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Nervous anorexia is the disease which is characterized by frustration of a feeding behavior. Patients (generally women), differ in a mental disorder, the distorted perception of own body expressed in and even if they have normal indicators of weight, then all the same aim to grow thin and very much are afraid of completeness. It forces the person to limit sharply itself in food.
In 95% of cases women have nervous anorexia, and most often the first displays of a disease appear at teenage age. Less often the illness proves at adult age. Anorexia affects representatives of the well-to-do of the population, usually young girls or unemployed young women, the number of the diseased grows in Western Europe every day. By the way, the disease practically does not occur among poor segments of the population and among representatives of black race. Mortality at this frustration makes 10-20%.
Nervous anorexia can pass as benign, and in heavy and long. For the first time this disease was described more than 200 flyings ago. Till 1960th years this illness met very seldom, now its frequency quickly grows.
Before strong loss in weight is found, patients are characterized as the gentle, hardworking people successful in study, without symptoms of mental disorders. Most often their families safe also belong to the highest or the middle class. Such people can suffer from sneers concerning their figure or excess weight. At the very beginning of a disease of people worries because of the completeness, and concern about weight increases as the patient grows thin. And even if at the person the organism is exhausted, he claims that it has an obesity. After emergence of symptoms of exhaustion, parents usually ask for the help the doctor. At inspections the exchange and hormonal shifts characteristic at starvation will be revealed, but patients deny an illness and do not want to be treated.
Symptoms of nervous anorexia
Modern researches indicate a role of a personal factor in a disease of nervous anorexia. Usually patients suffer from the overestimated vanity, isolation, disturbances of psychosexual development.
Usually the disease passes through 4 stages of the development.
The first stage of nervous anorexia is primary, or dismorfomanicheskiya. At this stage the patient has thoughts of the inferiority what is connected with ideas of itself, as about too full. Ideas of the excessive completeness are usually combined with criticism of own shortcomings of appearance (a shape of a nose, lips). Opinion of people around on his appearance of the person do not interest at all. At this time the patient has a suppressed, gloomy mood, the condition of uneasiness, a depression is observed. There is a feeling that people around sneer at it, critically it is considered. During this period of the patient constantly is weighed, tries to limit itself in food, but sometimes, being not able to cope with hunger, begins to eat at night. This period can last from 2 to 4 years.
The second stage of a disease — anorekticheskiya. During this period the weight of the patient can already be lost for 30%, and at the same time euphoria is felt. Such results are achieved by implementation of a rigid diet, and, inspired with the first results, the person begins it to toughen even more. At this time the patient loads himself constant exercise stresses and sports exercises, hyperactivity, working capacity is observed, but symptoms of hypotonia because of reduction of liquid in an organism appear. This period is characterized by emergence of an alopecia and xeroderma, vessels on a face can be damaged, disturbances of a menstrual cycle can be observed (amenorrhea), and at men the spermatogenesis, and also sexual desire can decrease.
Often vomiting after food is caused by patients, laxative and diuretic medicine is taken, given enemas to lose allegedly excess weight. Even if at the same time they weigh less than 40 kg, all of them equally realize themselves "too thick", and it is impossible to dissuade them that is caused by insufficiency of food of a brain.
Often reception of high doses of laxative can result in weakness of a sphincter, up to a prolapse of the rectum. At first artificially caused vomiting brings unpleasant feelings, however, at frequent use of this way, unpleasant feelings do not arise, happens only enough to incline a trunk forward and to press epigastric area.
Not seldom it is followed with bulimia when there is no feeling of saturation when patients can absorb a huge number of food, and then cause vomiting. Pathology of a feeding behavior, at first — cooking of a large number of food, "zakarmlivaniye" of the relatives, then — chewing of food and its spitting, and then — the caused vomiting forms.
Thoughts of food can become persuasive. The patient cooks food, lays the table, begins to eat the most tasty, however cannot stop, and eats everything that is in the house. Then cause vomiting and wash out a stomach in several liters of water. To grow thin can begin to smoke, drink much a lot of strong black coffee more painfully, can take the medicine reducing appetite.
Products with the high content of carbohydrates and proteins are excluded from a diet, try to eat vegetable and milk food.
The following stage of nervous anorexia is the cachectic stage. At this stage the weight of the patient is lost for 50%, irreversible dystrophic disturbances begin. The organism, because of a lack of protein and decrease in level of potassium, begins to swell. Appetite disappears, acidity of a gastric juice decreases, on walls of a gullet erosive defeats appear. Vomiting can come reflex, after meal.
Skin of patients becomes dry, becomes thinner and shelled, loses elasticity, hair and teeth drop out, nails break. However at the same time growth of hair in the face and a body can be observed. Arterial pressure as well as body temperature, is observed myocardium dystrophy, a vesceral ptosis, symptoms of anemia goes down, functions of a pancreas, and also secretion of a growth hormone and others can be broken. At this stage tendency to faints can appear.
Changes of a cachectic stage are usually irreversible, such complications of nervous anorexia can conduct to death. Physical and labor activity of patients decreases, the heat and cold is badly transferred. They continue to refuse food, also claim that they have an excess weight, i.e. the adequate perception of the body is broken. It should be noted that because of a strong degrowth of a body and lack of a fatty layer, and because of falling of level of estrogen there can be osteoporosis which can lead to a curvature of extremities, and also spins and to severe pains.
Gradually, in process of increase of a cachexia, patients stop being active, spend on a sofa more time, they begin chronic locks, nausea, muscular spasms, polyneurites. Mental symptoms of nervous anorexia at this stage – a depression, sometimes – aggression, difficulties in attempts to concentrate attention, bad adaptation to a surrounding situation.
For a conclusion from a condition of a cachexia, for patients medical supervision since at the slightest set of weight having nervous anorexia over again start using laxative is necessary and to cause vomiting after meal, to carry out heavy exercise stresses, however the depression can develop again. Normalization of a menstrual cycle comes not earlier than in half a year after treatment of nervous anorexia is begun. Before the mental condition of the patient is characterized by frequent change of mood, hysteria, to the dismorfomanichesky moods which sometimes are shown. For 2 years after an initiation of treatment recurrence of a disease which it is necessary to treat in a hospital are possible. This stage is called a reduction of nervous anorexia.
Sometimes also such kind of a disease at which the person refuses food not because of discontent with the appearance, and according to strange ideas that "the food is not acquired in an organism" meets, "the food spoils skin", etc. However at such patients the amenorrhea does not come, and exhaustion does not reach a cachexia.
Also 2 types of a feeding behavior at a disease are allocated. The first type – restrictive which is expressed that the person keeps to a rigid diet starves. The second type – cleaning, characterized in addition also episodes of an overeating and the subsequent clarification. At the same person both types can be shown at different times.
The reasons of nervous anorexia it is possible to call biological factors, for example, heredity i.e. if in a sort there were a disease of bulimia or obesity, psychological which are connected with immaturity of the psychosexual sphere, the conflicts in a family and with friends, and also the social reasons (imitation fashion, influence of opinion of surrounding people, the TV, glossy magazines, etc.). Perhaps for this reason, young girls (young men — more rare) are subject to nervous anorexia at whom the mentality did not get stronger yet, and the self-assessment is very overestimated.
Representation is widespread in our society that without slim beautiful figure it is impossible to achieve success in study or professional activity therefore many girls control the weight, but only at some it turns into nervous anorexia.
Emergence of nervous anorexia is connected with fashionable tendencies of the last time, and today this quite widespread disease. According to the last researches, 1,2% of women and 0,29% of men have nervous anorexia, and more than 90% from them are made by young girls aged from 12 till 23 flyings. Other 10% — men and women are more senior than 23 years.
Diagnosis of nervous anorexia
The doctor diagnoses nervous anorexia on the following signs: if at the person weight is 15% lower than the put norms of its age, i.e. the index of body weight will make 17,5 and less. Usually patients do not recognize the problem existing at them, to be afraid to gain weight, have sleep disorders, depressive frustration, unreasonable uneasiness, irascibility, sharp changes of mood. At women disturbances of a menstrual cycle, the general weakness, cardiac arrhythmia are observed.
The typical case of nervous anorexia is the young girl at whom loss in weight made 15% and more. She is afraid to grow stout, at her stopped monthly, and she denies at herself an illness. Also in the conditions of a hospital diagnosis of nervous anorexia vkluchat an ECG, gastroscopies, ezofagomanometriya and other researches. At nervous anorexia there are considerable hormonal changes which are shown in reduction of level of content of hormones of a thyroid gland. It occurs at simultaneous increase in level of cortisol.
Treatment of nervous anorexia
Most often the patients suffering from nervous anorexia ask for medical assistance before irreparable changes. In this case, recovery can spontaneously come, i.e. even without intervention of the doctor.
In more difficult cases of patients relatives bring into hospital, and treatment of nervous anorexia takes place in a hospital, by means of medicinal therapy, psychological assistance to the patient and members of his family, and also gradual return to a normal diet and increase in caloric content of food.
Most of patients is helped by hospitalization. At the initial stage of treatment forced alimentation, especially is used if the weight of bodies decreased more than by 40% in comparison with initial, and the patient persistently refuses the help. That is carry out intravenous administration of necessary nutrients and glucose, or through the tube entered into a stomach through a nose.
As a result of carrying out psychotherapy the somatic condition of the patient will be improved, and medicines are only addition to sessions. Treatment of nervous anorexia can conditionally be divided into 2 stages. At the first stage the main objective of treatment – to stop weight loss, and also to bring the patient out of a condition of a cachexia. At the following stage methods of psychotherapy and medicamentous means are applied.
Psychologists usually try to convince the patients that they need to take part in social life, to be engaged in study or work, to find time for a family. It will help them to distract from discontent with the body and again to ache with nervous anorexia. Besides, by means of cognitive psychology the normal self-assessment which is not connected with the weight and a shape of a body forms. Patients learn to perceive adequately the appearance and to control the behavior. Having a disease can keep the diary in which it will describe a situation in which he ate food. The individual psychotherapy promotes establishment of contacts with the patient, for clarification of the internal psychological reasons of nervous anorexia.
Methods of family psychotherapy can be productive if frustration is observed at small children, in this case because of change of the relations in a family also the child's attitude towards itself and the body changes. By the way, parents of very many, suffering from nervous anorexia, work in the food industry or trade in food stuffs.
Medical supplies are used at treatment of nervous anorexia as supportive applications. Antidepressant cyproheptadine is used for increase in weight, at the excited and compulsive behavior Olanzapine or Chlorpromazinum can be appointed. Fluoxetine promotes reduction of number of recurrence at recovered from nervous anorexia. Atypical neuroleptics influence uneasiness level, reducing it, and increase body weight.
During treatment patients are given all support, around it the quiet and stable atmosphere is established, are used technology of behavioural therapy where the bed rest is combined with recreational physical exercises which promote increase in density of a bone tissue, and also increase of level of estrogen. Such situation can become an example of behavioural psychotherapy: if the patient ate everything that to him was offered, or grew fat, then he can receive any encouragement, for example, longer walk, etc.
An important role in treatment of anorexia is played by a food allowance. At the initial stage the food not really caloric, but gradually caloric content increases. The diet is formed according to special schemes not to allow emergence of hypostases, damage of a stomach and intestines, etc.
It should be noted that mortality from an organism starvation as makes complications of nervous anorexia from 5% to 10%, and in this case the person dies of the infection which got to an organism. Sometimes, especially at late stages of a disease, at patients such symptoms of nervous anorexia as symptoms of mental disorders, and also tendency can be shown, though it is not frequent, to a suicide.
From a story about anorexia
The essence of anorexia is perfectly transferred in an old parable "The cured nonsense". The master of the North Iranian city Ray differed in melancholy, grief and anorexia. He considered that it – a cow, but not the person. He lowed as an animal, refused to eat human food, and demanded that it was taken away to be grazed on a meadow. Also he wanted that he was killed and used its meat. Because of it from the master remained only "skin and bone". The doctor Avicenna decided to help it. Having come to the palace, he cried: "Where this cow, I came to kill her!". It was taken away to the master. Before carrying out conceived, Avicenna examined it as the butcher, on availability of fat and meat. Also Avicenna told: "This cow does not suit for a slaughter, it is too thin. Let she will gain weight, and then I will take away her". Inspired with it, the master began to eat everything that to it was brought, gradually gained weight and recovered.
In 1689 doctor Morton designated this illness as "a nervous tuberculosis". At the beginning of the last century the disease was ranked as displays of schizophrenia, and then and as diseases of endocrine system. After it called Tviggi or Barbie's syndrome, and only in 1988 the illness received the name "nervous anorexia".