Anorexia nervosa (anorexia)

Girl with anorexia does not want to eat

Eating disorders have increased sharply in recent decades. The best known form is anorexia, colloquially known as anorexia nervosa.

Puberty is a big challenge for both the psyche and the body. Questionable beauty ideals and high social pressure have unfortunately ensured in recent decades that more and more young people – especially girls – develop an eating disorder. In the best-known form, anorexia nervosa (anorexia, anorexia), the person affected has a disturbed self-image. He feels that he is much too fat, often even when he is already severely underweight.


  • Those affected by anorexia consider themselves to be inadequate because of a distorted self-perception or. a disturbed body self-image for being much too fat.
  • Possible causes or. favoring factors are among other things a low self-esteem, private problems and perfectionist tendencies.
  • Severe underweight can lead to, among other things, sleep disturbances, deficient blood circulation and, in women, the absence of menstruation.
  • A major challenge is that the affected person recognizes the problem and admits the disease to himself or herself. Under this condition, psychotherapy is a promising treatment approach.

Frequency of anorexia in Austria

Official statistics on the prevalence of anorexia in Austria are scarce, as the disease has only gained relevance in recent years. The MHAT study (Mental Health in Austrian Teenagers) sees an increased risk of developing an eating disorder in around 31% of adolescent girls and 15% of adolescent boys. Other figures, however, speak of a prevalence up to 16 times higher in girls than in boys. It is undisputed that anorexia and other eating disorders have become increasingly common in recent decades and by far the most frequent occurrence is in adolescence.


Due to a disturbed body self-image and a distorted self-perception, those affected feel that they are too fat and unattractive. Anorexia nervosa is a psychosomatic disorder. It leads to an abnormal reduction in body weight, accompanied by a massive fear of gaining weight. Cases of anorexia have been reported since the age of 17. The cause of this disorder was documented in the nineteenth century, but it is still not fully understood today. It is assumed that there is not only one cause of anorexia, rather the interaction of different psychological factors is suspected as a trigger.

May promote the onset of anorexia nervosa:

  • Low self-esteem
  • Not feeling loved
  • Stressful life events
  • General dissatisfaction with life or oneself
  • Personality and socialization disorders
  • Problems in sexual development
  • Wanting to conform to a slimness ideal
  • Failures in various areas
  • Perfectionistic tendencies

In order to lose weight, sufferers use various strategies. These include excessive starvation, avoidance of high-calorie foods, excessive physical activity, and use of appetite suppressants and diuretics (promote the flushing of water and nutrients from the body).

Symptoms of anorexia

Avoiding high-fat and high-calorie foods. Shared meals are also avoided, and those affected often feel pressured to eat. Anorexia nervosa often occurs during or before puberty. Starvation slows down the process of physical maturation, or. Delayed.

Common consequences or. Phenomena occurring in parallel with anorexia include:

Massive weight loss is experienced as positive

Rituals and compulsions in eating behavior (eating at certain times, eating only as a reward for exercise)

Fear of weight gain

Avoidance of high-calorie and high-fat foods

Fear of losing control over food intake

Avoiding communal eating

Fixation on food and weight, conspicuous interest in the eating behavior of others

Vomiting of food

Sensitivity to noise and light

Difficulty with food choices

Frequent weighing (several times a day)

Increased athletic activity, trying to be constantly on the move

Absence of menstrual periods

Lanugo hair (downy hair on the face and back)

In the further course of the disease, the constant deficiency leads to disturbed hormone formation and regulation. Other symptoms that may occur are bradycardia (slow heartbeat), low blood pressure (hypotension), elevated blood sugar levels (hyperglycemia), edema and osteoporosis. In addition, women may stop menstruating and men may experience loss of libido and potency.

Diagnosis of anorexia nervosa

The American Association of Psychiatry criteria are used to diagnose anorexia nervosa. Underweight, fear of gaining weight, distorted body perception and, in women, amenorrhea (suspension of mind. 3 consecutive menstrual periods) are the decisive criteria.

Diagnosis of underweight

In determining whether someone is underweight or not, the body mass index (BMI) serves as the most important tool. Here, the body weight in kilograms is divided by the squared height in meters, divided.

Body weight in kg : (height in m)²

For example, the BMI of a 1.70 m tall person weighing 65 kg is 22.5, which is within the normal range. If the person weighed only 48 kg, his BMI of 16.6 would already be a first indication of the presence of anorexia. But gender also plays an important role. If the BMI of a woman of full age is below 17.5 or. if the weight of an adult male is less than 18.5, this is already a first indication of the presence of anorexia.

Fear of weight gain

Although those affected are severely underweight, they are very afraid of gaining weight, becoming fat or overweight. Often this fear increases as weight loss progresses – presumably because it then becomes more and more difficult to lose even more weight.

Distorted body perception

The person’s own body perception with regard to weight, size and shape is disturbed. The affected person feels that he or she is too fat or that certain parts of the body are too fat, even though he or she is severely underweight. In most cases, these feelings only affect the patient’s own body; other people of normal weight are not perceived as being too fat.

What is amenorrhea?

This term refers to the cessation of at least 3 consecutive menstrual periods. Due to the underweight, there is a hormonal disturbance – too little estrogen is secreted, which leads to the absence of menstruation. If weight gain occurs, this problem usually resolves itself.

Therapy: treating anorexia

The therapy of anorexia takes place on 2 levels. On the one hand, the aim is to normalize the body weight and to positively influence the distorted body perception through psychotherapy and behavioral therapy measures. On the other hand, it is important to work on the underlying difficulties that prevent people from overcoming anorexia.

Normalize body weight

At the beginning of the therapy is the establishment of normal weight. If a life-threatening condition has occurred due to starvation, the circulation is first stabilized by artificial nutrition (parenteral nutrition) and fluid intake. In the case of parenteral nutrition, solutions are administered intravenously. After the body weight has been normalized, work is done on personality development.

Psychotherapeutic treatment

There is no drug therapy for anorexia. However, if depression has developed as a result of the anorexia, treatment with antidepressants may be useful. Much more important in the treatment of anorexia is psychotherapeutic treatment, which should help the patient to develop a different self-perception. Behavioral, systemic and psychoanalytic approaches have proven to be particularly effective. In severe cases, therapy is carried out on an inpatient basis.

The therapy tries to find the cause of the anorexia in order to then work on it specifically. Family and relatives are also involved in the therapy, especially in the case of young patients. In joint therapy sessions, among other things, a common understanding of the disease is developed, arrangements for dealing with food are made and wishes for future cohabitation are discussed.

A frequent problem in the treatment of anorexia is the lack of motivation of the person affected, who often does not want to admit that he or she is ill. In many cases, therefore, group therapy takes place, in which newly admitted and already treated patients participate together.

What else can you do as a sufferer??

The transition between "normal Dissatisfaction with the body or. a "normal Dieting behavior and anorexia is fluid. Those affected believe that they still have their eating behavior under control and downplay the illness to themselves and others. Many of those affected realize early on that they are anorexic, but deny it. Fear of gaining weight causes them not to seek help from a.

However, a particularly important step in the treatment of anorexia is to admit your condition to yourself. To have successful therapy, you must admit to yourself that you have problems with eating behavior. Openness and honesty with the therapist can not only speed up the healing process, but are also a prerequisite for diagnosis.

Reflect on how the disease has changed your life. How has it affected social relationships in your life – your partner, family or friends? How has your mood changed, how has your performance at school or work changed? What goals and dreams in your life you can’t achieve when anorexic? What would you gain by beating anorexia nervosa? For many people, these reflections are a valuable support when it comes to finding the strength to face the changes in their lives that treatment will bring.

If you have decided to fight anorexia, your next step should be to see a doctor (e.g., a physician).B. Be a family doctor), a psychologist, psychotherapist, counseling center, or support group. There you will decide together which form of treatment is best for you and whether you will be treated as an outpatient or inpatient.

It is perfectly normal to be slow to give up your problematic behaviors. Experiencing setbacks and failures during treatment is also not uncommon. The most important contribution to the success of your treatment is openness and honesty with your therapists. If you have problems or difficulties, have the courage to address them. Doubts about treatment, or if you believe that an intervention is not effective, can also be raised with doctors or therapists.

Think about what you are afraid of and talk about it with your therapist. Get involved in new experiences and have the courage to try out new behaviors.

In addition to the actual therapy for anorexia, follow-up with psychotherapists and talking with family members is also important. Be sure to keep the appointments you make with your therapist, even if not every one of them feels equally "helpful." feels!

Anorexia: How can relatives support?

Anorexia usually also has a direct impact on the person’s environment. Lack of understanding, but also feelings of guilt can become widespread. Tensions and conflicts, often within the family, are the logical consequence. In most cases, relatives, friends or teachers do not recognize anorexia until the person has already become severely underweight.

Therefore, it is important to interpret the alarm signs correctly and not to deny the disease. Warning signs of anorexia may include:

  • Severe, rapid weight loss without plausible cause
  • Change your diet: avoid foods high in fat and calories
  • Eating according to rituals and diet plans
  • It takes a long time to eat small meals
  • Pretending to eat, z.B. Chewing and spitting out food
  • Frequent excuses to skip meals (z.B. "Have already eaten", "Don’t feel hungry", "Have stomach pain")
  • Drinking against hunger
  • Vomiting after eating
  • Dissatisfaction with one’s own body, fear of weight gain, frequent weigh-ins
  • Hiding the contours of the body, z.B. with wide clothes
  • Excessive physical activity, every opportunity is taken to exercise (v.a. after eating)
  • Mood swings and irritability
  • Sudden drop in performance at school or work
  • Lack of insight into the disease

If you notice several of these behaviors in someone close to you, talk to them about your suspicions or talk to someone close to that person. Do not look the other way! The sufferer may deny the problem out of self-protection, so such a conversation certainly does not come easily.

Do not blame!

Try to avoid accusations. Offer support, but do not push. If you’re overwhelmed with the situation, don’t hesitate to get help. If your suspicions are confirmed, consult a doctor. Only a professional – z.B. Doctor, psychotherapist, or staff member at a specialized counseling center – can diagnose whether or not this is anorexia. A first step you can take when you suspect the presence of anorexia is to go to your family doctor.

You do not have to deal with this difficult situation alone. On the contrary, relatives who seek help and exchange in counseling centers or self-help groups, even for themselves as fellow sufferers, often support the therapy process in a valuable way.

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