Anorexia nervosa
Last reviewed: 23.04.2024
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Anorexia nervosa (an - denial, orexis - aspiration, a urge to eat) - pathological eating behavior, expressed as a deliberate refusal to eat for the purpose of correcting the appearance, leading to pronounced endocrine and somatic disorders.
Anorexia is characterized by a persistent desire for thinness, a painful fear of fullness, a refusal to maintain a minimum normal body weight and, in women, amenorrhea. The diagnosis of anorexia is based on clinical data. Treatment consists of cognitive-behavioral therapy; olanzapine can help in weight gain, SSRIs, especially fluoxetine, can help prevent relapse.
Severe anorexia occurs infrequently, affects less than 0.5% of the general population. On the other hand, most of the light forms, as a rule, are not diagnosed. About 95% of patients with anorexia nervosa are women. Anorexia usually begins in adolescence.
Anorexia is most common in northern European countries. According to the generalized statistics given in 1985, it amounted to 4.06 cases per 100 thousand of the population. However, this figure is significantly higher among young girls. It is up to 1% among girls aged 16-18. The age of 15-19 years is 13%, 30-34 years - 14.1%, and at the age of 20-24 years and 25-29 years - 45 and 68.2% respectively. It should be noted that anorexia occurs mainly among female, ballet school students, as well as among university students.
The history of anorexia nervosa is to a certain extent connected with the cult of fasting and the upbringing of asceticism in the early Middle Ages. In the XVI-XIX centuries. Many were addicted to fasting, led an ascetic way of life. R. Morton (1697) was the first to describe the case of the disease of an 18-year-old girl who first had a depressed mood, then lost her appetite, then she began to induce vomiting, ceased to watch herself, which led to an extreme degree of exhaustion and death.
In the years 1914-1916. Simmonds examined cases of cachexia, in which there was an atrophy of the anterior lobe of the pituitary gland. Anorexia began to bind to endocrine disorders and be interpreted as "hypophyseal disease," "Simmonds disease in miniature." However, clinical studies, as well as the lack of morphological changes in the adenohypophysis in pathological anatomical studies, made it possible in the future to abandon the idea of anorexia nervosa as a variant of Simmonds disease.
After the 30s a new stage began in the notion of this disease. The German term "magersucht", introduced at this time, reflects the essence of anorexia nervosa as a passion for exhaustion.
In the 1960-1980's. The most significant increase in research on the problem of disease. They showed changes in his character. First, the frequency of the disease has increased, especially in men. Secondly, there is an increase in cases of bulimic anorexia nervosa. And in the early works mentioned artificially induced vomiting and intake of laxatives with anorexia nervosa. Since the 1970s, patients have become more likely to use these drugs after overeating. Similar episodes were called "binge" - a syndrome of food "binge", "intoxication", "overeating". Since 1979, the term "bulimia nervosa" began to spread. However, the legality of its existence is not finally clear, along with the term "nervous anorexia."
Anorexia refers to borderline mental pathology. Isolate anorexia nervosa as an independent border mental illness, in which the majority of patients have hereditary burden in the form of various anomalies of personality and accentuation of character in parents.
Separately, anorexia of the prepubertal period and an atypical form of anorexia nervosa, which is formed in the structure of the already existing hysterical neurosis, is singled out. Isolate the syndrome of anorexia nervosa within the framework of schizophrenia.
[What causes anorexia nervosa?
What causes anorexia is still unknown. In addition to the gender factor (women), a number of other risk factors have been identified. In Western society, completeness is considered unattractive and unhealthy, so the desire for harmony is widespread even among children. Over 50% of prepubescent girls use diets or other methods of controlling body weight.
What symptoms does anorexia have?
Anorexia can be mild and transient or prolonged and severe. Most patients are lean when they develop a concern for body weight and they limit food intake. Anxiety and anxiety about body weight increase, even if depletion develops.
Anorexia is an erroneous name, since appetite persists, even if the patient has reached the level of cachexia. Patients are concerned about food: they study diets and count calories, store, hide and throw away food, collect recipes, diligently prepare food for others.
What's bothering you?
How is anorexia diagnosed?
Negation is the main sign for a disease such as anorexia, patients resist testing and treatment. They usually get to the doctor at the insistence of relatives or because of concomitant diseases. Anorexia, as a rule, manifests itself with noticeable characteristic symptoms and signs, primarily loss of 15% or more of the body weight of a young girl experiencing fear of fullness, with amenorrhea, negation of the disease, and otherwise looking safely. Fat deposits on the body are practically absent.
How to examine?
How is anorexia treated?
If anorexia is not treated, the mortality from this disease is about 10%, although an unrecognized disease in mild form rarely leads to death. In the treatment, half of the patients gain all or almost all of the lost weight, they recover endocrine and other functions. Approximately in 1/2 patients a satisfactory result of treatment is noted, there can be relapses.
The remaining 1/2 patients who have anorexia have an unsatisfactory result of treatment, there are exacerbations, mental and somatic complications persist.
What prognosis does anorexia have?
The forecast remains not completely satisfactory. Data on the variation in the number of deaths from 2-3% to 16-20% in publications for 1970-1971 are given. Among the causes of death - infection, sepsis, bowel necrosis, complications of therapy.
According to three British hospitals, between the ages of 4 to 8-10 years (an average of 5-6 years) among the examined, anorexia nervosa or bulimia persisted in 56, 50, 38% of patients, respectively. Recovery occurred mainly between the 6th and 12th year after the onset of the disease.