Nervous anorexia

Content

Introduction

Anorexia nervosa (AN) is a serious mental disorder. People who find themselves in this condition try to keep their body weight as low as possible through a strong dietary restriction, inducing vomiting and practicing intense physical activity.

The disorder often manifests itself as an intense worry about one's weight and physical shape, which originates from the fear of being fat or the desire to be thin. Many people with AN have a distorted image of themselves and see themselves as fat, when they are not at all.

NA affects young women more frequently, although recently it is also becoming common among men. On average, the disorder first appears around the age of 16-17.

Signs and symptoms of anorexia nervosa

People with AN long hide their behavior from family and friends by lying about what they eat or by pretending to eat before others.

The signs that could indicate that a person has a problem with AN or other eating disorders are:

  • skipping meals, eating very little, or completely avoiding fatty foods
  • obsessively counting the calories of foods
  • get up from the table immediately to go vomit
  • taking medications that reduce hunger (anorectics), which help eliminate body fluids (diuretics) or laxatives
  • weigh yourself or constantly look in the mirror
  • physical problems, such as dizziness or dizziness, hair loss or dry skin

AN can often be associated with psychological problems such as depression, anxiety, low self-esteem, alcohol abuse and self-harming behaviors.

Ask for help

People with NA often don't seek help, mainly because they don't recognize they have a problem, but also because they are afraid. There are not a few who have kept the condition hidden for a long time.

The first important step a person with AN must take to get better is to become aware that they need help.

If you suspect that someone you know is suffering from AN, try talking to her / him about your fears and urge him / her to ask for help. Dialogue can be very difficult because these people have a very defensive approach and do not admit that they have the problem. Therefore, first of all it is important not to criticize or force them because this way of doing it can make the situation worse.

For more information and advice on how to deal with the problem, you can contact the SOS toll-free number 800.180.969.

If you think you can have AN, do not hesitate to ask for help and do it as soon as possible. You can start by talking to someone you trust, such as a family member or friend, and ask them to take you to your family doctor.

Treatment of anorexia nervosa

Before starting treatment for AN, it is necessary to undergo an assessment of the physical and psychological conditions by the family doctor and specialists. This preliminary assessment will guide the preparation of a therapeutic plan.

In most cases, the treatment involves the combination of psychotherapy and a sort of dietary / nutritional "rehabilitation" with the aim of helping the person to regain weight in a gradual and healthy way.

Specialists who care for patients with AN, as appropriate, include psychologists, psychiatrists, internists, endocrinologists, nutritionists and dieticians.

Less severe cases can be treated on an outpatient basis as it is the treatment that interferes least with the person's social life; therefore it is to be considered the first choice treatment; only in the most serious cases or in those in which outpatient treatment has not worked should a day hospital or ordinary admission to one of the accredited public or private centers specializing in the treatment of eating disorders be considered.

It may take several years of treatment for a complete recovery from an eating disorder and relapses are frequent. For example, a woman may have a relapse if she tries to lose the weight gained during pregnancy. About half of people with AN continue to exhibit some of the typical attitudes / behaviors of the disorder despite being treated.

If the person with AN remains without treatment for a long time, a number of important medical problems can develop, including bone fragility (osteoporosis), infertility, some cardiological problems (important arrhythmias).

Despite the fact that it is an infrequent condition, AN is one of the main causes of mortality from mental illness, both due to the effects related to malnutrition and because it can lead to suicide.

Symptoms

Although there are often different psychological and physical manifestations, the main symptom of anorexia nervosa (AN) is excessive weight loss achieved intentionally.

Intentional weight loss

The person with AN wants to keep their body weight as low as possible - much lower than normal weight for age and height. She is so worried about weight gain that she cannot eat normally.

In an effort to lose or keep their weight steadily low, these people can:

  • skipping meals, eating very little, or completely avoiding fatty foods
  • lying about what and where they eat
  • obsessively counting the calories in food
  • lying about the actual weight
  • engaging in excessive physical activity
  • take diet pills
  • induce vomiting, it is possible to notice that the person systematically leaves the table immediately after eating, or the presence of dental problems such as cavities and bad breath caused by acid vomiting

They can also take laxatives and diuretics, although this has little effect on the absorption of calories from food.

Self-esteem, body image and feelings

People with AN often believe that their worth as a person depends on their weight and physical appearance. They think they are appreciated more or feel better if they are thin and therefore consider their excessive weight loss a positive fact.

They often have a distorted view of what they look like; thinking they are fat when in reality they are not at all.

Some people with AN try to hide how thin they are by wearing loose fitting clothing.

Many carry out a behavior called "body control" which consists of continually repeating the following activities:

  • check your weight
  • measure your waist
  • look at your body in the mirror

People with AN often have low self-esteem and self-confidence. They can break up relationships, get away from family and friends, lose interest in activities that previously gave them pleasure.

The NA can also compromise academic performance or work performance.

Other signs of anorexia nervosa

Eating too little for a long time can also cause physical symptoms, such as:

  • bloating or constipation
  • headache
  • dizziness or vertigo
  • excessive fatigue
  • feeling cold
  • paleness in the extremities caused by poor blood circulation
  • dry skin
  • baldness
  • abdominal pain
  • sleep disorders
  • fine fuzz on the body
  • brittle nails

In children with AN, a delay in pubertal development may occur; they may gain less weight than expected, or not at all, and be shorter than their peers.

Menstrual irregularities or even total loss of menstruation (amenorrhea) may occur in women with AN.

Causes

The causes of anorexia nervosa (AN) are not clear, but most specialists believe that it is a combination of several factors.

Psychological factors

Many people with AN share certain personality traits and behaviors that can make them susceptible to developing the disorder. These traits include:

  • tendency to depression and anxiety
  • difficulty managing stress
  • excessive worry, fears or doubts about your future
  • perfectionism, they are very strict and demanding people
  • hyper-control in expressing emotions
  • presence of obsessions and compulsions, or involuntary thoughts, images or impulses that force you to perform certain actions, without necessarily having a full-blown obsessive-compulsive disorder

Some describe people with AN as having an overwhelming fear (a kind of phobia) of being fat.

Environmental factors

Puberty appears to be a critical factor in the development of AN. The presence of large hormonal changes along with stress, anxiety and low self-esteem during puberty is an explosive mixture capable of triggering the disorder in predisposed individuals.

Western culture and society seem to play a fundamental role. Girls, and to a lesser extent boys, are abundantly exposed to a series of media messages that constantly reinforce the idea that being thin is beautiful and successful.

Magazines and newspapers tend to highlight even the slightest "physical imperfections", such as having gained a few pounds or having cellulite, of famous people.

Other environmental factors that can contribute to the development of the NA are:

  • being under pressure in school, for example for exams or bullying, especially being teased about weight and body shape
  • activities, such as dance and athletics, where thinness is considered ideal
  • stressful events, such as losing your job, the end of a love affair, or a bereavement
  • difficult family relationships
  • physical or sexual abuse

The AN often begins with a diet that gradually gets out of control.

Biological and genetic factors

It has been hypothesized that changes in brain function or hormone levels may play a role in AN, although it has not been clarified whether the changes found in people with AN may be the cause of the disorder or if rather they are a consequence of malnutrition.

These changes can affect the part of the brain that controls appetite, or they can cause anxiety and guilt when eating, sensations that improve when you skip meals or after intense physical activity.

The risk of developing AN is greater in people with a family history of eating disorders, depression or substance abuse.

Diagnosis

A few questions about weight and eating habits can help your family doctor understand if a client has an eating disorder.

For example questions like this:

  • you have lost a lot of weight recently?
  • you feel comfortable with your current weight?
  • you regularly induce vomiting after eating?
  • if you have had a period of interruption of your period, how long it lasted?
  • you think you have an eating disorder?

they can, as long as the person answers the questions honestly, help the doctor validate a suspicion expressed by family members.

The intent of the family doctor is not so much to express judgments on behavior, but rather to assess the health of his clients.

Weight and Body Mass Index (BMI)

The weight of a person with anorexia nervosa is at least 15% below the average weight for age, gender and height.

The family doctor will check the weight and calculate the Body Mass Index (BMI). For adults, a normal BMI is between 18.5 and 24.9, although a BMI below 20 is of concern to some doctors. Adults with AN usually have a BMI below 17.5.

The BMI is not used with people under the age of 18, for whom the percentile tables are instead taken as a reference.

Other tests

The family doctor may not need any tests to make a diagnosis of AN, measuring blood pressure and heart rate, body temperature, examining hands and feet for signs of any complications of the disorder may be sufficient .

The doctor may also ask the patient to perform some simple physical exercises, such as going from sitting to squatting and standing, to assess muscle strength.

People with anorexia can also have heart problems, such as an irregular heartbeat (arrhythmia). Sometimes an electrocardiogram (ECG) may be needed.

Your doctor may also order blood tests to check your general health and measure the level of certain minerals, such as potassium.

Referral to the specialist (Specialist visit)

If the family doctor suspects a case of AN, he can send (refer) the client to one of the specialized centers for the treatment of eating disorders for a more detailed evaluation and an adequate treatment plan.

Therapy

Anorexia nervosa (AN) therapy involves the combination of psychotherapy with nutritional "rehabilitation" that gradually leads to a medically acceptable weight.

It is important for a person with AN to start treatment as early as possible to reduce the risk of serious complications, especially if they have already lost too much weight.

Therapeutic plan

In addition to the family doctor, the other specialists generally involved in monitoring treatment are:

  • psychologists
  • psychiatrists
  • nutritionists
  • pediatricians in cases where it is a question of children or adolescents
  • specialized nurses
  • dieticians

Before starting the treatment, the members of the multidisciplinary team will carry out a detailed assessment of the physical, psychological and social conditions and will develop a therapeutic plan.

Less serious cases can be treated on an outpatient basis, while the others require hospitalization in a day-hospital or in the ordinary regime at a hospital or a specialized center.

Psychotherapy

There are several psychological therapies that can be used to treat people with anorexia. Depending on the severity of the condition, treatment can last from 6 to 12 months.

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is based on the theoretical assumption that our way of seeing a certain situation conditions our behaviors and, conversely, our behaviors influence our way of thinking.

In reference to the NA, the psychotherapist will help to make the patient understand how the disorder is often associated with unfounded and wrong thoughts and beliefs about food and diet.

Here are some examples of these thoughts and beliefs:

  • getting fat is the worst thing that can happen to me in life
  • I'm sure everyone I know secretly thinks I'm fat
  • if I finish the whole meal, the people who are at the table with me will think that I am greedy and insignificant

The psychotherapist will encourage the adoption of a fairer and more realistic way of thinking which will result in healthier behavior.

Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy (IPT) is based on the assumption that relationships with other people and with the outside world in general have a tremendous effect on an individual's mental health.

AN can be associated with feelings of low self-esteem, anxiety and insecurity caused by difficulties in interacting with people. In the course of interpersonal psychotherapy, the therapist explores what are the negative aspects that come into play in interpersonal relationships and suggests how to resolve these difficulties.

Interventions on the family

NA not only affects the individual, but has a major impact on the whole family. Intervention in the family is an important part of the treatment of young anorexic people; it should focus on the eating disorder and involve family members in the discussion about how the disorder is affecting their lives It can help family members better understand the disorder and how you can help your anorexic family member.

Gaining weight in a healthy and balanced way

The treatment plan will include suggestions on how to increase the amount of food to eat to gain weight in a gradual and balanced way.

Physical condition, as well as weight, are monitored. The height of children and adolescents is constantly measured to ensure that they grow as expected.

At first, the person is prescribed small amounts of food to eat, then portions can progressively increase as the body gets used to getting the right amount of food.The aim is to follow a regular diet, with three meals a day, possibly with vitamin and mineral supplements.

The goal of outpatient treatment is to achieve an average weight gain of 500 grams per week. During hospitalization in a specialist center, however, the goal is to achieve a weekly weight increase of between 500g and 1kg.

Mandatory medical treatment

In rare cases, a patient with AN may refuse treatment even if seriously ill and at risk of survival. In these cases, as a last resort, the doctor can resort to the Compulsory Health Treatment provided for by Law 833/78 (Article 34) or by Law 13 May 1978, n. 180 to restore an adequate nutritional intake and improve the severely compromised physical conditions which are the main conditions for the improvement of the psychiatric situation.

Treatment of other problems caused by anorexia

If a person induces vomiting regularly, they will receive dental hygiene advice to prevent erosion of tooth enamel caused by the acid action of gastric juice. For example, they will be advised not to brush their teeth immediately after vomiting, but to rinse the mouth with water to avoid further damage to the enamel.It may be recommended to avoid acidic foods and to rinse the mouth frequently.A regular dental check-up is also recommended.

If you take laxatives or diuretics to lose weight, you will be advised to reduce them gradually since the sudden interruption can cause problems such as nausea and constipation.

Medicines

Drug therapy alone is generally not effective in the treatment of AN, but it can be used in combination with psychotherapy to treat those problems, such as obsessive-compulsive disorder (OCD) and depression, which in some cases are associated with AN.

Two of the main categories of drugs used are:

  • selective serotonin reuptake inhibitors (SSRI), a type of antidepressant that can help anorexic people who have problems with depression and anxiety
  • olanzapine, a drug that can help reduce anxiety related to weight and diet problems in people who have not responded to other treatments

We tend to avoid the use of SSRIs until the person with AN begins to gain weight because the risk of serious side effects is higher in people who are particularly underweight. Drugs are used with extreme caution in young people under 18.

Help and support

If you have an eating disorder or know someone who has it, you can contact the S.O.S. Eating Disorders - 800.180.969.

Associations of family members and users also play a very important role in raising public awareness and national politics and can represent a network of solidarity and help for families in difficulty.

Complications

If the AN is not treated quickly and adequately, it can lead to very serious complications. In some cases, the disorder can even be fatal.

Other health problems

Long-term anorexia nervosa (AN) can lead to serious complications, often the result of malnutrition. Some of these complications improve if the disorder is treated, others are permanent.

The health problems associated with anorexia are:

  • muscle and bone problems, including weakness, bone fragility (osteoporosis) and physical development problems in children and adolescents
  • sexual problems, including absence of periods (amenorrhea) and infertility in women, loss of sexual desire and erectile dysfunction in men
  • cardiocircolator problemsi, including poor circulation, irregular heartbeat, low blood pressure, heart valve disease, heart failure, swelling of the feet, hands and face (edema)
  • problems with the nervous systemdifficulties with concentration and memory and in some cases even convulsions
  • other issues, kidney or liver damage, anemia and low blood sugar (hypoglycemia)

Some people with AN may develop another eating disorder called bulimia nervosa (refers to those people who after binging are sick and use laxatives in order to get rid of the food they eat).

Complications in pregnancy

If an anorexic person becomes pregnant, she will need to undergo close monitoring both during gestation and after delivery.

AN during pregnancy can increase the risk of problems, such as:

  • miscarriage
  • premature birth
  • giving birth to underweight children
  • having to resort to caesarean section

It is possible that a person with a past history of anorexia from which she is cured may need special assistance and support during pregnancy.

Bibliography

NHS. Anorexia nervosa (English)

Ministry of Health. Eating disorders

Ministry of Health. Clinical, structural and operational appropriateness in the prevention, diagnosis and therapy of eating disorders. Papers of the Ministry of Health. 2013, n. 17/22

EpiCentro (ISS). Anorexia and bulimia. Epidemiological aspects

In-depth link

Presidency of the Council of Ministers - Higher Institute of Health - La Sapienza University of Rome - USL 1 Umbria. Eating disorders

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