inability to even sit on something hard and take a bath, because the bones protrude and it became very painful. Sorry, even irritations on the buttocks are painful were. My hair was falling out, my skin was like a lizard. I hadn’t had my period for two years and my gastrointestinal tract didn’t work as long. And this is a constant worry about food, which takes up all my time and even my life. I couldn’t draw, play the guitar or write. I started aggressive at home and did not communicate much.
Having decided to recover, I didn’t eat much, everything was done little by little, victory after victory. It turned out to be difficult to gain weight; in 1.5 years it was almost imperceptible to others. But they even began to get to know me more often. The sparkle in the eyes appeared again. My loved ones were happy to the point of tears that I was finally eating and not dying!
I got my period for the first time in two years. I didn't believe it at first. I started crying. I told my mom and she cried too. It happened on dad's birthday, and when dad found out in the evening, he came to my room and just hugged me. He never cried like that..."
“After a year of inducing vomiting after eating, my skin deteriorated, my teeth began to crumble, my hair fell out, I developed stomach problems, and permanent dental damage appeared on my knuckles. Health problems sobered me up. I realized that it doesn’t matter what I’m overweight: losing weight is not worth the lost health and nerves.”
Eating disorders (also called eating disorders or eating disorders) are a group of complex psychogenic pathologies ( anorexia, bulimia, orthorexia, compulsive overeating disorder, compulsive desire to exercise etc. ) which is manifested in a person by problems with nutrition, weight and appearance.
Weight, however, is not a significant clinical marker because the disease can affect even people with normal body weight.
Eating disorders, if not treated promptly and with adequate methods, can become a permanent disease and seriously jeopardize the health of all organs and systems of the body (cardiovascular, gastrointestinal, endocrine, hematological, skeletal, central nervous system, dermatology, etc.) and, in severe cases, lead to death. Mortality among people with anorexia nervosa 5-10 times higher than healthy people the same age and gender.
These disorders currently represent an important public health problem, as the age of onset has gradually decreased in recent decades. anorexia And bulimia, as a result of which diseases are increasingly diagnosed before the onset of menstruation, up to 8-9 years in girls.
The disease affects not only teenagers, but also children before they reach puberty, which has much more serious consequences for their body and psyche. Early onset of the disease may lead to more high risk irreversible damage due to malnutrition, especially in tissues that have not yet reached full maturity, such as bones and the central nervous system.
Given the complexity of the problem, early intervention is of particular importance; It is essential that specialists with different specializations (psychiatrists, pediatricians, psychologists, nutritionists, internal medicine specialists) actively collaborate with each other to achieve early diagnosis and taking prompt action.
According to official estimates, 95,9% people suffering from eating disorders are women. The incidence of anorexia nervosa is at least 8 new cases per 100,000 people per year among women, while in men it is between 0.02 and 1.4 new cases. Concerning bulimia, Every year per 100 thousand people have to 12 new cases among women and about 0.8 new cases among men.
Causes and risk factors
We talk about risk factors, not causes.
In fact, these are disorders of complex etiology in which genetic, biological and psychosocial factors interact with each other in pathogenesis.
In the consensus document on eating disorders, prepared by the Higher Sanitary Institute in collaboration with the association “USL Umbria 2”, the following disorders were noted as predisposing factors:
- genetic predisposition;
- , drug addiction, alcoholism;
- possible adverse/traumatic events, chronic childhood illnesses and early feeding difficulties;
- increased socio-cultural pressure to be thin (models, gymnasts, dancers, etc.);
- idealization of thinness;
- dissatisfaction with appearance;
- low self-esteem and perfectionism;
- negative emotional states.
Signs and symptoms
Common signs of eating disorders include problems with eating, weight and appearance. However, each option manifests itself in a certain way.
Anorexia nervosa
This is a psychiatric pathology with the highest mortality rate (the risk of death in these patients during the first 10 years from the onset of the disease is 10 times higher than in the general population of the same age).
People who suffer from anorexia nervosa are afraid of gaining weight and engage in persistent behaviors that prevent them from gaining weight, through extreme dieting, vomiting, or very intense exercise.
The onset is gradual and insidious, with a gradual reduction in food intake. Reducing calorie intake involves reducing portions and/or eliminating certain foods.
In the first period, we observe a phase of subjective well-being associated with weight loss, improved image, a sense of omnipotence, which gives the ability to control hunger; later, concerns about the lines and shapes of the body become obsessive.
The fear of losing weight does not decrease with weight loss, it usually increases in parallel with weight loss.
Common practices include excessive exercise (compulsive/obsessive), constant monitoring of mirrors, clothing sizes and scales, counting calories, eating over several hours, and/or chopping food into small pieces.
Obsessive-compulsive symptoms are also exacerbated by decreased caloric intake and weight.
The affected people absolutely deny that they are in dangerous condition for their health and life and against any treatment.
The level of self-esteem is influenced by physical fitness and weight, in which weight loss is a sign of self-discipline, weight gain is perceived as a loss of control. Typically, they come for clinical examination under pressure from family members when they observe weight loss.
To lose weight, in addition to avoiding food intake, patients can resort to the following methods:
- compulsive exercise;
- resort to taking laxatives, anorexigenic drugs, diuretics;
- provoke vomiting.
People with anorexia nervosa have:
- extreme thinness with the disappearance of fat deposits and muscle atrophy;
- dry, wrinkled skin, the appearance of fluff on the face and limbs; reduction of sebaceous production and sweat; yellowish coloration of the skin;
- bluish hands and feet due to exposure to cold ();
- scars or calluses on back side fingers (Russell's sign), due to continuously placing fingers in the throat to induce vomiting;
- dull and thinning hair;
- teeth with opaque enamel, caries and erosions, gum inflammation, enlarged parotid glands(due to frequent self-induced vomiting and subsequent increase in acidity in the mouth);
- (slowdown heart rate), arrhythmia, and hypotension;
- stomach cramps, delayed gastric emptying;
- constipation, hemorrhoids, rectal prolapse;
- sleep changes;
- (disappearance, at least 3 consecutive cycles) or disturbances;
- loss of sexual interest;
- and increased risk of fractures;
- memory loss, difficulty concentrating;
- depression (possible suicidal ideation), self-harm behavior, anxiety, ;
- possible rapid fluctuations in electrolyte level, with important consequences for the heart (up to cardiac arrest).
Bulimia
The main feature that distinguishes it from anorexia is the presence of repeated overeating.
This causes episodes in which large amounts of food are consumed in a short period of time (bulimic crises alone, planned, characteristic rate of eating). It is preceded by dysphoric mood states, interpersonal stress states, feelings of dissatisfaction with body weight and shape, feelings of emptiness and loneliness. There may be a short-term reduction in dysphoria after binge eating, but it is usually followed by a depressed and self-critical mood.
People with bulimia engage in repetitive compensatory behaviors to prevent weight gain, such as spontaneous vomiting, overuse of laxatives, diuretics or other drugs, and excessive physical exercise.
Bulimic crisis is accompanied by a feeling of loss of control; feelings of alienation, with some reporting similar experiences of derealization and depersonalization.
Often the onset of the disease is associated with a history of dietary restrictions or after emotional trauma in which the person is unable to cope with feelings of loss or disappointment.
Binge eating and compensatory behavior occurs on average once a week for three months.
Spontaneous vomiting (80-90%) reduces the feeling of physical discomfort, in addition to the fear of gaining weight.
Uncontrolled eating of large amounts of food ( compulsive overeating )
Binge eating disorder is characterized by repeated episodes of compulsive eating over a limited period of time and a lack of control over food during meals (for example, feeling like you can't stop eating or that you can't control what or how much you eat).
Episodes of binge eating are associated with at least three of the following:
- Eat much faster than usual;
- Eat until you have painful feeling overcrowding;
- Eat a lot without feeling hungry;
- Eating alone due to embarrassment about the amount of food you swallowed;
- Feeling self-loathing, depression, or extreme guilt after eating too much.
Binge eating causes distress, discomfort, and occurs on average at least once a week over the past six months without compensatory behavior or disorder.
Restrictive eating behavior
Restrictive eating behavior is mainly characteristic of adolescence, however, it can also occur in adults.
This is an eating disorder (eg, apparent lack of interest in food; avoidance based on sensory characteristics of food; anxiety about unpleasant consequences food intake), which is manifested by a persistent failure to adequately assess the contribution of nutrition. As a result, this provokes:
- Significant weight loss or, in children, failure to achieve expected weight or height;
- Significant nutritional deficiencies;
- Dependence on enteral nutrition or oral nutritional supplements;
- Explicit interference with psychosocial functioning.
The disorder includes many disorders called by other terms: e.g. functional dysphagia, hysterical lump or choking phobia(inability to eat solid food due to fear of choking); selective eating disorder(limited nutrition to a few foods, always the same, usually carbohydrates, such as bread-pasta-pizza); orthorexia nervosa(obsessive desire to eat right, eat only healthy food); food neophobia(phobic avoidance of any new food).
Rumination disorder
Mericism or rumination disorder is characterized by repeated regurgitation of food over a period of at least 1 month. Regurgitation is the regurgitation of food from the esophagus or stomach.
Repeated regurgitation is not associated with gastrointestinal disorder or other diseases (for example, hypertrophic pyloric stenosis); it does not occur exclusively during anorexia nervosa, bulimia nervosa, binge eating disorder, or restrictive eating behavior.
If symptoms arise in the course of mental retardation or pervasive developmental disorder, or intellectual disability and other neurodevelopmental disorders, they are in themselves severe enough to warrant further clinical attention.
Pica
Cicero is an eating disorder characterized by the persistent intake of non-edible substances over a period of at least 1 month. Common substances taken vary depending on age and availability, and may include wood, paper (xylophagy), soap, earth (geophagy), ice (pagophagy).
The consumption of these substances does not correspond to the level of individual development.
These eating behaviors are not part of culturally or socially accepted normative practices. It may be related to mental retardation or chronic psychotic disorders with long-term institutionalization
If eating behavior occurs in the context of another mental disorder (intellectual disability, autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is severe enough to require further clinical attention.
Complications
Eating disorders can have serious health consequences, most commonly with anorexia nervosa, due to the effects of malnutrition (affecting all organs and systems of the body) and elimination behaviors (gastrointestinal tract, electrolytes, kidney function).
Women with eating disorders have greater perinatal complications and are at increased risk of developing postpartum depression.
For these reasons, the assessment medical complications requires specialists in this field.
Anorexia, in the long term can cause:
- endocrine disorders ( reproductive system, thyroid gland, stress hormones and growth hormone);
- specific nutritional deficiency: lack of vitamins, lack of amino acids or essential fatty acids;
- metabolic changes (hypercholesterolemia, hyperazotemia, ketosis, ketonuria, hyperuricemia, etc.);
- problems with fertility and decreased libido;
- cardiovascular disorders (bradycardia and arrhythmias);
- changes in the skin and appendages;
- osteoarticular complications (osteopenia and subsequent bone fragility and increased risk fractures);
- hematological changes (microcytic and hypochromic due to iron deficiency, leukopenia with a decrease in neutrophils);
- electrolyte imbalance (especially important potassium reductions, with risk of cardiac arrest);
- depression (possibly suicidal ideation).
Bulimia may cause:
- enamel erosion, gum problems;
- water retention, swelling lower limbs, bloating;
- acute, swallowing disorders due to damage to the esophagus;
- decreased potassium levels;
- amenorrhea or irregular menstrual cycles.
Treatment of eating disorders
Nutritional rehabilitation for eating disorders at every level of treatment, whether outpatient or intensive with partial or full hospitalization, should be carried out within the framework of a comprehensive interdisciplinary approach that includes the integration of psychiatric/psychotherapeutic treatment with nutrition, in addition to nutritional complications, with the specific psychopathology of the disorders eating behavior and general psychopathology that may be present.
Multidisciplinary intervention is indicated particularly when eating disorder psychopathology coexists with undernutrition or overeating.
During treatment, it must be constantly taken into account that malnutrition and its complications, if any, contribute to the maintenance of eating disorder psychopathology and interfere with psychiatric/psychotherapeutic treatment and, conversely, if weight restoration and elimination of dietary restriction are not associated with improvement in psychopathology, there is a high likelihood of relapse.
Depending on the intensity of treatment, the interdisciplinary team may include the following professionals: doctors (psychiatrists/child neuropsychiatrists, nutritionists, therapists, pediatricians, endocrinologists), nutritionists, psychologists, nurses, professional educators, psychiatric rehabilitation specialists and physiotherapists.
Having multidisciplinary clinicians has the advantage of facilitating the management of complex patients with serious medical and psychiatric problems comorbid with an eating disorder. Additionally, both the psychopathology of the eating disorder and caloric and cognitive restriction, as well as the physical, psychiatric, and nutritional complications that ultimately arise, can be appropriately addressed through this approach.
In fact, people suffering from eating disorders should receive both psychiatric and mental health interventions. psychological aspects, as well as nutritional, physical and socio-environmental aspects. These interventions should also be rejected depending on the age, type of disorder, as well as on the basis of clinical assessment and the presence of other pathologies in the patient.
Interesting
Any eating disorder can cause the development serious problems with health. As a rule, it is based on psychological factors. Therefore, it is necessary to get rid of them together with specialists.
Types of problems
Experts know that eating disorders can manifest in different ways. Treatment tactics in each specific case should be selected individually. It will depend on the diagnosis and condition of the patient.
The most popular types of disorders are:
It is not always possible to recognize people who suffer from any of these disorders. For example, with bulimia nervosa, weight may be within the normal range or slightly below the lower limit. At the same time, people themselves do not understand that they have an eating disorder. Treatment, in their opinion, they do not need. Any condition in which a person tries to create dietary rules for himself and strictly adheres to them is dangerous. For example, complete refusal to eat after 16 hours, strict restriction or complete refusal to eat fats, including plant origin, should be wary.
What to look for: dangerous symptoms
It is not always possible to understand that a person has an eating disorder. You need to know the symptoms of this disease. A small test will help determine if there are problems. You just need to answer the following questions:
- Do you have a fear that you will gain weight?
- Do you find yourself thinking about food too often?
- Do you refuse food when you feel hungry?
- Are you counting calories?
- Do you cut food into small pieces?
- Do you periodically experience bouts of uncontrolled eating?
- Do people often tell you that you are thin?
- Do you have an obsessive desire to lose weight?
- Do you vomit after eating?
- You get
- Do you refuse to eat fast carbohydrates (baked goods, chocolate)?
- Does your menu include only dietary dishes?
- Are people around you trying to tell you that you could eat more?
If you answered “yes” to these questions more than 5 times, then it is advisable for you to consult a specialist. He will be able to determine the type of disease and choose the most appropriate treatment tactics.
Characteristics of Anorexia
Refusal to eat occurs in people as a result of mental disorders. Any strict self-restraint, unusual choice of foods are characteristic of anorexia. At the same time, patients have a constant fear that they will get better. Patients with anorexia may be 15% below the established lower limit of normal. They have a constant fear of obesity. They believe that weight should be below normal.
In addition, people suffering from this disease are characterized by the following:
- the appearance of amenorrhea in women (lack of menstruation);
- disruption of body functioning;
- loss of sexual desire.
This eating disorder is often accompanied by:
- taking diuretics and laxatives;
- exclusion of high-calorie foods from the diet;
- inducing vomiting;
- taking medications intended to reduce appetite;
- long and exhausting workouts at home and in gym with the goal of losing weight.
To establish a final diagnosis, the doctor must fully examine the patient. This allows you to exclude other problems that manifest themselves in almost the same way. Only after this can treatment be prescribed.
Characteristic signs of bulimia
But people with food-related disorders can develop more than just anorexia. Specialists can diagnose a neurogenic disease such as bulimia. With this condition, patients periodically lose control of how much they eat. They have bouts of gluttony. Once the overeating is completed, patients experience severe discomfort. There is pain in the stomach, nausea, and often episodes of gluttony end with vomiting. Feelings of guilt for such behavior, self-loathing and even depression cause this disorder eating behavior. It is unlikely that you will be able to carry out treatment on your own.
Patients try to eliminate the consequences of such overeating by inducing vomiting, gastric lavage, or taking laxatives. You can suspect the development of this problem if a person is haunted by thoughts about food, has frequent episodes of overeating, and periodically feels an irresistible craving for food. Often episodes of bulimia alternate with anorexia. If left untreated, this disease can lead to rapid weight loss, but at the same time the established balance in the body is disrupted. As a result, there are severe complications, and in some cases, death is possible.
Symptoms of compulsive overeating
When figuring out how to get rid of an eating disorder, many people forget that such problems are not limited to bulimia and anorexia. Doctors are also faced with such a disease as compulsive overeating. In its manifestations it resembles bulimia. But the difference is that people suffering from it do not have regular fasting. Such patients do not take laxatives or diuretics and do not induce vomiting.
With this disease, bouts of gluttony and periods of self-restraint in food may alternate. Although in most cases, between episodes of overeating, people constantly eat a little something. This is what causes significant weight gain. For some, this may only occur periodically and be short-term. For example, just like this certain people react to stress, as if eating away problems. With the help of food, people suffering from compulsive overeating seek an opportunity to gain pleasure and provide themselves with new pleasant sensations.
Reasons for the development of deviations
For any nutritional disorders, you cannot do without the participation of specialists. But help will be effective only if the causes of eating disorders can be identified and eliminated.
Most often, the development of the disease is provoked by the following factors:
- high self-standards and perfectionism;
- presence of traumatic experiences;
- stress experienced due to ridicule in childhood and adolescence about ;
- mental trauma resulting from sexual abuse at an early age;
- excessive concern for the figure and appearance in the family;
- genetic predisposition to various eating disorders.
Each of these reasons can cause self-perception to be impaired. A person, regardless of his appearance, will be ashamed of himself. People with such problems can be identified by the fact that they are not happy with themselves, they cannot even talk about their body. They attribute all failures in life to the fact that they have an unsatisfactory appearance.
Problems in teenagers
Very often, eating disorders begin during adolescence. Significant hormonal changes occur in the child’s body, and his appearance becomes different. At the same time, the psychological situation in the team also changes - at this time it is important for children to look as is customary, and not to go beyond the established standards.
Most teenagers are concerned about their appearance, and against this background they may develop various psychological problems. If the family did not devote sufficient time to the development of objective, adequate self-esteem in the child, and did not instill a healthy attitude towards food, then there is a risk that he will develop an eating disorder. In children and adolescents, this disease often develops against the background of low self-esteem. At the same time, they manage to hide everything from their parents for quite a long time.
These problems develop, as a rule, at the age of 11-13 years - during puberty. Such teenagers concentrate all their attention on their appearance. For them, this is the only means that allows them to gain self-confidence. Many parents play it safe, fearing that their child has developed an eating disorder. With teenagers, it can be difficult to distinguish the line between normal preoccupation with appearance and pathological condition, at which it is time to sound the alarm. Parents need to start worrying if they see that their child:
- tries not to attend events where there will be feasts;
- spends a lot of time on physical activity in order to burn calories;
- too dissatisfied with his appearance;
- uses laxatives and diuretics;
- obsessive about weight control;
- is overly scrupulous about monitoring the calorie content of foods and portion sizes.
But many parents think that children cannot have an eating disorder. At the same time, they continue to consider their teenagers at the age of 13-15 as kids, turning a blind eye to the disease that has arisen.
Possible consequences of eating disorders
Underestimate the problems that can lead to indicated symptoms, it is forbidden. After all, they not only have a detrimental effect on health, but can also cause death. Bulimia, like anorexia, causes renal failure and heart disease. At frequent vomiting, which leads to a lack of nutrients, the following problems may develop:
- kidney and stomach damage;
- feeling constant pain in a stomach;
- development of caries (it begins due to constant exposure to gastric juice);
- lack of potassium (leads to heart problems and can cause death);
- amenorrhea;
- appearance of “hamster” cheeks (due to pathological enlargement of the salivary glands).
With anorexia, the body goes into what is called starvation mode. The following signs may indicate this:
- hair loss, brittle nails;
- anemia;
- amenorrhea in women;
- decrease in heart rate, respiration, blood pressure;
- constant dizziness;
- the appearance of hair fuzz throughout the body;
- the development of osteoporosis - a disease characterized by increased bone fragility;
- increase in joint size.
The sooner the disease is diagnosed, the faster it will be possible to get rid of it. In severe cases, even hospitalization is necessary.
Psychological help
Many people with obvious eating disorders believe that they do not have any problems. But without medical help it is impossible to correct the situation. After all, you can’t figure out how to conduct psychotherapy for an eating disorder on your own. If the patient resists and refuses treatment, then the help of a psychiatrist may be needed. At integrated approach You can help a person get rid of problems. After all, when severe violations Psychotherapy alone will not be enough. In this case, drug treatment is also prescribed.
Psychotherapy should be aimed at a person working on his own image. He must begin to adequately evaluate and accept his body. It is also necessary to correct the attitude towards food. But it is important to work through the reasons that led to such a violation. Experts who work with people suffering from eating disorders say their patients are overly sensitive and prone to frequent episodes. negative emotions such as anxiety, depression, anger, sadness.
For them, any restriction in food or overeating, excessive physical activity is a way to temporarily alleviate their condition. They need to learn to manage their emotions and feelings, without this they will not be able to overcome an eating disorder. How to treat this disease needs to be discussed with a specialist. But the main goal of therapy is to develop the patient’s correct lifestyle.
Those who have difficult family relationships or constant stress at work do a worse job of getting rid of the problem. Therefore, psychotherapists must also work on relationships with others. The sooner a person realizes that he has a problem, the easier it will be to get rid of it.
Recovery period
The most difficult task for patients is developing self-love. They need to learn to perceive themselves as individuals. Only with adequate self-esteem can one restore physical state. Therefore, nutritionists and psychologists (and in some cases psychiatrists) should work on such patients simultaneously.
Professionals should help you overcome your eating disorder. Treatment may include:
- drawing up a nutrition plan;
- inclusion of adequate physical activity in life;
- taking antidepressants (only necessary if there are certain indications);
- work on self-perception and relationships with others;
- treatment of mental disorders such as anxiety.
It is important that the patient has support during the treatment period. After all, people often break down, take breaks from treatment, and promise to return to the planned plan of action after a certain time. Some even consider themselves cured, although their eating behavior remains virtually unchanged.
