Recognize and treat anorexia

Anorexia only affects young girls? By the way! In fact, the most common patients are women between the age of 15. and 25. The majority of people affected by the disease are under the age of 18 (around 1 percent suffer from anorexia). But adults who are fully involved in life also suffer from eating disorders. They are the silent dark figures. Some successfully hide the disease from their environment for years and are under enormous pressure to perform and suffer.

Orthorexia: When healthy eating becomes a compulsion

Those who claim that false ideals of beauty are the trigger of the mental illness are looking at anorexia too one-sidedly. An eating disorder is very complex; there are many different factors that cause it to develop. We spoke to an expert to find out how you can recognize anorexia, what causes it and how sufferers and their families can get help.

Definition: What is anorexia?

Anorexia nervosa, as anorexia is called in technical language, is an eating disorder caused by mental factors. It is characterized by strong control over one’s own body weight. Associated with this is the fear of gaining weight and rejection by others. "The world of thought of those affected is permanently preoccupied with food," explains Dr. Bernhard Osen, Head Physician of the Psychosomatics Specialist Center at the Schon Klinik Bad Bramstedt. He specializes in the topic of eating disorders, anxiety disorders and obsessive-compulsive disorders.

The different variants of anorexia

The eating disorder progresses differently for all sufferers, although many have the most common symptoms in common. Doctors distinguish between the following forms of anorexia:

Restrictive anorexia or non-purging type: This form of the disorder is characterized by excessive starvation; often supplemented by a strong urge to exercise

Recognize and treat anorexia

Purging type: This manifestation is also called bulimic form of anorexia nervosa. This regularly leads to binge eating, which the affected person would like to undo by vomiting or taking laxatives. Unlike women who have bulimia, the body weight of the purging type is at least 15 percent below normal weight

Symptoms and diagnosis: the signs of anorexia nervosa

The typical and clearest identifying feature of anorexia nervosa is severe weight loss that is consciously induced. The strict control of food and weight determines the thoughts and actions of the affected person. Anorexics often find themselves using the following individually distinctive descriptions or actions:

  • I do not feel my body.
  • My body works against me, I have to fight it.
  • I weigh myself very often – I often perform a certain ritual.
  • I always see problem areas on my body.
  • I have a panic fear of gaining weight.
  • My head is in control of my life.
  • I spend many hours thinking about eating and not eating.
  • I log my food and exercise.
  • I have tics and compulsions (for example, washing or control compulsions).
  • I eat according to certain rules (for example, very slowly or in sequence).
  • The choice of food I consume is one-sided.
  • I eat and drink only low-calorie, low-fat, and sugar-free foods.
  • I unfortunately often suffer from depressive moods.
  • I exercise excessively or do a lot of work standing up.
  • I often think about how I can burn calories on the side.
  • I fake eating to others.
  • I cook for others and encourage them to eat.
  • I collect cookbooks and kitchen utensils or watch cooking shows.
  • I rarely do anything that relaxes me or makes me feel fun.
  • I withdraw from family members.
  • I don’t feel sick or too thin.

The signs do not necessarily indicate anorexia, but they are – especially if several occur simultaneously – warning signals for an unnatural relationship to one’s own body and to food. In any case, they should be taken seriously as a clue and monitored further. For diagnosis, the International Classification of Diseases ICD-10 also lists the following as characteristics of anorexia:

Weight loss: Weight loss is brought about by the sufferers themselves. This is done by avoiding high-calorie foods, excessive physical activity, intentional vomiting, purging, and/or the use of appetite suppressants or dehydrators.

BMI below 17.5: Anorexic is defined as having an actual body weight that is at least 15 percent below the BMI (body mass index) of 17.5.

Body Schema Disorder: Sufferers set their individual weight threshold very low. I am driven by a constant fear of gaining weight. Even after losing a lot of weight, they still feel too fat and focus on non-existent problem areas.

Endocrine disorders: When I fall below a certain weight threshold, hormone regulation is often disturbed. This can lead to a lack of menstruation and loss of libido.

Affected people and progression: Who does anorexia affect?

Statistically, every two hundredth woman in Germany becomes anorexic in her lifetime. Girls and women between the ages of 14 and 25 suffer most frequently from the eating disorder. The age of sufferers has dropped significantly in recent years. "In the 1970s, the average age for the onset of the disorder was still around 20 years old. In the 90s it decreased to 15 years. Today it is already at 14 years", according to Osen.

Recognizing and treating anorexia

"There is an interesting study from Australia. According to the study, 47 percent of 6-year-old girls have already thought about going on a diet. The girls had the attitude that one was more popular if one was slim. It has been attributed to the beginning of compulsory education, because children then begin to compare themselves with classmates.", according to Osen. "The thought of dieting is not yet an eating disorder, but it shows that body awareness and dissatisfaction with one’s own body is already an issue at this age", according to the expert.

But adult women are also affected by the disease. Tabloids often report on matchstick-thin celebrities. Away from the media, however, the subject is rarely discussed. In this context, women between the ages of 30 and 50 are more likely to suffer from anorexia than assumed. A U.S. study of the School of Medicine at Mount Sinai in New York, involving 5,700 women aged 40 to 60, found that nearly 4 percent had an eating disorder at the time of the study. Around 15 percent said they had had an eating disorder at some time in their lives.

However, the disease usually does not begin late in life. Many already struggled with the eating disorder in adolescence and suffer a relapse in adulthood. Although the disease is very treatable, the relapse rate after successful therapy is 50 percent. For many relapse patients, the disease had taken a back seat for a while due to family planning or professional careers. However, if they are confronted with difficult situations or a stroke of fate in the course of their lives, the disease has a good chance of regaining more control over life.

Causes: Where does anorexia come from?

"The starting point of anorexia is a strong dissatisfaction with one’s own body, which often arises from an emotional problem", explains Dr. Osen. However, a single reason behind this cannot be generally determined. But there are factors that cause anorexia to develop.

Risk factors include:

Genetic predisposition: "Anorexia occurs in clusters in families. This means that the daughter of an anorexic mother has a severalfold increased risk of developing an eating disorder herself", According to Dr. Osen. "There is a genetic predisposition (vulnerability) that makes one more susceptible to developing an eating disorder", explains the expert. "But not everyone who has this condition necessarily develops the eating disorder. Especially if one has many possibilities to deal with emotional stresses in an alternative way", explains Osen.

personality: Women who are affected by anorexia usually have low self-esteem and link this to their figure and appearance. They seek the approval of others and avoid conflicts. Anorexia often develops during puberty. For affected girls, finding their own identity often leads to being overwhelmed and feeling insecure. In addition, those affected are often very perfectionistic. "Without perfectionism, anorexia is almost impossible to develop. It requires a lot of discipline," says Osen.

Family influences: It is not uncommon for anorexics to have grown up in an environment where performance or discipline are of central importance. Conflicts and emotions were rarely addressed. Competition with siblings also often plays a role.

Psychological conflict and trauma: Bad experiences such as abuse, rape, the loss of a relative or a difficult family situation can also cause the eating disorder

Learning experiences: If an anorexic receives positive feedback on her weight loss, she may learn from it and try to grab more appreciative responses by reducing her body weight again

Societal ideal of slimness: Young women in particular, who still have to develop their identity as women, can be unsettled by the current ideal of beauty. Being slim is often propagated in the media as a guarantee of success in all areas of life. So that the beauty ideal or the comparison with peers leads to an influence, however, other personal, psychological or genetic factors must be present as a rule

Consequences: How anorexia harms body and soul

What consequential damage to expect depends on the age at which anorexia begins and how long it lasts. These are the most common effects:

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