Symptoms of anorexia nervosa

Symptoms of anorexia nervosa may 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. Patients often tend to manipulate others, are deceitful about consumed food and covert behavior, such as induced vomiting - which is the basic psychological symptoms of anorexia. Compulsive overeating, accompanied by vomiting and the use of laxative and diuretics (the behavior of overeating-purification, is observed in 50% of cases.Other patients use only a restriction of food intake.Most patients with anorexia use excessive physical exercises to control body weight.

Often observed bloating, digestive disorders, constipation. Patients usually lose interest in sex. Depression is often observed. Somatic symptoms of anorexia are: bradycardia, low blood pressure, hypothermia, lanugo or small hirsutism, swelling. Even patients who appear to be cachectic remain very active (including following intensive exercise programs), they do not develop symptoms of nutritional deficiency and there is no increased susceptibility to infections.

Endocrine symptoms of anorexia include prepubertal or early pubertal luteinizing hormone secretion patterns, low levels of thyroxine and triiodothyronine, increased secretion of cortisol. If a patient has severe eating disorders, then theoretically any system of organs can be affected. Menstruation usually stops. Dehydration and metabolic alkalosis can be observed, a decrease in potassium concentration occurs; all this is exacerbated by induced vomiting, the use of laxatives and diuretics. Decreased the mass of the heart muscle, the size of the cavities, cardiac output. In some patients, the QT interval is prolonged (even with the heart rate), which, together with the risk caused by electrolyte disturbances, can lead to the development of tachyarrhythmias. Sudden death may occur, more often because of ventricular tachyarrhythmias.

MV Korkina (1986) distinguishes depending on which symptoms of anorexia predominate, several periods of the disease - the initial, anorectic, cachectic, stage of the reduction of anorexia nervosa.

[1], [2]

Symptoms of anorexia of the first period

The first period - the formation of dizmorphomania (dissatisfaction with appearance, the desire to correct the defect).

Symptoms of anorexia of the second period

The second stage is anorectic; ends with a weight loss of 25-50% of the initial body weight and is represented by a wide clinical symptomatology, secondary somatic disorders, changes in the endocrine system. Symptoms of anorexia for this period are as follows: patients dissimulate their disease, claim that they have no appetite, but when they are examined psychologically they demonstrate a high nutritional requirement; they have no true anorexia. They limit themselves in eating, use intense physical activity. 50-60% of patients do not withstand hunger and resort to vomiting after eating, in some patients, vomiting is associated with emerging bouts of bulimia. Vomiting is initially accompanied by unpleasant vegetative manifestations, however it quickly becomes habitual. After it and rinsing the stomach with a lot of water there is a feeling of lightness, pleasure from "purity". Patients also use passive methods of weight loss - taking diuretics and laxatives. Almost all of them have amenorrhea at this stage: there are such symptoms of anorexia as bradycardia, hypotension. At the same time, high motor activity remains. There are hypothermia, chilliness, dry skin, alopecia, constipation, swelling.

Symptoms of an anorexia of the cachectic period

Weight loss of more than 50% of the initial body weight leads to cachexia, and in the absence of medical assistance, a cachectic stage develops. Patients completely lose critical attitude to their condition, subcutaneous fat is absent, hypertrichosis, dry skin, edema, trophic changes, bradycardia, hypotension, pronounced electrolyte imbalance are noted. These symptoms of anorexia without therapeutic intervention lead to death.

Symptoms of anorexia are determined by the presence of dysmorphophobic experiences (mainly this amounts to conviction of excessive fullness), fear of possible obesity, expressed aspiration to lose weight. There is a behavior aimed at loss of body weight in the form of self-limitation in nutrition with periods of deliberate fasting, intensification of physical activity, intake of laxatives, self-induced vomiting. As a rule, intensive weight loss is noted with loss of not less than 15% of body weight, there is no menstrual cycle. Amenorrhea can be accompanied by significant weight loss, but 25% of women are preceded by it.

Primary somatic or endocrine pathology is not detected. During the period of the syndrome of anorexia nervosa, the body mass deficit with pronounced cachexia is 30-50% and more from the body weight to the disease. In the dynamics of the syndrome, four stages are distinguished:

1. primary, initial;
2. anorectic;
3. cachectic;
4. stage of reduction of anorexia nervosa.

Symptoms of anorexia are often combined with a bulimia nervosa syndrome. The disease usually begins at the age of 14-20 years. The young are very rare. Significant weight loss, as a rule, leads to the development of secondary somatoendocrine shifts.