Anorexia and bulimia are disorders that patients most often do not realize, deny and even resist treatment, even when the objective consequences of the disease in the body can be seen even in the mirror with the naked eye. In anorexia, the main symptom is low weight. In the case of bulimia – episodes of overeating followed by specially induced vomiting or other “excess calorie cleansing procedures”. Most often, these disorders occur in young people and are not always treated in time, so the risk of death is quite high.
How to recognize anorexia and bulimia?
The main signs of anorexia are the following:
- 1. Weight loss! Rapid weight loss and body mass index (BMI) below 17.5.
- How to calculate it: divide the weight in kilograms twice by the height in centimeters. For example: weight 50, height 1.70 cm, then BMI=50/1.70 2 =50/1.70/1.70=17.3. So, BMI=17.3 is less than 17.5. This means that a person with a height of 1.70 cm and a weight of 50 kg meets one criterion for anorexia. A normal BMI is 18.5 and above.
- It is important to rule out other causes of weight loss (e.g. tumor)!
- 2. There is a fear of gaining weight and a fear of obesity, thus there is a strong tendency to lose weight by restricting oneself.
- 3. Weight loss is achieved by avoiding food and products that “promote weight gain”, as well as such techniques as inducing vomiting, using laxatives or diuretics, excessive sports exercises.
- 4. The perception of one’s body image is distorted – an objectively very thin girl may consider herself “fat” and deny problems with eating.
- 5. Girls and women lose their periods (if they have had them) or don’t even start until the age of 17. Other hormonal disorders related to the thyroid gland, pancreas, adrenal glands can also occur.
Bulimia , unlike anorexia, is usually characterized by a normal weight. The main signs of bulimia are as follows:
- 1. Binge eating – periodically food is taken uncontrollably in large quantities, accompanied by a strong feeling of hunger. Such episodes of binge eating are the main difference between bulimia and anorexia.
- 2. Immediately after the binge episode, there is a tendency to induce vomiting in order to get rid of the ingested food, which may also include the use of laxatives, strict diets or fasting, and sometimes excessive sports training.
- 3. Self-esteem is highly dependent on body weight and shape.
How do eating disorders develop?
Genetic, environmental, psychological and social factors serve as the basis for the development of eating disorders. There are also two levels of disorders – psychotic and non-psychotic or neurotic. In rarer cases (psychotic level) the disease is based on nightmare ideas and a pathological process in the brain, such patients may also be diagnosed with schizophrenia. However, the most common variant of eating disorders is neurotic, when the basis of the disease is an internal conflict that has contact with the sphere of human relations and the upbringing model. From a psychosocial point of view, anorexia and bulimia patient(s) are especially dependent on the opinion of the people around them, it is important for them to receive a positive assessment from important people. On the other hand, relations with both parents are described negatively – from the point of view of anorexia patients, their parents are too demanding, they criticize a lot, on the one hand, they try to make their child ideal, on the other hand, they show little support and show little love and care. The desire to control your weight and eating is an attempt to draw attention to yourself, to teach yourself your power and ability to control your life, when other methods of managing your life are prohibited. The desire to control one’s body is a kind of protest against the fact that the parents control the patient’s life. Until a person has completed the psychological process of separation from his parents, which is called separation, has not learned to be independent from his parents’ point of view, his mental state is strongly influenced by any conflict with them. Similar to anorexic patient(s), bulimic patient(s) also have problems with separation and the process of personality maturation. From a psychodynamic point of view, eating disorders are based on an internal conflict between the desire to be liked by others, to be loved and appreciated, and the inability to form emotionally close relationships, self-shame and fear of being rejected.
THE TEST
EAT-26 contains 26 allegations. It should be noted to what extent these statements describe you. Possible options: «never», «rarely», «sometimes», «often», «very often», «always».
- I dread the thought of gaining weight.
- I abstain from food despite hunger.
- I find myself preoccupied with thoughts of food.
- I have binge eating episodes where I can’t stop.
- I divide my food into small pieces.
- I know how many calories are in my food.
- I am able to refrain from food that contains a lot of carbohydrates (bread, rice, potatoes).
- I feel that the people around me would like me to eat more.
- I feel sick after eating.
- After eating, I feel a heightened sense of guilt.
- I can’t stop wanting to lose weight.
- When I exercise, I think I’m burning calories.
- People around me see me as too thin.
- I’m obsessed with the fat in my body.
- It takes me more time to eat food than other people.
- I stay away from food that contains sugar.
- I eat diet products.
- I feel like nutrition is controlling my life.
- I have self-control when it comes to nutrition.
- I feel pressured by people around me to eat.
- Nutritional issues take up a lot of my time.
- I feel discomfort after eating sweets.
- I’m on a diet.
- I love the feeling of an empty stomach.
- After eating, I have an impulsive urge to throw up food.
- I enjoy new and tasty foods.
You can get 0-3 points for each statement. A total of 26 statements can be scored from 0 to 78 points.
Points for statements 1-25: «never» = 0, «rarely» = 0, «sometimes» = 0, «often» =1, «very often» = 2, «always» =3.
Points for statement 26: «never» = 3, «rarely» = 2, «sometimes» = 1, «often» = 0, «very often» = 0, «always» = 0.
If you get 20 or more points, it indicates a high risk that you have an eating disorder. You should consult a doctor to clarify the diagnosis.
Panacea for anorexia and bulimia!
Treatment depends on the severity and type of disorder.
The biggest problem is patients’ resistance to treatment and the tendency to deny the problem with all their might. Sometimes the patient(s) formally agrees to the treatment, but does not follow the doctor’s recommendations. Therefore, educational and psychotherapeutic work with the whole family is in the foreground. The first goal is to overcome rumination and create motivation for treatment. Changing the family’s behavior regarding weight regain leads to a corresponding change in the patient’s attitude, which is especially true for adolescent patients, who are also more often affected by eating disorders. Unfortunately, anorexia is a rather dangerous disease and the risk of its death reaches up to 10-15% according to some sources… In cases where the patient’s condition is so severe that it may threaten life, involuntary psychiatric treatment in an inpatient setting may also be applied of his own will, but such cases are examined by the council of doctors and the final decision is taken by the court. In general, the treatment of such patients is a team effort and the following specialists are involved in the treatment: a psychologist or psychotherapist, a psychiatrist, a nutritionist, but if the functions of the vital organs are significantly disturbed, then doctors of other relevant specialties also participate in the treatment. A special diet is drawn up for the patient(s) and drugs are prescribed that stimulate the appetite and reduce anxiety, because in almost all cases, after starting the therapy, the patient(s) gradually increase anxiety and restlessness, which is facilitated by the fear of weight gain and the exacerbation of internal conflict. Most often, such drugs that can both increase appetite and reduce anxiety and improve mood are antidepressants, which are used in the form of a course. In order for the treatment results to be permanent, family psychotherapy and individual psychotherapy are needed, during which the patient’s internal conflict is resolved and the ways of communication in the family are changed. Writing a diary is also an important element of the therapy, in which the patient(s) notes the products eaten throughout the day, the time of eating and a description of the surrounding environment. In rare cases, anorexia is based on nightmare ideas, and under them can be hidden a disease such as schizophrenia. In such cases, the greatest emphasis will be on medication – neuroleptics, but such cases are evaluated by a psychiatrist.
Authors of the article: resident doctor in psychiatry, Alina Kuznetsova doctor psychiatrist Pēteris Zālītis
Sources of information:
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