Neuropsychiatric anorexia and bulimia

3.716 per 1 million population per year. Women suffer from anorexia 20 times more often than men. Among school-age girls it is 1-2% (in wealthy strata of the population it is higher).

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Causes of Anorexia

Up to 10% of girls who have sisters are susceptible to the disease. However, it is necessary to emphasize the importance of family behavioral status, rather than direct genetic influence. In such a situation, a hypothalamic tumor is diagnosed extremely rarely, although at first it is believed that we are dealing with neuropsychic anorexia (from this point of view, cases where amenorrhea precedes weight loss are suspicious). Some researchers see in the ruthless desire to lose weight a struggle for self-control in order to become an individual in society. Dietary problems in early childhood, very close attention of parents to nutrition issues and relationships in the family, which leave this person without a sense of adequate social significance, without a sense of identity, are of great importance in the development of the disease. There is little basis for the hypothesis that the main problem in this disease is psychosexual underdevelopment.

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Symptoms of Anorexia

Symptoms of anorexia usually appear at the age of 16-17 (12 years for boys), often after a strict diet. The patient begins to attach great importance to losing weight (this becomes an overvalued idea), and it begins to seem to her that she is repulsively fat, while in fact she is losing weight. In such cases, patients often resort to intense physical exercise, taking laxatives, and inducing vomiting. The patient sees her main virtue as embodied in her body shape and weight. Such patients may experience episodes of "binge eating", followed by self-reproach, repeated vomiting, and isolation - patients hide their morbid idea of losing weight from others. (Note: if gluttony is not accompanied by weight loss, then nervous bulimia is diagnosed.)

Somatic complications of "binge eating"

Most often, this is a rupture of the stomach, metabolic complications associated with excessive (self-induced) vomiting.

Diagnosis of anorexia

Below are the diagnostic criteria for anorexia nervosa according to DSM-III-R.

1. Body weight is more than 15% below ideal.
2. Fear of obesity even when very thin.
3. The correct perception of one’s own body weight is disrupted (i.e. a person feels full even when thin).
4. Amenorrhea: Menstruation has been absent for more than three cycles, provided that the patient is not taking any relevant pills.

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Treatment of anorexia

It may be necessary to hospitalize the patient to restore normal body weight. As the patient's body weight is restored, she should be returned to her place of residence. Family therapy seems to be more effective than psychoanalytic treatment. If the problem is "binge eating," this condition can be corrected using behavioral psychotherapy. For example, the patient may agree to eat only in one room of the house and eat only during lunch, or agree not to eat at home or when shopping, or agree to buy only those products that she usually buys when she is full. It may also help to buy groceries with a friend. It is also advisable to take only the amount of money that is enough for the products listed in the patient's inventory.

Prognosis of anorexia

About 2% of patients with anorexia die (from starvation), and 16% remain significantly below normal body weight for another 4-8 years.