Eating disorders: anorexia nervosa (anorexia nervosa)

Corinna Schultheis

Eating disorders: Anorexia nervosa (anorexia nervosa)

Anorexia nervosa is the most common eating disorder, often with life-threatening consequences of malnutrition.(Image: Nomad_Soul/fotolia.com)

Anorexia nervosa is the most common psychological eating disorder

The most frequently diagnosed eating disorder is anorexia nervosa. Predominantly girls in puberty and young women fall ill. In Germany, every 100. to 200. Girls between 15 and 19 years affected. But also in boys and men anorexia nervosa and other eating disorders are recognized more and more often. Sufferers suffer from a psychologically induced eating disorder that reduces food intake to a minimum, leading to severe underweight. Without therapeutic help, anorexia nervosa often leads to malnutrition or even life-threatening malnutrition. Anorexia has the highest mortality rate of all psychological eating disorders. Nearly every fifth person with anorexia nervosa dies as a result of anorexia or commits suicide. This underscores the importance of appropriate treatment at the earliest possible stage, which usually includes psychotherapy and nutritional counseling.

Definition

Anorexia nervosa, also known as anorexia, describes a mentally induced eating and body schema disorder. The Greek origin of the term anorexia nervosa means "nervous loss of appetite", but describes the clinical picture only very inaccurately. Rather than a loss of appetite, there is a pathological need for weight loss. Anorexia is when the body mass index (BMI) is below 17.5, or. the actual body weight is 15 % below the expected weight, and the underweight is self-induced. Psychological causes lead to a disturbed body perception, so that anorexics believe to be too fat despite their underweight and thus reduce the food intake strongly out of fear of weight gain or even refuse it completely at times.

Anorexia nervosa is the most common eating disorder, often with life-threatening consequences of malnutrition. (Image: Nomad_Soul/fotolia.com)

The clinical picture of anorexia nervosa varies greatly from person to person, but typically sufferers are almost exclusively preoccupied with the topics of food, nutrition and body weight. If anorexia occurs in isolation, it is referred to as restrictive anorexia nervosa. If those affected suffer from a mixed form and also show characteristics of the so-called bulimia (bulimia nervosa), one speaks of the purging type. In principle, however, bulimia should be distinguished from anorexia nervosa. In contrast to anorexics, people suffering from bulimia are usually of normal weight. In bulimia nervosa, the disordered eating behavior manifests itself primarily in ravenous hunger with eating attacks, usually followed by self-induced vomiting and the abuse of laxatives. In addition to the mixed form, anorexia can also turn into bulimia or, more rarely, follow from bulimia.

Often the term anorexia is also used for anorexia nervosa, but anorexia nervosa is not synonymous with this term. Anorexia is a general lack of appetite without a causal relationship. Furthermore, earlier names for anorexia nervosa are still in use, such as e.g.B. Anorexia hysterica or anorexia mentalis.

Symptoms – the most important characteristic is underweight

Main criterion of anorexia is underweight or. a body weight that is at least 15% below the expected weight, brought about by the reduction or refusal of food intake by the sufferer themselves. If you take a closer look at anorexia nervosa as a mental illness and its symptoms, there are many, also individual, signs of an anorexia that is beginning or has already existed for a long time. The underlying body schema disorder causes anorexics to perceive themselves as too fat, although they are usually already underweight. Even with complete emaciation (cachexia), this disturbed perception remains.

Anorexics feel too fat despite being underweight due to a body schema disorder, and actual conditions are misperceived. (Image: Des/fotolia.com)

The own body perception is disturbed to the extent that signals and actual states are not or wrongly perceived. Hunger or fatigue, for example, are hardly noticed in anorexia. The pain of self-injury by cutting ("scratching") or burning the skin is perceived by some sufferers as the only way to feel their body.

Anorexics are often very performance-oriented and suffer from fear of failure. One’s own success and self-confidence increasingly depend only on controlling one’s own weight. Although anorexics avoid food, they are constantly preoccupied with their diet. In the same way, sufferers reject their body, but concentrate their thoughts and actions completely on their own body weight. Typical behavioral changes in anorexics are often characterized by a panic fear of gaining weight. Sufferers therefore monitor their body weight very closely, sometimes several times a day. They focus on counting calories and are very familiar with food and its nutritional values. They usually eat only very specific and predominantly low-fat foods, and often abuse appetite suppressants and laxatives. Weight gain is to be prevented by as little rest as possible and sometimes also extreme sporting activities. If there are additional symptoms of bulimia, vomiting is also consciously and self-induced after eating.

There is usually little understanding of the disease among those affected, so signs and symptoms are denied or downplayed. Often, anorexics develop conspicuous eating behaviors or stubborn eating rituals. Not infrequently, the feeling of hunger is suppressed by drinking more water. Many who suffer from anorexia nervosa no longer participate in communal meals and conceal their own eating behavior. On the other hand, it is not uncommon for anorexics to cook with friends and relatives and to be intensively involved in food preparation. The change in behavior can also affect social life to such an extent that patients have little contact with other people and no longer pursue their own interests.

Many bodily functions are negatively affected by low weight and persistent malnutrition. In many cases there is a hormonal regulation disorder on the axis of hypothalamus, pituitary gland and gonads. This can manifest itself in girls and women suffering from anorexia via irregular or absent menstruation (amenorrhea), and in men lead to a loss of potency. Infertility and loss of libido can also be associated with the disease. If the disorder begins before puberty, it can also lead to growth disorders and a lack of breast or child genital development. The growth of lanugo hair is also frequently reported.

The panic fear of gaining weight drives anorexics into a real mania of control over their body weight. (Image: Ralf Geithe/fotolia.com)

Consequences of anorexia

Other symptoms of an altered or. slowed metabolism in anorexia nervosa include hair loss, decreased body temperature (hypothermia), low blood pressure (hypotension), and slowed pulse (bradycardia). Lack of protein can lead to water retention (edema), frequent vomiting and laxative abuse lead to internal dehydration and a loss of electrolytes. There is an increased susceptibility to infections and, in later stages, depression and even suicidal tendencies can occur.

After a prolonged period with anorexia, some sufferers permanently from long-term consequences that can affect the cardiovascular system, organ functions, or blood conditions, among other things. Known are for example osteoporosis, renal insufficiency, anemia, cardiac arrhythmia, infertility, constipation or chronic constipation.

Causes – Does dieting mean the beginning of anorexia nervosa??

An eating disorder does not develop overnight. The first signs may be dissatisfaction with one’s own weight and eating behavior and the resulting behavior to reduce weight, such as dieting or fasting.

Puberty often plays a role in the development of anorexia nervosa. Due to various psychological, social and biological factors, those affected are often initially dissatisfied with their own weight. (Image: terovesalainen/fotolia.com)

However, anorexia is usually caused by various factors, with psychological, social and biological causes coming together. Often puberty plays an important role in the development of anorexia nervosa. Stressful situations, high performance demands and physical changes, together with other factors, can be the cause of the development of an eating disorder. The following, for example, are known as typical causes:

  • Problems in the family,
  • Genetic factors,
  • Lack of self-confidence and other personal factors,
  • Societal pressures and role expectations,
  • Performance demands (z.B. during competitive sports),
  • Bullying,
  • Beauty and slimness ideals,
  • Abuse or mistreatment.

Diagnosis

Since those affected often do not consider themselves to be ill, it is often the case that people from their family and acquaintances are the first to seek professional help. In the case of a suspected eating disorder, it is advisable to seek medical advice or to contact counseling centers that are familiar with this topic and know how to deal with those affected in a sensitive and empathetic manner.

During a medical examination, the affected person, if necessary. also together with relatives or caregivers, asked about eating behavior and body perception. In the interviews (partly according to predefined questionnaires), all symptoms, factors and individual aspects of a possible anorexia nervosa should be asked for, in order to record as precise a clinical picture as possible. In addition, there is a physical examination at the u.a. the exact body weight is determined. Using the BMI percentile curves for minors or the BMI for adults, the physical condition of the sufferer is defined. In addition, further examinations can take place in order to exclude the possibility that underweight has physical causes, e.g., a weight loss of the patient.B. Hyperthyroidism. It is also important to recognize possible physical consequences of anorexia at an early stage and to treat them if possible.

Treatment

Anorexia is a serious eating disorder and can even be life-threatening. About 15% of people suffering from anorexia nervosa die as a result of the physical damage or through suicide. This makes anorexia the most lethal form of all eating disorders. Only ca. 50 % of all anorexics can be completely cured, often serious physical consequential damages remain.

The main criterion for successful treatment is an accurate diagnosis as well as the insight and acceptance of the sufferer about his or her own illness. Without the patient’s own desire for treatment and help, therapy has little chance of success. However, this is lacking in most of the patients. Therefore, inpatient therapy is often sought in order to remove those affected from their usual environment for a longer period of time and also to remove them from possible causes.

Those affected often do not see themselves as ill, but the insight into their own illness is fundamental for successful treatment of anorexia nervosa. (Image: Photographee.eu/photolia.com)

Does anorexia need to be treated on an outpatient or inpatient basis?

The form of treatment depends on the individual severity and characteristics of anorexia nervosa. If the disease is still at its beginning and there is neither severe malnutrition nor other psychiatric illnesses, therapy can take place on an outpatient basis. However, if the weight loss is already too severe or there are aggravating concomitant symptoms of anorexia nervosa, inpatient therapy is usually necessary.

Various treatment concepts are used for eating disorders. In order to offer the most comprehensive and complete therapy possible, physical and psychological treatments are very often combined. An outpatient therapy can be combined with a phased inpatient therapy. A fixed component of the treatment of anorexia is individually tailored psychotherapy. This can take the form of individual, group or family therapy. Newer forms of psychotherapy based on the focal psychodynamic approach have proven to be particularly effective in this context. This therapy focuses on the processing of emotions. Those affected are specifically prepared for everyday life after the end of therapy. Overall, focal psychodynamic therapy provides significantly better results than previous standard treatment, as reported in 2014 in the journal The Lancet.

It is important that any therapy is based on a sound knowledge of eating disorders and anorexia nervosa. In case of a (combined) inpatient therapy, a clinic for psychosomatic medicine and psychotherapy with special expertise on eating disorders should be visited. Through additional nutritional counseling, those affected should learn to eat healthily and to eat without fear again. Participation in self-help groups can support the healing process, and antidepressants or estrogens are also used in the therapy.

At the beginning of the diagnosis of anorexia, there are usually medical and therapeutic discussions. An important component of the various treatment concepts for eating disorders is later individually adapted psychotherapy. (Image: Photographee.eu/photolia.com)

The initial goal of treatment for anorexia is (continuous) weight gain. In the context of weight gain, a so-called refeeding syndrome can occur. The resumption of a normal diet after a prolonged period of starvation can suddenly lead to severe symptoms of heart failure with edema due to associated changes in mineral metabolism. This too can become life-threatening.

In addition to the urgent task of raising and stabilizing the body weight of anorexics, it is also important to compensate for possible existing deficiency symptoms. Sufferers must learn to eat normally and regularly again and to perceive the signals of their body correctly.

Last resort for anorexia nervosa: Force-feeding

If the therapies are not successful and the underweight is life-threatening or there is a risk of suicide, hospitalization may be necessary without the patient’s consent. If all options are exhausted, the end result is force-feeding as a life-saving measure.

Naturopathic treatment of anorexia nervosa

Since anorexia is a serious disease that can be life-threatening and is caused by many individual factors, the treatment is very complex and must be supervised by a doctor in any case. Self-therapy is not possible.
Homeopathy is often used in addition to psychotherapy and other medical treatment of the patient. But as diverse as the symptomatology of anorexia are the possibilities of an additional homeopathic treatment. A remedy that is often used is Natrium muriaticum (common salt), which u.a. The aim is to stabilize the mainly young sufferers and thus improve the chances of success of psychotherapy.

Current state of research

Relatively little is known about anorexia nervosa, so that too much time often passes between the onset of anorexia nervosa and treatment.

Only recently, an international group of researchers, led in Germany by the Medical Faculty of the University of Duisburg-Essen (UDE), proved that not only psychological causes play a role in anorexia nervosa. The research results showed: A certain gene provokes eating disorder Anorexia nervosa. Anorexia can therefore also be congenital. This opens the way for new forms of therapy and also changes the way we look at anorexics. The results of this study were published in the journal The American Journal of Psychiatry.

More recent research suggests that a susceptibility to anorexia is created in the womb, according to a paper in Nature Communications. (jvs, cs)

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