in this article:
Anorexia nervosa is a particularly serious eating disorder. Those affected hit a marked weight loss because of the morbid fear of weight gain and distorted vision of their body image. The triggering causes are unclear. In this regard, doctors have formulated various theories, which start from the assumption that, at the origin of anorexia nervosa, there is a set of biological, psychological and environmental factors. The symptomatology of anorexia nervosa is very wide and depends mainly on the fear of getting fat. This fear causes the patient not to eat properly and, for this reason, develops a number of issues related to the absence of food. Therapy includes psychotherapy treatments and interventions aimed at restoring normal body weight.
What is anorexia nervosa?
Anorexia nervosa, or simply anorexia, is a serious eating disorder, which, in those affected by it, is due to:
- An excessive weight loss
- A strong fear of getting fat
- A distorted view of one’s own body image.
The anorexic subject, in fact, is very skinny, constantly monitors his or her body weight, avoids eating, and sees more ’fat’ than there actually is. Anorexia nervosa disrupts a person’s life, because body-bound thinking interferes with any other daily activity, from school or work to interpersonal relationships.
Anorexia Nervosa causes
The precise causes of anorexia nervosa are unclear. According to doctors and experts on the subject, its appearance would contribute to a set of biological, psychological and environmental factors.
Based on some scientific findings, some researchers argue that the onset of nerve anorexia is linked to genetic predisposition. In other words, they believe that the expression of certain genes is a favored factor in nerve anorexia. At present, the aforementioned theory still has some pending points that only future research can clarify definitively.
Analyzing the psychological profile of people with anorexia nervosa, food-borne experts have noted that many patients have in common a certain type of behavior. For this reason, they thought that the appearance of anorexia nervosa is somehow linked to the personality and behavioral features of an individual.
In the details of the above study, people who are predisposed to develop anorexia nervosa would be:
- Those who have a strong tendency to suffer from anxiety or depression.
- Those who have difficulty managing stress.
- Those who are easily concerned about the future or are, for some reason, afraid.
- Perfectionist subjects, who strive to be rigorous goals and who are very demanding from themselves.
- Individuals who are particularly reserved.
- Those who have obsessions / compulsions or who suffer from the so-called obsessive-compulsive disorder.
An environmental factor is any circumstance, event, or habit that can affect an individual’s life to a certain extent. According to the opinion of physicians and specialists in eating disorders, the most important environmental factor associated with the appearance of anorexia nervosa would be the media exposure to the ‘slim equals beautiful’ myth, typical of modern Western culture.
Moreover, if we consult any magazine or watch television, we have a high chance of having advertisements that have protagonists for women and / or men, many times successful, from the dry physical and without blemishes.
In addition to the exaggeration of media impact, other environmental factors that seem to contribute, more or less markedly, to the development of nerve anorexia are:
- Practicing sports or work activities in which it is important to have an extremely thin physique. It is the case, for example, of those who practice dance or art gymnastics or models that come out of the profession. For all these individuals, body weight control is a must.
- The emotional stress that sometimes can result from the death of a dear person, a change of home or school, loss of work, the end of a romantic relationship, and so on.
- Anatomic changes that occur during puberty. During the years of puberty, the human body undergoes several modifications. Particularly obvious, such modifications may be a great discomfort to some individuals, especially if the latter meet a scornful feedback from peers or are a center of unwelcome attention. This would explain, in part, why nerve anorexia affects predominantly subjects of young age.
- Being a woman. Compared to men, women have greater emphasis on body weight and this may be why they are more likely to become ill with anorexia nervosa.
- The presence in the family of people with anorexia nervosa or other similar eating disorders. Such situations could, emotionally, involve some family members and, in the latter, induce the development of similar issues. Generally speaking, subjects on whom the impression of a family member with anorexia nervous is most made are adolescents.
- A poorly controlled slimming diet.
- Being subjected to physical violence or sexual aburse. According to some studies, there would be some correlation between such episodes and nerve anorexia.
Anorexia symptoms and complications
Anorexia nervosa presents a series of symptoms and physical signs and a series of behavioral manifestations. Symptoms and physical signs are the result of insufficient nutrition (physical symptoms), while behavioral manifestations depend on the fear of fatigue and distorted vision of their own body image (behavioral symptoms).
Inadequate nutrition has many physical consequences.
In fact, it determines:
- Weight loss. Generally, in patients with anorexia nervosa is extreme.
- Clear thinning
- Meaning of recurring fatigue. The sick are more aware of it when they start moving.
- Head turns and dizziness
- Blue fingers coloring
- Tearing, breaking and / or falling hair
- No menstruation, in women
- Lanugo, that is, appearance of a fine and soft hair in some parts of the body (for example, the face)
- Dry and / or yellowish skin
- Intolerance to the cold
- Cardiac abnormalities (arrhythmias)
- Edema in the arms and legs
- Anomalies in the number of blood cells
- Reduced libido, that is, little sexual impulse
Behavioral symptoms and emotional sphere
The fear of weight gain and the belief that they are fat induces anorexia nervosa patients to take abnormal behaviors aimed at weight loss.
Among these abnormal behaviors there are usually:
- Observance of a highly restrictive diet, if not of a real fast. This, then, is what causes the physical manifestations mentioned above.
- Exhaustive and continuous practice of physical activity.
- Self-induced vomiting, to eliminate the food that is taken and which the patient thinks might induce weight gain. Generally, this behavior is also associated with the intake of laxatives, diuretics, cleanses and other similar products.
- The obsessive count of calories taken daily.
The fear of getting fat and the idea of being fat heavily affects the life of an anorexia nervosa patient.
The latter, in fact, is generally a subject that:
- He or she is almost worried about food and measuring their own body weight.
- Meals are skipped.
- They appear as moody and lacking emotions.
- They are isolated from the social context and struggling to establish / maintain relationships with other people.
- They are irritated or tends to irritate easily.
- They are very conscious of food, claiming to have eaten when it is not so.
- They are preoccupied with their weight.
- They suffer from moments of depression.
- They have suicidal tendencies (in the most serious cases).
Anorexia nervosa may have many complications, which can seriously affect the health and well-being of those affected.
- Heart problems, such as prolapse of the mitral valve, heart arrhythmias and heart failure;
- Muscle problems (muscular atrophy) and / or bones (osteoporosis);
- Sexual problems such as infertility (in women) and erectile dysfunction (in humans);
- Circulatory problems such as persistent hypotension;
- Gastrointestinal problems (constipation, abdominal swelling, abdominal pain, etc.) with persistent nature;
- Renal impairment;
- Abnormalities of electrolytes present in the body. In general, they tend to alter levels of potassium, sodium and chlorine;
- Damage to the brain and peripheral nerves;
- Depressive and / or persistent anxiety;
- Personality disorders and obsessive-compulsive disorders;
- Dependence on alcohol or other substances.
In the face of a suspected case of anorexia nervosa, doctors typically resort to a scrupulous target examination, some laboratory tests, an assessment of the psychological profile of the patient, and some instrumental examinations for the assessment of certain vital organs’ health (first and foremost, the heart). Though they are not specific, these tests are very useful, as they usually allow you to accurately determine the nature of the problem. For a proper diagnosis of anorexia nervosa, it is also worth remembering the importance of consulting the so-called Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a collection of all the peculiar characteristics of known mental and mental illnesses, including their respective criteria for diagnosis.
The objective examination is, basically, the measurement of the so-called body mass index (or BMI). The body mass index is a very significant parameter on which doctors base much of the body’s body weight estimates.
Anorexia Nervosa Excess of Sport, in fact, allows to determine whether the patient is of normal weight, underweight, overweight, obese or severely obese.
By completing the objective examination, the doctor observes the appearance of the skin, measures the blood pressure and temperature, hears the heart and checks the muscle tone with appropriate physical exercises.
Laboratory analyzes generally include a full-fledged emocromium and an evaluation of the level of the various electrolytes. All this allows the physician to determine the health status of important organs such as the liver, kidneys and thyroid.
The assessment of the psychological profile is usually an expert in mental and psychological illness. Briefly, it consists of a questionnaire, in which the specialist asks the patient to describe his own thoughts, habits and relationship with food.
The instrumental examinations allow the physician to know the severity of the anorexia in the act, whether it has resulted in complications, etc. In fact, they consist of tests, such as chest x-rays and electrocardiograms, which clarify the patient’s functional and health status.
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, an individual suffers from anorexia nervosa if:
- He or she assumes less food than your body requires, to work the best.
- He or she has an extreme fear of getting fat and taking abnormal behaviors to avoid increasing her body weight.
- He or she has a distorted vision of his body image, looking fat and needing to lose weight.
The treatment of anorexia nervosa is complex and requires the collaboration of specialists such as dietitians, physicians experienced in eating disorders, psychiatrists and psychologists. In fact, a patient with anorexia nervosa requires not only an ad hoc diet plan, but also an adequate psychological support (psychotherapy). In other words, the goal of therapy is to cure the body (ie, physical symptoms) and, at the same time, to cure the mind (i.e. behavioral symptoms). As stated, it is important to act briefly and when the disease is at the initial stages and has not yet induced complications.
The patient’s awareness of suffering a serious illness, which needs care, is the starting point for achieving healing. People with anorexia nervosa, who refuse their condition of ill, do not undergo any cure or, however, struggle to follow regularly the intended therapeutic pathway.
For most cases of anorexia nervosa, treatment is outpatient type. This means that the patient receives all the care they need, attending a specialized hospital center every day and returning home, at the end of each therapeutic session. In other words, a sick person has a table of appointments to follow, established by the team of doctors who have taken care of him. Outpatient treatments are very beneficial, as they avoid the patient’s inconvenience of hospitalization. Therapy involves hospital stay, when, according to doctors, the disease is at an advanced or severe stage. In these conditions, in fact, patients need continued medical care.
Psychological help for anorexic persons
The support of friends and family is indispensable to helping anorexia sufferer to overcome their fears and anxieties: in this way, the patient is stimulated to take more calories (at least 1,500 to 1,800 Kcal per day), understanding that food is not an enemy.
The main problem is that anorexia nervosa sufferers tend not to give weight to their problem, not realizing it: lack of collaboration by the patient is a heavy obstacle, which not always can be overcome. Drugs and psychological therapies are indispensable to ensure the survival of the patient.
Eating disorders are psychiatric disorders characterized by altered nutritional behavior.
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge Eating Disorder (BED)
The symptoms of anorexia that do not meet all of the criteria for a specific disorder are classified as Non-Specified Nutrition Disruption (NSND) Disorders. In this regard, it should be noted that the presence of one or more pathological symptoms, although insufficient for a complete diagnosis, is to be considered a serious risk factor in the evolution of a properly diagnosed eating disorder, and therefore stresses the need for a rapid diagnostic route and a specific therapeutic program.
Depending on the presence or absence of regular binge or elimination methods, anorexia nervosa differs in the following subtypes:
- Anorexia nervosa with restrictions: diet, fasting and physical activity
- Anorexia nervosa with abduction / elimination methods: regular binge and elimination measures (self-induced vomiting, laxatives, diuretics or enteroclisms).
Thanks to the understanding of the diagnostic criteria it is possible to trace an (even if approximate) profile of anorexic; the ability to recognize (more or less in detail) such behaviors and attitudes can be of crucial importance in early diagnosis, as a determining factor in the prevention of chronicization and for the treatment of anorexia nervosa.
First, the anorexic subject presents a weight and Body Mass Index below the normal threshold (IMC <18.5). The evidence of this aspect depends mainly on two factors: the time and severity of the disease, the ability to hide its own thinness. It is common that anorexia / or resort to various gimmicks to hide their condition; among them, the most common ones are: dress in bulky clothes that hide the thinness, avoid eating in public and lying about their eating habits. It is also common practice that anorexicism exudes excessive physical activity by assuming a marked ‘healthiness’; among anorexic patients, frequent compensation methods such as self-induced vomiting, laxative, diuretics, or enteroclisms are commonplace when it is not possible to avoid feeding normally.
All this can be associated with a detachment from friendships and family ties due to a marked sense of inadequacy. Often it is possible to recognize anorexia’s tendency to acquire excessive levels of attention from people and the surrounding environment, while in the field of work and / or school such individuals are distinguished by the assiduous search for excellence in their results, denying the possibility of intention failure.
In the early stage of the disease, anorexia seems euphoric, happy and carefree; it is a transient condition that often generates the first suspects of eating disorders. At the time of the diagnosis or the search for the symptoms, there is an irrefutable distortion of one’s own body, its forms and its weight, evidencing an absolute discrepancy between the actual body condition and the perceived body.
Nutrition is experienced as a terrifying practice, an enemy to fight with anything: hence the distinction between anorexia nervosa with restrictions, which includes diet, fasting and physical activity, and anorexia nervosa with binge eating and purging.
Anorexia nervosa is a serious psychiatric disorder requiring multidisciplinary intervention (psychologist or psychiatrist – internist – dietician or nutritionist) of a specialized hospital center. Unfortunately, a major limitation to the diagnosing and care of anorexia individuals is represented by their negation and repudiation of the therapy itself.
However, early recognition of bodily discomfort is an important alarm bell (as well as the first symptom and risk factor) for suspecting an eating disorder. Popularization of the information and the disclosure of typical symptoms are undoubtedly a determining factor in the prevention of anorexia nervosa.
Psychotherapy for anorexia nervosa includes several types of treatments
Cognitive-analytical therapy (or CAT)
It is based on the theory that certain mental disorders and certain behaviors, such as those that characterize anorexia nervosa, derive from particular experiences of past years. The therapist who practices the CAT has, by purpose, reminded the patient of past life events that have triggered certain mental disorders and certain behaviors and help him find a remedy.
It consists in preparing the patient to recognize and dominate so-called ’distorted thoughts’ – that is behavioral symptoms – induced by anorexia nervosa. It includes a part ’in the studio’, with the psychotherapist, and a ‘home’ part, reserved for exercise and improvement of domain techniques.
It is based on the idea that interpersonal relationships and the outside world generally has a decisive influence on a person’s mental health. According to those who practice this type of psychotherapy, anorexia nervosa would be attributed to feelings of low self-esteem, anxiety and insecurity, born as a result of a problematic relationship with other people. The therapeutic goal is to find out what interpersonal relationships have begun to develop the eating disorder and remedy it.
It’s a type of psychotherapy that affects the whole family of the sick. Those practicing this type of treatment claim that an individual can heal from a disorder such as anorexia nervosa, only if even their family (who spend a lot of time with them) know the connotations of the disease. Family therapy is particularly suitable for younger patients who share the drama of anorexia nervosa with the family. Generally, psychotherapy lasts between 6 and 12 months.
To help the patient in restoring normal body weight, there should be engaged a dietitian who prepares an ad hoc diet, depending on the patient’s health condition. Clearly, the treating physician and the family must ensure that the patient follows the diet and feeds according to the specialist’s instructions. For the most severe nerve anorexia cases, food delivery takes place, at least for the first period, by nose-gastric probe.
Some basic steps of restoring normal body weight:
- At first, the amount of food given should be very small, as the patient’s body is no longer used to receiving normal meals.
- Food intake should be increased gradually, giving the body time to re-digest for normal meal digestion.
- Generally, outpatient treatments are a therapeutic goal of making the patient pay 1 lb per week.
Despite numerous scientific research, there is currently no specific drug against anorexia nervosa. It is, however, appropriate to point out that, in some cases, psychotherapists prescribe antidepressants (selective serotonin reuptake inhibitors) or antipsychotics (olanzapine) to alleviate, respectively, any conditions of depression or anxiety.
For people with anorexia nervosa, prognosis depends on several factors, some of which have already been mentioned. Generally, they have more hopes to heal those who undergo the treatment at some point in time, while experiencing much more difficulty in the healing pathway for patients at an advanced stage of eating disorder. Today, therapeutic solutions that a person with a nerve anorexia can rely on are different and have proven, on more than one occasion, their effectiveness.
At present, it is also complicated not to know the precise causes, but to prevent anorexia nervosa is impossible. Anorexia diet is not aimed at healing from mental illness, but it is, however, a necessary aspect to the subject’s survival.
In particular, diet plays an essential role such as:
- Support of the body: avoiding the onset of metabolic complications.
- Food education: helps the sick to re-establish a healthy relationship with food
The table below summarizes some of the hotspots for anorexia diet
|Caloric input as close as possible to normal, without too much increase. Anorexia diet should oppose a total refusal of eating, so sometimes a single spoonful of soup is a great achievement.||Try to eat meals in a company. Coexistence is a preventative factor towards anorexia nervosa. Also, doing so, the anorexic cannot hide the foods or practice self-induced vomiting. It is a very difficult correction to implement because, often, the subject feels a strong shame or fear of eating in front of others.|
|Fraction the meals in very small and digestible portions. The anorexic stomach is often of reduced size and functionality. If the subject agrees to eat, it would be beneficial to not have any negative sensations of gastric fullness or digestive difficulty.||Positive attitude.|
The meals should be offered with delicacy, without imposition that could trigger instantaneous refusal.
On the other hand, anorexics often have a difficult temperament to handle. Here the experience of health technicians should be engaged.
|It is necessary that the foods are cooked to the natural (steam, etc.) and with little added fat. Foods are especially beneficial in their liquid form (semolina, vegetable smoothies, etc.)||Gradual feeding. Often, at first it is more profitable to let the anorexic person choose which foods to eat.|
It is recommended that you start with the foods you like or ’allow’ them from their diet and decide together what to add in the future.
|Wealth of essential nutrients. Although low, the diet for anorexia must be as rich as possible with essential nutrients. Among them: vitamins, mineral salts, amino acids and fatty acids. Customization.||Anorexia nervosa diet should be customized to 100%.|
Each case is in its own right, so there are no highly specific guidelines.
Alternating foods and trying to choose at least one food for each key group is an aspect that in the long term favors the covering of various nutritional needs.
|Whenever possible, the diet for anorexia nervosa must include a food integration plan. Some products, such as amino acids in liquid form, salts and vitamins (in broths, stocks, etc.) can be added to the meals.|
Anorexia treatment with drugs
The psychological disturbance that accompanies the patient suffering from anorexia is generally difficult to treat, since the therapy involves reestablishing the patient’s physical condition and psychological support. For anorexia, the term ’restitution of body weight’ is synonymous with ’obesity’, and the obsession of an anorexic patients is precisely avoid increasing thei weight; this makes it difficult to accept a cure. That is why the support of a psychotherapist can undoubtedly help the sick to come up. Drugs are also a valuable aid to helping anorexic patients to increase their weight and, above all, to accept themselves.
Drugs are also indicated to control and overcome all symptoms associated with anorexia such as bone loss, depression, menstrual cycle alteration, dehydration, and alteration of the physiological blood values.
Below are the classes of medicines most frequently used in anorexia therapy, and some examples of pharmacological specialties. It is up to the physician to choose the active ingredient and the most suitable posology for the patient, depending on the severity of the illness, the health of the patient and his / her response to the treatment:
Antidepressants and anxiolytics
Indicated to cure the psychological causes that trigger or foster anorexia nervosa. These drugs help the patient relax. It is advised to avoid the administration of SSRI (selective serotonin reuptake inhibitors) in case of epilepsy in the context of anorexia and depression.
Amitriptyline (e.g. Laroxyl, Triptizol, Adepril)
The drug belongs to the class of tricyclic antidepressants. Also finds for the treatment of pediatric nerve anorexia (> 9 years): it appears that a dose of 1.25 to 2.5 mg daily medication results in therapeutic benefits to counteract anxiety and obsessive compulsive food attitudes. A study was conducted in which anorexic persons was given a daily dose of 2.5 mg, up to a maximum of 5-10 mg: doses higher than 2.5 mg did not bring any greater benefit than lower doses, at least In the case of anorexia nervosa.
Risperidone (e.g. Risperdal, Risperidone ACV)
Atypical antipsychotic medication (neuroleptic). Do not take concomitant dementia: similar behavior increases the risk of stroke. Administration of this drug seems to give discrete results, especially for obsessive and anxious behavior towards food. The dosage should be carefully determined by the physician.
Clorpromazine (e.g. Clorpr C FN, Largactil)
An antipsychotic and dopaminergic antagonist, used to treat schizophrenia in the context of anorexia nervosa. The drug was widely used in therapy in the past. The dose is very variable from subject to subject; For example, in the case of anorexia nervosa associated with psychosis, the indicative dose is 25-50 mg, to be taken by intramuscular injection (the dose may gradually increase in subsequent injections). To treat anorexia in the context of mania, the recommended dose of this drug is 10 mg, to be taken orally 3-4 times a day.
Olanzapine (e.g. Zyprexa, Zyprexa Velotab, Zypadhera, Zalasta, Olanzapine Mylan, Olanzapine Teva, Olanzapine Neopharma, Olanzapine apotex, Olanzapine Glenmark Europe, Olazax)
Atypical antipsychotic also used to treat anorexia nervosa, especially in children older than 9 years. Indicatively, the optimum dose for treating anorexia disorders is between 1.25 mg and 2.5 mg, to be taken oscillarily once a day. Doses above 2.5 mg do not suggest further improvements. Consult your doctor.
Prednisolone (e.g., Solprene, Deltamidrine): The recommended dose as an adjuvant for the treatment of anorexia is 15-30 mg / day. Consult your doctor before taking corticosteroids; Do not suspend treatment on its own initiative.
Desamethasone (e.g. Decadron, Soldesam)
It is recommended to take a dose of drug between 2 and 4 mg per day. Consult your doctor.
Megestrol (eg Megace, Megexia, Gestroltex): For the treatment of anorexia, it is recommended to take the medicine as an oral suspension at an indicative dose of 800 mg per day. Alternatively, you can take 625mg / 5ml (concentrate) or 800mg / 20ml. The increase in weight derived from the administration of this active agent is a side effect (curative, in this case), favored by increased appetite. The drug is also used for the treatment of certain cancers (breast and endometrium).
Vitamin D and Calcium (eg Eurocal D3, Calinat, Folanemin)
We have seen anorexic patients with a bone decalcification, and therefore, in order to cope with this problem, vitamin D and calcium administration is particularly suitable. The dose should be determined by the doctor after careful patient diagnosis.
Some antihistamines act by stimulating appetite, thus increasing the weight of those who take them.
Ciproeptadine (e.g. Periactin)
antiserotonin agent, indicated for the treatment of anorexia nervosa. It is recommended that therapy be initiated with a dose of 2 mg, to be taken orally 4 times a day. For the maintenance dose, it is recommended to gradually increase the 8 mg dose, every 3 weeks, to be taken 4 times a day. Generally, the therapeutic effect of treating nerve anorexia is within the range of 32 mg per day. Consult your doctor.