What is anorexia nervosa?
Anorexia nervosa is an eating behavior disorder that was first described in the mid-nineteenth century. It is characterized by a profound distortion of body image and a relentless pursuit of thinness that can lead to starvation; there is a deliberate weight loss, induced or maintained by the same patient. The patient refuses to maintain minimum normal weight within, has intense fear of gaining weight.
It usually begins in adolescence so that mainly affects young women. It is 10 times more common in women than in men.
It is difficult to estimate the prevalence (total number of cases in
our population) of this disease, but it is estimated that approximately
between 0.5 and 1% of girls adolescent anorexia nervosa.
What are the signs and symptoms of anorexia nervosa?
According to the World Health Organization, the diagnostic criteria for anorexia nervosa are:
Due to similarities with bulimia
nervosa, and to differentiate nerve from this other disorder anorexia
eating behavior, must be ruled out that episodes of overeating or binge
eating, and that there is a persistent concern and compulsion food. These symptoms are essential for the diagnosis of bulimia nervosa.
- Significant weight loss or lack of weight gain in children, so that body weight is maintained at least 15% below the expected normal weight for age and height corresponding.
- The weight loss is self-induced by rejecting the fattening foods, or by self-induced vomiting, use of laxatives, diuretics (which makes you urinate more often) or drugs that suppress appetite, or excessive exercise. Often patients invent rules about what foods are allowed, or who claim that exercise is necessary after ingesting some food.
- Body image distortion with an intense and persistent fear of gaining weight or becoming fat, all linked to the constant feeling of being overweight even when their weight is objectively lower than other people of the same height, so that the patient far lower than that of its body weight is imposed. That is, those with anorexia pursue a very low weight.
- Weight loss causes hormonal disorders that can lead, among other consequences, to the drawdown in women and impotence and loss of sexual interest in boys.
Of interest
Biological factors
Read our section ' Depression and mental health 'related articles:
- (General) eating disorders
- Bulimia nervosa
Recently described the involvement of genetic factors in susceptibility to developing anorexia nervosa. They may also be important in the onset of anorexia nervosa alterations in brain endorphins, serotonin and in various hormones.
Psychological factors
Factors such as a death in the family , child abuse and other forms of stress can be potential triggers of anorexia. Also, these patients are often too perfectionist and may have obsessive traits. It has also been an association between disorders depression and anorexia nervosa, so these patients often have low self-esteem and low self-confidence.
Socio-cultural factors
Are important social and cultural pressures around the thinness and physical exercise. As in bulimia nervosa, anorexia nervosa patients often have strong academic performance. Certain professional groups such as dancers or models are at increased risk of developing this disease. There is often too narrow and problematic relationships with parents.
What are the causes of anorexia nervosa?
The causes of anorexia nervosa remain unknown. However, in most cases it is caused by a combination of biological, psychological and socio-cultural factors:
What evolution has anorexia nervosa?
The course and outcome of anorexia nervosa varies greatly depending on a number of features.
Thus, there are cases with spontaneous healing without treatment,
although they are a minority, while at the other end there are cases
that have a chronicity of symptoms, with a gradual deterioration of
general condition of the patient that can lead to death. The sooner treatment begins, the greater the chances of recovery. However, anorexia nervosa can last months or years, and many more years may be needed before a normal weight is restored.
They are considered poor prognostic factors a late symptom onset (late
teens), the persistence of symptoms for years, poor relations between
the patient and his close relatives, a disturbed personality traits, and
a very low weight initiation of treatment.
Cardiovascular disorders - Cardiac arrhythmias
- Myocardial atrophy
- Hypotension and fainting
- Edema in legs and arms
- Constipation and digestive cramps
- Acute dilatation of stomach
- Osteoporosis , which causes brittle bones
- Stop at growth
- Muscle paralysis
- Cortical atrophy
- Neurological disorders
- Alterations of hypothalamic hormones
- Infertility
- Diabetes
- Thyroid abnormalities
- Hypothermia
- Increased fatigability
- Alterations in blood ions
- Renal impairment
- Urinary infections
- Decrease in number of blood cells
- Altered immunity
- Appearance of body hair (lanugo)
- The skin becomes drier
- Redness of the skin
- Depression
- Loss of concentration
- Obsessive disorders
- Increased risk of suicide
It is common for patients with anorexia nervosa lose interest in interacting with their friends. They can experience a number of complications:
The treatment aims - Make the person regain a healthy weight
- Restore a healthy eating patterns
- Treat any physical complication or associated with associated psychiatric problems
- Addressing thoughts, feelings and beliefs concerning food and body image
- Getting family support.
Several psychological interventions are being used both bulimia nervosa and treatment of this disorder of eating behavior:
- Cognitive behavioral therapy: the mode most commonly used psychological treatment for bulimia nervosa. This treatment modality has been developed from previously developed cognitive therapy for depression and other psychiatric disorders.
- Motivational therapy: often particularly useful in the initial stages of treatment.
- Interpersonal therapy
- Cognitive analytic therapy: is a therapeutic modality of short duration, usually between 16 and 20 sessions, which combines elements of cognitive therapy and psychodynamic psychotherapy orientation.
- Rational Emotive Therapy
- Family therapy: This is a mainstay of treatment in a significant number of cases.
- Other group therapy
There is no single treatment has been shown effective in all cases and will vary depending on individual circumstances.
While the treatment of anorexia nervosa includes both pharmacological
and psychological treatment -such as in bulimia nervosa and in most
psychiatric disorders- is the combination of both strategies which
achieves a better response.
In general, treatment of patients with anorexia nervosa is performed on an outpatient.
However, hospitalization (preferably in dedicated units) will be
required when there has been repeated failures of outpatient treatment,
when coexist physical or psychological problems that may require more
intensive treatment or when the patient's nutritional status requires,
it is advisable when the patient's weight has dropped to 20-25% that
corresponds to the age and height.
Also, groups and self-help books are useful for some patients.
Drug treatments
In some cases, the administration of medication is required.
The drugs used in the treatment of anorexia nervosa, primarily for
promoting weight gain, to treat depression or other psychiatric symptoms
associated, for the treatment of medical complications and relapse
prevention. Drugs that can be used are:
- Antidepressants: in part due to the high frequency of depressive and obsessive symptoms seen in anorexic patients, antidepressants, either administered alone or in combination with any psychotherapy are most commonly used drugs in this disease. Clomipramine or inhibitors of serotonin reuptake as fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram are those who have shown a better result, but we must wait until it has gained some weight gain before observe its effects.
- Appetite stimulants: research studies that have evaluated the efficacy of drugs such as cyproheptadine, clonidine, naloxone or other appetite-stimulating drugs, have shown no benefit of these drugs in treating anorexia nervosa.
- Other drugs: risperidone, olanzapine, lithium, or anxiolytics can be helpful in certain subgroups of patients.
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