In anorexia, also known as pubertal anorexia, anorexia nervosa or anorexia mentalis, food intake is disturbed to such an extent that the body no longer receives a sufficient amount of individual, several or all food components due to a great fear of becoming fat, altered eating behavior and a disturbance in the perception of one’s own body, a so-called body schema disorder. Affected people lose significant weight on purpose.
As a result, the body with its cells, tissues and organs can no longer function optimally. Processes in the body can be disrupted as a result and a wide range of ailments can occur in all tissues and organs of the body. The diagnosis of anorexia is made with an interview, physical examination and other tests. The treatment of anorexia depends on its cause and severity and consists of several treatment measures.
General
The Anorexia is also Pubertal anorexia, Anorexia, anorexia nervosa or Anorexia mentalis cited. Literally translated, anorexia means loss of appetite or reduction in appetite. The suffix nervosa is meant to indicate that anorexia has a mental cause. Anorexia nervosa is a disorder of Eating disorder, in which sufferers go on strict diets up to and including complete denial of food Intends to lose significant weight or maintaining a weight that is much too low for their age. This underweight causes severe physical sequelae that can be life-threatening. Due to a disturbance in the perception of one’s own body, a so-called body schema disorder (see Figure 1), those affected still feel too fat despite being underweight.
Causes
There are no single, definite cause for the development of anorexia. Eating disorders such as anorexia are caused by various factors. factors include genetic factors, psychological and family factors, and societal factors. Genetic factors are characteristics inherited from parents to children. To the psychological and family factors include relationship problems, self-esteem conflicts, conflicts with one’s own sexuality, negative childhood experiences and family influences.
Influences of the family can be an alcohol addiction or mental illness of family members, great importance of weight and external appearance in the family, overprotection of the children by the parents as well as a disturbed relationship with the mother, father or between the parents. Possible Social factors are the widespread ideal of thinness, which is the ideal of beauty to strive for, especially for women, and the pressure to perform in Western society. This social pressure mainly affects the female gender. For example, social pressure and the widespread ideal of thinness have led to the fact that women in Germany would like to be five kilograms lighter on average, regardless of whether they are overweight, normal weight or underweight at the moment.
Genetic, psychological, family and social factors cause affected individuals to have a disturbed perception of their own body and figure, which is referred to as Body schema disorder (see Figure 1). In response to certain triggers, this body schema disorder leads to an eating disorder such as anorexia with an altered eating behavior and different measures for the prevention of getting fat or being fat.
Trigger for the occurrence of an eating disorder are common Stressful events such as new school or work challenges, loss events, separations, illnesses or the physical and mental changes of puberty. But constant teasing for being overweight can also trigger the onset of an eating disorder.
frequency
The incidence of eating disorders has increased in industrialized countries in recent decades. In this context, anorexia is a common problem in society as a whole rather rarely. In the group mainly affected of young women between the ages of 15 and 25 However, this disorder can occur in up to one in a hundred young women are found. The female gender is significantly more often affected by an eating disorder than the male. Only just 5 to 10% Of the individuals who are affected by anorexia nervosa are male. The age peak of anorexia is 14 years old.
Eating disorders also occur more frequently in middle and higher social classes than in lower social classes.
Those at particular risk of developing anorexia include Model, ballet dancers and athletes.
symptoms
In the case of anorexia, one for age and body size are clearly Too low body weight, a steady Employment with the body weight, fear before weight gain, diets up to food refusal and other measures to the Weight reduction, Misperception of one’s own figure (see Figure 1) as well as different physical sequelae in the foreground.
The insufficient body weight is less than 85% of the expected body weight for their age, height and sex or the so-called Body Mass Index BMI is below 17.5 kg/m2. The BMI helps to assess body weight. Here the body weight in kilograms is divided by the body height in meters squared. A BMI between 18.5 and 25 kg/m2 is considered normal. This too low body weight can be caused by a intentional weight loss, by a deliberately insufficient weight gain or by the deliberately maintaining a body weight that is too low for the person’s age is caused. The affected persons try to get out of anxiety of being or becoming fat to prevent weight gain at all costs by continually losing weight or maintaining an extremely low body weight.
Thereby avoid Affected individuals turn to eating foods that contain a lot of calories, take various Diets restrict eating to individual foods or sometimes even almost completely abstain from food intake. They also eat extremely slow, so that it takes them an extraordinarily long time to consume the smallest amounts of food. many affected persons refuse to eat together with the family. In some cases, the affected person becomes so preoccupied with food that he or she begins to read cookbooks, cook for others without eating afterwards, or collect and hide food. In addition to dieting and starvation, sufferers also try to keep their weight off through self-induced vomiting or the abuse of laxatives, urine-promoting drugs or Appetite suppressants to reduce. Also excessive physical activity is used to help with weight loss. In some cases, this causes the body weight to be reduced to such an extent that Life threat exists.
Affected persons tend to depressive moods, which are dependent on weight. In the case of successful starvation and weight loss, the affected person feels better and are proud of their performance. Especially in the beginning they are confirmed in their behavior by compliments about their figure from their circle of acquaintances.
Along with weight loss, anorexia nervosa involves a significant change in attitude and a completely distorted perception of one’s own body image, a so-called "body Body scheme disorder (see Figure 1), so that those affected still perceive themselves as too fat even if they are severely underweight. For this reason, very many sufferers also notice not that they are suffering from a disease, which causes them harm and therefore they need treatment.
Due to weight loss, inadequate nutrient intake and increased physical activity, anorexia can lead to a lack- or malnutrition lead to a deficiency of one, several or all nutritional components. As a result, various processes in the body are disturbed, which manifests itself with a wide range of physical sequelae and complaints in all tissues and organs of the body can show (see Figure 2). This includes a disturbance of the menstrual cycle with a lack of menstrual periods in women, a so-called Amenorrhea, and Infertility respectively a loss of sexual desire and the Potency for men.
Next are constipation, low Body temperature, slower Heartbeat, deep blood pressure, slowed Breathe, Hair loss, fluffy hairiness on the back as in premature babies and fluid accumulation in the tissues, so-called edema, possible. Due to insufficient oxygen supply with the blood, a blue-red discoloration of the skin on fingers, toes, hands, feet and face can occur, which is Acrocyanosis is called anorexia (see Figure 3). In addition, so-called Blood count changes with a deficiency of red and white blood cells as well as electrolyte disorders with a lack of potassium, Chloride and Sodium possible, with a potassium deficiency in particular leading to life-threatening cardiac arrhythmias can lead to cardiac arrest. A decrease in red blood cells, a so-called Anemia, leads to pallor, fatigue, loss of performance, concentration problems and breathing difficulties, a decrease in white blood cells, a so-called Leukopenia, increased susceptibility to infections.
If anorexia occurs before the completion of puberty, affected individuals may have growth disorders as well as Failure or abortion of the Pubertal development, including the development of the breasts in girls and the development of the testicles and penis in boys, occur. In particular, if affected persons take pronounced laxatives, a decrease in the Bone stability with increased bone fragility in terms of a Osteoporosis possible.
Diagnosis
Precisely because individuals suffering from anorexia do not realize they are ill due to the body schema disorder, and because weight loss makes them feel good and drives them to professional and physical achievements, the presence of an anorexia often not recognized for a long time. In addition, people suffering from anorexia often hide the weight loss from relatives and acquaintances by wearing loose clothing. In most cases, it is only the collapse at the limit of physical endurance or the urging of relatives or friends that drives the affected person to see a doctor. Even then, the affected persons often resist out of fear of becoming fat, but still knowing that their behavior is detrimental to health and life-threatening.
The doctor will make a detailed interview The doctor will also conduct a discussion with the affected person and his or her. He will inquire about the family and social life situation and living conditions, about the previous physical and mental development as well as about diseases and treatments. In particular, he will ask about complaints and changes, eating habits, weight development, self-induced weight loss, use of laxatives, urine stimulants and/or appetite suppressants for weight loss, physical activity and attitude towards one’s own weight and figure. Then he will carefully examine the person concerned examine.
The weight of the person can be assessed by the physician with the aid of the Body Mass Index (BMI). This is the person’s body weight in kilograms divided by the person’s height in meters squared. A BMI between 18.5 and 25 kg/m2 is considered normal. In anorexia the BMI under 17.5 kg/m2 or the body weight is less than 85% of the body weight to be expected for the person’s age, height and gender.
Further examinations such as a Blood test or a electrocardiogram ECG with recording of the heart curve also help the doctor to detect various deficiencies and the severity of the physical changes caused by the eating disorder.
Based on the interview, physical examination and other tests, the doctor can make a diagnosis of an eating disorder. When determining the form of the eating disorder, it is important to keep in mind that anorexia and binge eating can also occur together or in succession.
With the help of further examinations and discussions, the doctor must then treat the Cause for the eating disorder, if it is not already known.
therapy
As mentioned above, people often do not realize that they are suffering from an illness and therefore need to be treated. Partial refuse they even refuse any treatment measures. This, together with the various causative factors, complicates the treatment of anorexia nervosa.
For the treatment of anorexia various treatment measures necessary. These measures are laid down in a Treatment plan compiled. First of all, the body weight of the affected person must be increased, the physical consequences of anorexia must be treated and the processes in the body of the affected person must be normalized.
Treatment of anorexia often requires a stay of three to six months in a hospital. Particularly in cases of body weight below 75% of normal body weight, life-threatening physical sequelae, and depressive moods with the risk of suicide, affected persons should be treated in a hospital. Even after discharge from the hospital, there is often still a need to many years of psychotherapy necessary at regular intervals, so that eating disorders do not reoccur in affected persons. In addition, the visit of self-help groups The third phase can be helpful for those affected by an eating disorder to exchange information and experiences with each other and to support each other in the healing process. There are also residential communities for persons with eating disorders who are professionally supervised.
The treatment plan for a person suffering from anorexia consists of several phases:
In a first phase the Body weight lifted are. In some cases, artificial feeding is necessary when the underweight threatens the life of the affected person, but they simply do not want to or cannot eat. In the case of artificial nutrition, the necessary nutrients and fluids are given directly into the stomach or in the form of an infusion directly into the blood via a tube through the nose or the abdominal wall, a so-called tube, without the affected person having to chew and swallow these beforehand. Also need physical after-effects the anorexia treats are.
In a second phase the person receives an Meal plan, for which the person is responsible, but which is at the same time carefully monitored by the nursing staff. In addition, with a so-called psychotherapy be started in groups or alone. The patients are made aware of how much they are harming their bodies with their behavior. The body schema disorder must be treated and thus normalize the distorted image that sufferers have of themselves (see Figure 1). The affected person must be relieved of the constant preoccupation with weight as well as the fear of gaining weight. Together with the affected person Behavioral strategies develop a set of rules to replace the satisfying effect of weight loss and with which they can cope with everyday life as well as stressful situations in the family and in society. In addition to Talk therapies above all the Movement therapy as well as the Gestalt and music therapy particularly helpful. The treatment of physical sequelae is continued.
In a third phase The aim is for the person affected to improve their food intake and eating behavior independently regulate, which also includes the independent preparation of food. Psychotherapy in groups, alone or with the family and the treatment of physical sequelae are continued.
In the fourth phase the main focus for younger affected persons is the Family increased in treatment included. In older affected persons, the focus in the fourth phase is on the fact that they increasingly gain weight in all areas of life independent will. At the same time, those affected are prepared for discharge from the hospital and return to their familiar surroundings.
The fifth phase is that after discharge from the hospital, the affected person is followed up in regular check-ups, so that the spit that started in the second phase can be psychotherapy can become.
Especially when people who suffer from anorexia are also affected by Depression are affected, the intake of certain drugs, so-called Antidepressants, help in the treatment of anorexia.
prognosis
The prognosis of anorexia depends on it, how long the disease already exists. With anorexia, the about two thirds of the people involved cured become. However, a large proportion of these people continue to deal with their eating behavior. Some of them also suffer from depressive moods, anxiety, compulsions, depression or abuse of substances such as medications or drugs. With the third of those affected, the prognosis is pronounced unfavorable. For them, anorexia either persists in part, for example in the form of problematic attitudes toward food and the body, or as a whole, or may progress to another form of eating disorder, often to Binge eating addiction, go over. 5 to 20% of those affected can suffer from the consequences of anorexia that has existed for years or decades die.