Treatment of eating behavior. How to understand that you have an eating disorder. What problems may arise

Eating disorders (ED)- these are diseases characterized by unhealthy eating behavior, which is based on concern for one's own weight and appearance.

Eating disorders can involve inappropriate or excessive food consumption, which can ultimately significantly impair an individual's well-being. The most common forms of eating disorders (EDs) are anorexia, bulimia and compulsive overeating- all of them are found in both women and men.

Eating disorders can develop at any stage of life, but tend to develop and become more common during adolescence or early adulthood. The right therapy can be very effective in treating many types of eating disorders.

If eating disorders are not treated and left without proper attention, the symptoms and consequences can be very disastrous, lead to the destruction of health and even lead to the death of the patient. Eating disorders are often accompanied by mental disorders, such as anxiety disorders, depression, neurosis, substance abuse and/or alcohol abuse.

Types of Eating Disorders. RPP is:

The three most common types of eating disorders are:

• Bulimia - This eating disorder is characterized by frequent overeating, accompanied by “compensatory” behavior - induced vomiting, excessive physical activity and abuse of laxatives and diuretics. Men and women suffering from Bulimia may fear weight gain and feel dissatisfied with the size and shape of their own body. Binging and purging tend to happen in secret, creating feelings of shame, guilt and lack of control. Side effects of bulimia include gastrointestinal problems, severe dehydration, and heart problems caused by electrolyte imbalances.

Causes of Eating Disorders

The exact cause of eating disorder has not yet been officially confirmed. Anna Vladimirovna Nazarenko, head of the Eating Behavior Recovery Clinic, based on more than 15 years of practical experience, believes that one of the common reasons is the individual peculiarity of the aesthetic perception of the individual, which is embedded in us even before birth. In simple terms, the main reason is the desire to be thin and beautiful from an aesthetic point of view, as an individual personality trait. The type of eating disorder a patient develops depends on psychological characteristics and external social factors.

Examples of psychological characteristics:

• Negative perception of one's own body;
• Low self-esteem.

Examples of social factors:

• Dysfunctional family dynamics;
• Profession and occupation that promote weight loss, for example, ballet and modeling;
• Aesthetically oriented sports that promote a muscular, toned body;
• Examples:
• Body-building;
• Ballet;
• Gymnastics;
• Struggle;
• Long distance running;
• Family and childhood trauma;
• Cultural pressure and/or pressure from peers and/or friends and colleagues;
• Difficult experiences or life problems.

To date, no research has been conducted on eating disorders and no evidence has been found to support the theory of a genetic predisposition to eating disorders. The only thing that has been reliably proven is that the risk of developing bulimia is higher if someone in the family has an addiction (alcohol, drugs or bulimia).

Signs and Symptoms of an eating disorder

A man or woman with an eating disorder may exhibit a range of signs and symptoms, such as:

Treatment of eating disorders in 2019

Given the severity and complexity of these diseases, patients require comprehensive treatment under the supervision of a team of different specialists specializing in the treatment of eating disorders. Here, too, everything depends on the level of personality destruction. Specialists include: a professional eating disorder specialist, a psychotherapist, in some cases a gastroenterologist, an internist and a neurologist.

At the moment, in Israel and Russia they are mainly used outdated methods of inpatient treatment with antidepressants, which destroy the liver and kidneys, have a short-term effect. The patient is constantly in a inhibited state and the psychotherapist does not have the opportunity to effectively work and conduct personality psychotherapy in this patient’s state. This condition only helps doctors in the hospital feed the patient and has a short-term effect, i.e. gives a short time of remission, but does not provide a long-term sustainable and successful final recovery, since it is necessary to work with the patient through awareness. As practice shows, the latest PSYCHOTHERAPY indicates that the best method of treatment for eating disorder is outpatient treatment and psychotherapy without hospitalization and antidepressants (the only exception may be cases of acute anorexia, when we are talking about life and death).

To solve many of the problems that a man or woman faces in restoring their health and well-being, individual treatment plans. Treatment of eating disorder usually takes place under the supervision of one or more specialists (psychologist, neurologist, etc.):

• Medical supervision and care. The biggest challenge in treating eating disorders is addressing any health problems that may have resulted from disordered eating;
• Nutrition: We are talking about restoring and stabilizing a healthy weight, normalizing eating habits and developing an individual nutrition plan;
• Psychotherapy: Various forms of psychotherapy (individual, family or group) can help address the underlying causes of eating disorders. Psychotherapy is a fundamental part of treatment because it can help the patient survive traumatic life events and learn how to properly express their emotions, communicate and maintain healthy relationships with others;
• Medications: Some medications can be very effective in relieving symptoms of depression or anxiety that may occur with an eating disorder or in reducing binge eating and purging.

Depending on the severity of the eating disorder, different levels of treatment may be recommended for the patient, ranging from outpatient support groups to inpatient treatment centers. In any case, the patient first of all needs to recognize the presence of an eating disorder and seek help from specialists.

Stories of girls cured from eating disorders

Key Points About Eating Disorders

• Anorexia kills. This disease actually has the highest mortality rate of any mental disorder. The media often reports celebrity deaths from anorexia. Perhaps the first such case was the death of Karen Carpenter in the early eighties. The singer suffered from anorexia and abused emetics. She ultimately died of heart failure. Many years later, her sad experience was repeated by Christina Renee Henrich, a world famous gymnast who died in 1994.

• "Female Athlete Syndrome" is a dangerous disease that can leave professional athletes at risk of serious health problems for life. Their coaches, friends and family should support them and help prevent them from developing an eating disorder.

• Major changes in life can trigger the development of eating disorder. Starting university studies is no exception. A young man or woman leaves home, leaves friends and family behind to venture into the unknown. For some, college can be much more difficult emotionally than for others. The beginning of adulthood can be a serious psychological shock and, unfortunately, being a student can trigger the development of an eating disorder.

• Eating disorders are believed to be more common among wealthy women with good education who belong to a high socio-economic class. Eating disorders are also often considered to be a uniquely “European” disease and are therefore rarely seen in other ethnic groups. However, this is all a big misconception. In fact, eating disorders have existed for quite a long time in many cultures and ethnic groups. And this is further proof that there are no barriers or restrictions for eating disorders. Men, women, Europeans, African-Americans, residents of the Caucasus, Kazakhstan, etc. can become victims of eating disorders. For example, in the Anna Nazarenko Eating Behavior Recovery Clinic, the second place in terms of the number of requests belongs to Kazakhstan, the third place is shared by Belarus and Ukraine, and the first place belongs to Russia.

• According to the National Eating Disorders Association, lesbian, gay, bisexual and transgender people (and other members of the LGBT community) are at higher risk of developing eating disorders, including anorexia and bulimia. Single gay and bisexual men are more likely to suffer from anorexia (because they are forced to maintain thinness as a competitive advantage), while gay and bisexual men in relationships are more likely to suffer from bulimia. Lesbian and bisexual women with eating disorders are not much different from heterosexual women with eating disorders, but lesbian and bisexual women are more likely to have mental health disorders.

• In pursuit of the ideal. Ballerinas work hard to succeed in their profession, but as a result, they often become victims of eating disorders. It's no secret that ballet dancers often suffer from eating disorders, and this is understandable, since during training and rehearsals in front of a large mirror they have to compare themselves with their competitors. Moreover, professional ballet itself promotes unhealthy thinness.

• Does vegetarianism contribute to the development of eating disorders? Currently, about five percent of Americans consider themselves vegetarians (they exclude meat and animal products from their diet). This percentage does not take into account those who consider themselves “quasi-vegetarians” (people who eat some animal products but whose diet is mostly plant-based). Vegetarianism is much more common among those who suffer from eating disorders. About half of patients struggling with an eating disorder practice some form of vegetarian diet.

• The most serious complications resulting from eating disorders are malnutrition or an unstable heartbeat. However, a number of complications associated with eating disorders can have serious long-term consequences for the patient's health, even if they are not obvious and practically do not manifest themselves. Bone loss, or osteoporosis, is a silent but very serious disease that often affects patients with anorexia.

• Due to the huge number

Today they are increasingly saying that after obesity, another, no less dangerous problem has come to society - eating disorders. Everyone knows anorexia and bulimia, which mainly affect teenagers and stars striving for an ideal figure. However, few people know that disorders of this kind include a dozen more diseases that lead to numerous problems: obesity or dystrophy, social maladaptation, deterioration of well-being and a whole bunch of psychosomatic pathologies.

In the absence of professional and timely treatment, the lives of such people turn into a real nightmare. Therefore, it is important to know as much as possible about eating disorders in order to promptly recognize them in your friends, family, or yourself.

What it is

In various sources you can find the abbreviation for eating disorder - it can be deciphered as both an eating disorder and an eating disorder. These are all names for the same disease.

Examples have been known since ancient times: the asceticism of the Spartans often led them to exhaustion and anorexia, and Roman hedonism led to overeating and obesity.

The history of studying disorders of this kind begins in 1689, when the doctor Morton described a case of anorexia in an 18-year-old girl, calling the disease “nervous consumption.” More detailed studies began to be carried out only towards the end of the 19th century. In particular, the English doctor William Gall (it was he who first introduced the term “anorexia nervosa”), the French neurologist C. Lasegue and the Russian pediatrician A. A. Kisel contributed.

Large-scale research began in the 80s. XX century The very first of them was carried out within the framework of the Human Genome Project. The objects of study were twins. It was revealed that one of the causes of anorexia is genetics, since the desire for thinness was recognized at the chromosomal level. Research related to bulimia showed the same thing: it was concluded that it is a separate phenotype. Moreover, the chromosome regions responsible for bulimia and obesity are in close proximity.

Today, due to the urgency of the problem, additional research is being carried out everywhere both in the West and in Russia. They provide detailed descriptions of premorbidity, course, and possible outcomes. They show the role of various factors (genetic, social, biological) in the occurrence of pathology. Its connection with other mental illnesses is revealed. Based on the results of these studies, diagnostic and treatment methods are being developed.

Directory of RPP. Pharmacophagia is a form of eating disorder when a person is tempted to overeat on any medications.

Statistics

The following figures can indicate the seriousness and relevance of the problem:

• 50% of people suffering from eating disorder are depressed;
• 50% of people suffering from eating disorders are models;
• 35% of diets end in eating disorder;
• 10% of people suffering from eating disorder receive qualified help, the rest are embarrassed or simply do not want to turn to specialists and try to cope with the problem on their own, which only worsens their condition;
• 10% of people suffering from eating disorders are men;
• anorexia is the third most common mental disorder among adolescents;
• Overall mortality rate as a result of eating disorders: 4% for anorexia, 3.9% for bulimia, 5.2% for other eating disorders.

Directory of RPP. Geomelophagia is a form of eating disorder when a person overeats raw potatoes in large quantities.

Classification

ICD-10

Since eating disorder is an official diagnosis requiring mandatory treatment, this disease is included in the ICD-10. According to the International Classification of Diseases, the following types of pathology are distinguished.

Anorexia nervosa (coded F50.0)

It is characterized by a conscious fight against excess weight, even when it is not there, through diets and even complete refusal of food. Leads to exhaustion, painful thinness and all the ensuing consequences.

The ICD also lists atypical anorexia nervosa (code F50.1), when, with a normal clinical picture, only 1-2 characteristic symptoms of the disease are observed.

Bulimia nervosa (code F50.2)

It is characterized by alternating two periods: panic about one’s excess weight (which, again, may not actually exist) and bouts of overeating. A person can go on a diet and fast for several days, and then break loose and eat unhealthy foods. This happens every time. Moreover, after gluttony, remorse and guilt begin; the patient takes measures to get rid of the food he just ate: he takes large doses of laxatives, artificially induces vomiting, etc.

Separately, the ICD notes atypical bulimia nervosa (code F50.3), when the clinical picture contains only 1-2 signs of a typical form of the disorder.

Psychogenic vomiting

This disorder has several subtypes in ICD-10 depending on the main provoking factor:

1. Vomiting, deliberately induced in bulimia nervosa (see above).
2. Regularly recurring vomiting as a result of dissociative disorders (code F44).
3. Vomiting due to hypochondriasis (code F45.2).

The following cases are not reflected in ICD-10:

1. Vomiting as a somatic symptom of one of the diseases.
2. Vomiting during pregnancy.
3. Vomiting caused by emotional stress (as in the case of overeating).

Psychogenic overeating (code F50.4)

Is an unhealthy response to distress. As a result of a traumatic situation, a person loses control over his appetite. He eats everything almost 24 hours a day. Ultimately, this leads to obesity. The most common causes are accidents, death of loved ones, long-term illnesses, surgeries, and emotional stress. At risk are mentally unstable people who are prone to obesity.

These are the most common eating disorders, but not the only ones. ICD-10 also indicates rarer cases associated with this mental pathology:

• consumption of inedible inorganic matter by adults (code F50.8);
• perverted appetite in adults (code F50.8);
• psychogenic loss of appetite (code F50.8);
• Disorders of unknown origin (code F50.9).

In the near future, an updated version of ICD-11 is being prepared, in which the section dedicated to eating disorders is planned to be significantly changed. Proposed modifications:

1. Grouping of eating disorders according to age criteria: for children, adolescents and adults.
2. Expansion of the diagnostic framework: to include an assessment of age-related symptoms and signs of the disease due to cultural implications.
3. Clarification of the “dangerously low body weight” indicator.
4. Separating it into a separate category and at the same time including it in bulimia nervosa as one of the main symptoms.
5. Isolation of selective eating disorder (restrictive eating disorder) into a separate category.
6. Application of a universal time criterion to all categories. Most likely, it will be equal to 28 days.

The text of ICD-11 is already ready, but it will come into force only in 2022.

Other diseases

Eating disorders are not limited to the deviations recorded in ICD-10. There are types of this pathology about which debates continue in modern science and there is no consensus on their clinical picture and treatment methods. Nevertheless, they are actively discussed. Some of them are already included in ICD-11.

Allotriophagy

The term is derived from two ancient Greek words “alien” and “is.” Other names: pica, pica, parorexia, perversion of taste or appetite. Eating unusual and inedible foods: chalk, toothpaste, coal, clay, sand, ice, raw dough, minced meat, cereals. An extremely dangerous form is ingestion of sharp objects (nails or glass). The mildest and most temporary form of the disease is endointoxication in pregnant women.

Diabulimia

The term is derived from two words - “diabetes” and “bulimia”. The diagnosis is made to people suffering from type I diabetes who, in order to lose weight, deliberately reduce the dosage of insulin or refuse to inject it at all.

Drankorexia

The term is derived from the words “intoxicated” and “appetite”. Following an alcohol diet for weight loss. If possible, most meals are replaced with alcoholic beverages without snacks. Often leads to alcoholism and liver cirrhosis.

Orthorexia nervosa

The term “orthorexia” is derived from the Greek words “correct” and “appetite”. Obsessive desire for proper nutrition. The result is a too limited list of products allowed for consumption. A person becomes so obsessed with this idea that it crowds out all other interests and hobbies from his life. Any violation of the diet leads to severe depression.

Obsessive-compulsive overeating

One of the symptoms of obsessive-compulsive disorder is a mental illness. Manifests itself in uncontrollable appetite.

Selective eating disorder

Refusal from a specific food group not only for a long period (for example, during fasting), but also forever. And if not consuming soups or buckwheat may still be understandable, then the inclusion of blue or green foods in the list of prohibited foods clearly indicates a mental disorder.

Pregorexia

The term is derived from the Greek words for “pregnancy” and “lack of appetite.” Conscious refusal to eat while carrying a child. The goal is to lose weight, maintain your figure after childbirth, and try to hide your belly. A condition that is equally dangerous for the health of the expectant mother and for the development of the fetus. It often ends in miscarriages, termination of pregnancy, stillbirth, and congenital defects in babies.

Directory of RPP. Bibliophagia is an eating disorder characterized by eating paper pages from books.

Causes

One of the tasks of modern research carried out in the field of the above disorders is to find out the nature of their origin. To date, the following possible causes of eating disorders have been identified.

Physiological:

• damage to the hypothalamus;
• hormonal imbalance, lack of serotonin;
• deviations in the operation of peripheral saturation mechanisms.

Emotional:

• depression;
• dysthymia - chronic bad mood;
• bipolar affective disorder;
• cyclothymia - temporary dysthymic hypomanic periods;
• manic syndrome.

Social:

• propaganda of thinness in society as one of the norms and values;
• stereotype of consciousness: thinness = success, health, attractiveness, discipline and willpower, while excess weight = unattractiveness, laziness and incompetence;
• the tendency of modern society to evaluate people by their appearance, in which one of the key roles is played by figure, weight, and body constitution.

Personal:

• poor relationships with parents in childhood;
• the desire to lose weight is like the desire to become a child again;
• personal immaturity;
• the desire to stand out from the crowd, attract the attention of others, prove the strength of your character and the ability to control everything that happens in your own life;
• conflicts related to problems of growing up, self-esteem, independence;
• a state of constant mental tension;
• dependence on the assessment of society, the desire for approval from others;
• hiding your true emotions, ostentatious behavior;
• tendency towards perfectionism;
• traumatic, unresolved situations.

In psychoanalysis, eating disorders are treated as oral regression. Food returns people suffering from eating disorders to a state of harmony and calm that they previously felt only around their mother. Proponents of this concept compare these feelings to those experienced by a child during breastfeeding. Food is a kind of oral way of compensating for internal experiences. Some studies support this approach, since most patients were weaned early.

Directory of RPP. Foliophagy is a food pathology in which acorns, grass, hay, straw, cones, and leaves are eaten in large quantities.

Symptoms

If an eating disorder has not yet gone too far in its development, a person himself can recognize its symptoms. In an advanced form of the pathology, the signs will be noticeable to the naked eye, as they are reflected in the appearance. They should be seen first of all by the relatives and friends of the eating disorder sufferer.

Deviations in behavior:

• social maladjustment: considering their body imperfect, such people interrupt communication with friends and relatives, hiding from them and not leaving home;
• unhealthy interest in everything related to food: watching cooking programs, reading books about diets, weight loss, healthy eating, studying information on this topic;
• reverse state: avoidance of all situations related to food;
• long shopping trips with detailed study of labels;
• weighing several times a day, and the opposite situation: deliberately ignoring weight problems;
• refusal to eat, overeating, alternating these periods, or eating inedible food;
• excessive enthusiasm for weight loss methods such as dieting, fasting, sports, taking laxatives, enemas, and artificially inducing vomiting.

Emotional and mental clinical picture:

• depression, feelings of constant anxiety, chronic fatigue syndrome;
• an uncontrollable desire to lose weight due to an eating disorder overrides all other interests and aspirations of a person and becomes an obsession;
• panic fear of gaining weight;
• self-esteem in people with eating disorders is extremely low, as they constantly compare their bodies with figures that are promoted in the media, not in their favor.

Changes in appearance:

• weight problems: excessive thinness, obesity or sudden fluctuations;
• exacerbation of skin diseases: allergic reactions and dermatoses;
• hair loss, separation of nail plates.

In terms of health, serious digestive problems manifest themselves first of all: from heartburn to ulcers. Then malfunctions in the liver and kidneys begin. Libido decreases. Almost all organs suffer from both malnutrition and overeating.

The sooner a person or his loved ones recognize the signs of an eating disorder, the greater the chance of a full recovery and minimal complications.

Directory of RPP. Coniophagy is a rare disease in which a person cannot resist eating dust.

Peculiarities

In children

The main causes of eating disorders in childhood:

• lack of parental affection, care, love;
• excessive demands on the part of parents;
• an emotionally reserved dad and a dominant, domineering, controlling mom;
• complete dependence on parents;
• excellent student syndrome, which creates a constant feeling of guilt for any mistake and a panicky fear of doing something wrong;
• low self-esteem;
• school maladjustment.

It is easy to recognize an eating disorder in a child by refusal to eat, weight loss and depression. In most cases, the prognosis is favorable, since the problem is identified in a timely manner. Working with psychologists and nutritionists gives good results at such an early age.

In teenagers

The most difficult situation with eating disorders occurs during adolescence. It is precisely those imposed stereotypes of society that promote thinness as an ideal that work. Against the background of hormonal changes and puberty, as well as poor relationships with parents and experiences of first love, the disease only gets worse. Unfortunately, it is precisely this age period that accounts for the largest number of deaths from anorexia and bulimia, of which a considerable percentage are suicides.

Parents should be more attentive to any changes in eating behavior in their teenage children. In case of refusal of treatment, measures are taken forcibly to preserve their life and health.

In adults

Most experts tend to look for the causes of eating disorders among adults in childhood. A significant percentage of patients are models, public people, who a priori should look ideal (=thin). The success of treatment depends on the person’s awareness of the problem. In the period from 18 to 35 years, most suffer from anorexia and bulimia, while after 35 years, various forms of overeating are more often diagnosed.

Directory of RPP. Catopyrheiophagy causes people to overeat sulfur match heads.

Diagnostics

At the moment, the main diagnostic method is psychological testing. The original name is Eating Attitudes Test (EAT). Translation: food attitude test. Author of the development: David Garner, an employee of the Clark Institute of Psychiatry in Toronto. Year of creation: 1979, but improved in 1982. Includes 26 questions. The results are considered reliable and valid. The test is used as an initial diagnosis for eating disorder.

However, EAT results alone are not sufficient to make a diagnosis. Therefore, typical diagnostic techniques are carried out: collecting information, conversations with the patient himself and his relatives, studying the medical record, blood and urine tests, if necessary, ultrasound and MRI, additional psychological testing is possible. Often specialized specialists are also involved: endocrinologist, gastroenterologist, nutritionist, psychotherapist, psychiatrist.

Directory of RPP. Acuphagia is the most dangerous of all such disorders, as a person is drawn to eating sharp objects.

Treatment

To begin treatment, the person himself must want to get rid of his obsessions and behavioral deviations. Usually people are not aware of the problem and refuse to contact specialists. Therefore, family and friends must be prepared to do this forcibly. Only a few are able to fight this disease on their own, since its nature is mental and often has its roots in childhood.

The largest Center for the Study of Eating Disorders (CRED) is located in Moscow, although similar organizations also operate in other cities, providing medical assistance to people suffering from this disease.

As a rule, after diagnosis, treatment for eating disorders in such centers is carried out in the following areas.

Dietetics:

• restoration of impaired nutrition;
• preparation of an individual diet for each individual patient;
• in severe cases - the appointment of nasogastric or nasointestinal tube feeding;
• formation of the correct model of eating behavior.

Somatics:

• restoration of impaired functions of various organs and systems of the body;
• constant medical supervision;
• prescription of medications;
• droppers;
• physiotherapy;
• assistance in organizing the rehabilitation period.

Psychotherapy:

• individual psychotherapy;
• group classes;
• dialectical behavior therapy;
• multifamily therapy;
• integrative therapy;
• art therapy;
• body-oriented psychotherapy.

If treatment for eating disorders is not possible in an inpatient setting at such a center, loved ones can come to specialists alone, without the patient, to get advice on how to treat the disease at home. The likelihood of coping with pathology with such a remote approach is low, but there are still chances.

Directory of RPP. Geophagy is a fairly common eating disorder characterized by constant eating of dirt, earth, and clay.

Consequences

What are the consequences of untreated eating disorders?

• decreased quality of life;
• problems at work, in interpersonal relationships, social maladjustment, isolation, autism;
• , heart disease, hypertension, type II diabetes mellitus, gastroesophageal reflux disease, shortness of breath, gastrointestinal pathologies, osteopenia, osteoporosis, anemia;
• nervous exhaustion, mental disorders of personality and behavior, bipolar disorders;
• alcoholism;
• death due to exhaustion or severe physiological pathology caused by eating disorder, suicide.

Directory of RPP. Lithophagy is an irresistible urge to eat stones.

Books

1. Belmer S., Khavkin A., Novikova V. Eating behavior and food programming in children.
2. Malkina-Pykh I. Therapy of eating behavior.
3. Meia M., Halmi K., Lopez-Ibora H. H., Sartorius N. Eating disorders.
4. Nardone G., Verbitz T., Milanese R. Captive of food. Short-term therapy for eating disorders.
5. Fedorova I. Psychotherapeutic aspects of eating disorders.

Directory of RPP. Trichophagia - eating hair, wool and other fibers.

An eating disorder is a serious illness that requires urgent and long-term treatment. The sooner it is recognized and treated, the greater the chance of a full recovery. However, the desire of the patient himself plays an important role here. As practice shows, if he does not have the motivation to get rid of the pathology, even the most effective methods may not work. Therefore, great responsibility falls on his loved ones: to support, persuade, adjust. Be attentive to those around you: your help in such cases can save their lives.

Pay attention to warning signs. You must be honest with yourself if you notice these symptoms. Remember, eating disorders can have life-threatening complications. Don't underestimate the seriousness of an eating disorder. Also, don't think that you can do it on your own without anyone's help. Don't overestimate your strength. Key warning signs to look out for include:

• You are underweight (less than 85% of the generally accepted norm for your age and height)
• You are in poor health. You notice that you bruise frequently, are exhausted, have a pale or sallow complexion, and dull and dry hair.
• You feel dizzy, you feel cold more often than others (the result of poor circulation), your eyes are dry, your tongue is swollen, your gums bleed, and your body retains fluid.
• If you are a woman, your menstrual cycle is three months or more late.
• Bulimia is characterized by additional symptoms, such as scratches on one or more fingers, nausea, diarrhea, constipation, swollen joints, and so on.

Pay attention to changes in behavior. In addition to physical symptoms, eating disorders are also associated with emotional and behavioral changes. These include:

• If someone tells you that you are underweight, you will be skeptical of such a statement and will do everything possible to convince the person otherwise; you don't like talking about being underweight.
• You wear loose, baggy clothes to hide sudden or significant weight loss.
• You apologize for not being present during meals, or find ways to eat very little, hide food, or induce vomiting after eating.
• You are obsessed with dieting. All conversations come down to the topic of dieting. You try your best to eat as little as possible.
• You are haunted by the fear of becoming fat; you are aggressively opposed to your figure and weight.
• You are subjecting your body to grueling and severe physical stress.
• You avoid communicating with other people and try not to go out.

Eating disorders (also called eating disorders or eating disorders) are a group of complex psychogenic pathologies ( anorexia, bulimia, orthorexia, compulsive overeating disorder, compulsive desire to exercise etc. ) , which manifests itself in a person with problems with nutrition, weight and appearance.

Weight, however, is not a significant clinical marker because the disease can affect even people with normal body weight.

Eating disorders, if not treated promptly and with adequate methods, can become a permanent disease and seriously jeopardize the health of all organs and systems of the body (cardiovascular, gastrointestinal, endocrine, hematological, skeletal, central nervous system, dermatology, etc.). d.) and, in severe cases, lead to death. Mortality among people with anorexia nervosa 5-10 times higher than in healthy people of the same age and gender.

These disorders currently represent an important public health problem, as the age of onset has gradually decreased in recent decades. anorexia And bulimia, as a result of which diseases are increasingly diagnosed before the onset of menstruation, up to 8-9 years in girls.

The disease affects not only teenagers, but also children before they reach puberty, which has much more serious consequences for their body and psyche. Early onset of the disease can lead to a higher risk of permanent damage due to malnutrition, especially in tissues that have not yet reached full maturity, such as bones and the central nervous system.

Given the complexity of the problem, early intervention is of particular importance; It is extremely important that specialists with different specializations (psychiatrists, pediatricians, psychologists, nutritionists, internal medicine specialists) actively collaborate with each other for the purpose of early diagnosis and prompt action.

According to official estimates, 95,9% people suffering from eating disorders are women. The incidence of anorexia nervosa is at least 8 new cases per 100,000 people per year among women, while in men it is between 0.02 and 1.4 new cases. Concerning bulimia, Every year per 100 thousand people have to 12 new cases among women and about 0.8 new cases among men.

Causes and risk factors

We talk about risk factors, not causes.

In fact, these are disorders of complex etiology in which genetic, biological and psychosocial factors interact with each other in pathogenesis.

In the consensus document on eating disorders, prepared by the Higher Sanitary Institute in collaboration with the association “USL Umbria 2”, the following disorders were noted as predisposing factors:

• genetic predisposition;
• , drug addiction, alcoholism;
• possible adverse/traumatic events, chronic childhood illnesses and early feeding difficulties;
• increased socio-cultural pressure to be thin (models, gymnasts, dancers, etc.);
• idealization of thinness;
• dissatisfaction with appearance;
• low self-esteem and perfectionism;
• negative emotional states.

Signs and symptoms

Common signs of eating disorders include problems with eating, weight and appearance. However, each option manifests itself in a certain way.

Anorexia nervosa

This is a psychiatric pathology with the highest mortality rate (the risk of death in these patients during the first 10 years from the onset of the disease is 10 times higher than in the general population of the same age).

People who suffer from anorexia nervosa are afraid of gaining weight and engage in persistent behaviors that prevent them from gaining weight, through extreme dieting, vomiting, or very intense exercise.

The onset is gradual and insidious, with a gradual reduction in food intake. Reducing calorie intake involves reducing portions and/or eliminating certain foods.

In the first period, we observe a phase of subjective well-being associated with weight loss, improved image, a sense of omnipotence, which gives the ability to control hunger; later, concerns about the lines and shapes of the body become obsessive.

The fear of losing weight does not decrease with weight loss, it usually increases in parallel with weight loss.

Common practices include excessive exercise (compulsive/obsessive), constant monitoring of mirrors, clothing sizes and scales, counting calories, eating over several hours, and/or chopping food into small pieces.

Obsessive-compulsive symptoms are also exacerbated by decreased caloric intake and weight.

The affected people absolutely deny that they are in a dangerous condition for their health and life and are against any treatment.

The level of self-esteem is influenced by physical fitness and weight, in which weight loss is a sign of self-discipline, weight gain is perceived as a loss of control. Typically, they come for clinical examination under pressure from family members when they observe weight loss.

To lose weight, in addition to avoiding food intake, patients can resort to the following methods:

• compulsive exercise;
• resort to taking laxatives, anorexigenic drugs, diuretics;
• provoke vomiting.

People with anorexia nervosa have:

• extreme thinness with the disappearance of fat deposits and muscle atrophy;
• dry, wrinkled skin, the appearance of fluff on the face and limbs; reduction of sebaceous production and sweat; yellowish coloration of the skin;
• bluish hands and feet due to exposure to cold ();
• scars or calluses on the back of the fingers (Russell's sign), due to continuously putting the fingers down the throat to induce vomiting;
• dull and thinning hair;
• teeth with opaque enamel, caries and erosions, gum inflammation, enlarged parotid glands (due to frequent self-induced vomiting and subsequent increase in acidity in the mouth);
• (slow heart rate), arrhythmia, and hypotension;
• stomach cramps, delayed gastric emptying;
• constipation, hemorrhoids, rectal prolapse;
• sleep changes;
• (disappearance, at least 3 consecutive cycles) or disturbances;
• loss of sexual interest;
• and increased risk of fractures;
• memory loss, difficulty concentrating;
• depression (possible suicidal ideation), self-harm behavior, anxiety, ;
• possible rapid fluctuations in electrolyte levels, with important consequences for the heart (up to cardiac arrest).

Bulimia

The main feature that distinguishes it from anorexia is the presence of repeated overeating.

This causes episodes in which large amounts of food are consumed in a short period of time (bulimic crises alone, planned, characteristic rate of eating). It is preceded by dysphoric mood states, interpersonal stress states, feelings of dissatisfaction with body weight and shape, feelings of emptiness and loneliness. There may be a short-term reduction in dysphoria after binge eating, but it is usually followed by a depressed and self-critical mood.

People with bulimia engage in repetitive compensatory behaviors to prevent weight gain, such as spontaneous vomiting, overuse of laxatives, diuretics or other drugs, and excessive exercise.

Bulimic crisis is accompanied by a feeling of loss of control; feelings of alienation, with some reporting similar experiences of derealization and depersonalization.

Often the onset of the disease is associated with a history of dietary restrictions or after emotional trauma in which the person is unable to cope with feelings of loss or disappointment.

Binge eating and compensatory behavior occurs on average once a week for three months.

Spontaneous vomiting (80-90%) reduces the feeling of physical discomfort, in addition to the fear of gaining weight.

Uncontrolled eating of large amounts of food ( compulsive overeating )

Binge eating disorder is characterized by repeated episodes of compulsive eating over a limited period of time and a lack of control over food during meals (for example, feeling like you can't stop eating or that you can't control what or how much you eat).

Episodes of binge eating are associated with at least three of the following:

• Eat much faster than usual;
• Eat until you feel painfully full;
• Eat a lot without feeling hungry;
• Eating alone due to embarrassment about the amount of food you swallowed;
• Feeling self-loathing, depression, or extreme guilt after eating too much.

Binge eating causes distress, discomfort, and occurs on average at least once a week over the past six months without compensatory behavior or disorder.

Restrictive eating behavior

Restrictive eating behavior is mainly characteristic of adolescence, however, it can also occur in adults.

This is a disorder of eating (eg, apparent lack of interest in food; avoidance based on sensory characteristics of food; worry about unpleasant consequences of eating) that is characterized by a persistent inability to adequately appreciate the contribution of nutrition. As a result, this provokes:

• Significant weight loss or, in children, failure to achieve expected weight or height;
• Significant nutritional deficiencies;
• Dependence on enteral nutrition or oral nutritional supplements;
• Explicit interference with psychosocial functioning.

The disorder includes many disorders called by other terms: e.g. functional dysphagia, hysterical lump or choking phobia(inability to eat solid food due to fear of choking); selective eating disorder(limited nutrition to a few foods, always the same, usually carbohydrates, such as bread-pasta-pizza); orthorexia nervosa(obsessive desire to eat right, eat only healthy food); food neophobia(phobic avoidance of any new food).

Rumination disorder

Mericism or rumination disorder is characterized by repeated regurgitation of food over a period of at least 1 month. Regurgitation is the regurgitation of food from the esophagus or stomach.

Repeated regurgitation is not associated with a gastrointestinal disorder or other diseases (eg, hypertrophic pyloric stenosis); it does not occur exclusively during anorexia nervosa, bulimia nervosa, binge eating disorder, or restrictive eating behavior.

If symptoms arise in the course of mental retardation or pervasive developmental disorder, or intellectual disability and other neurodevelopmental disorders, they are in themselves severe enough to warrant further clinical attention.

Pica

Cicero is an eating disorder characterized by the persistent intake of non-edible substances over a period of at least 1 month. Common substances taken vary depending on age and availability, and may include wood, paper (xylophagy), soap, earth (geophagy), ice (pagophagy).

The consumption of these substances does not correspond to the level of individual development.

These eating behaviors are not part of culturally or socially accepted normative practices. It may be associated with mental retardation or chronic psychotic disorders with long-term institutionalization

If eating behavior occurs in the context of another mental disorder (intellectual disability, autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is severe enough to require further clinical attention.

Complications

Eating disorders can have serious health consequences, most commonly with anorexia nervosa, due to the effects of malnutrition (affecting all organs and systems of the body) and elimination behaviors (gastrointestinal tract, electrolytes, kidney function).

Women with eating disorders have greater perinatal complications and are at increased risk of developing postpartum depression.

For these reasons, the assessment of medical complications requires specialists in the field.

Anorexia, in the long term can cause:

• endocrine disorders (reproductive system, thyroid, stress hormones and growth hormone);
• specific nutritional deficiency: lack of vitamins, lack of amino acids or essential fatty acids;
• metabolic changes (hypercholesterolemia, hyperazotemia, ketosis, ketonuria, hyperuricemia, etc.);
• problems with fertility and decreased libido;
• cardiovascular disorders (bradycardia and arrhythmias);
• changes in the skin and appendages;
• osteoarticular complications (osteopenia and subsequent bone fragility and increased risk of fractures);
• hematological changes (microcytic and hypochromic due to iron deficiency, leukopenia with a decrease in neutrophils);
• electrolyte imbalance (especially important potassium reductions, with risk of cardiac arrest);
• depression (possibly suicidal ideation).

Bulimia may cause:

• enamel erosion, gum problems;
• water retention, swelling of the lower extremities, bloating;
• acute, swallowing disorders due to damage to the esophagus;
• decreased potassium levels;
• amenorrhea or irregular menstrual cycles.

Treatment of eating disorders

Nutritional rehabilitation for eating disorders at every level of treatment, whether outpatient or intensive with partial or full hospitalization, should be carried out within the framework of a comprehensive interdisciplinary approach that includes the integration of psychiatric/psychotherapeutic treatment with nutrition, in addition to nutritional complications, with the specific psychopathology of the disorders eating behavior and general psychopathology that may be present.

Multidisciplinary intervention is indicated particularly when eating disorder psychopathology coexists with undernutrition or overeating.

During treatment, it must be kept in mind that malnutrition and its complications, if any, contribute to the maintenance of eating disorder psychopathology and interfere with psychiatric/psychotherapeutic treatment and, conversely, if weight restoration and elimination of dietary restriction are not associated with improvement in psychopathology, there is a high likelihood of relapse.

Depending on the intensity of treatment, the interdisciplinary team may include the following professionals: doctors (psychiatrists/child neuropsychiatrists, nutritionists, therapists, pediatricians, endocrinologists), nutritionists, psychologists, nurses, professional educators, psychiatric rehabilitation specialists and physiotherapists.

Having multidisciplinary clinicians has the advantage of facilitating the management of complex patients with serious medical and psychiatric problems comorbid with an eating disorder. Additionally, both the psychopathology of the eating disorder and caloric and cognitive restriction, as well as the physical, psychiatric, and nutritional complications that ultimately arise, can be appropriately addressed through this approach.

In fact, people suffering from eating disorders should receive interventions that address both psychiatric and psychological aspects, as well as nutritional, physical and socio-environmental aspects. These interventions should also be rejected depending on the age, type of disorder, as well as on the basis of clinical assessment and the presence of other pathologies in the patient.

Interesting

What are eating disorders, how do they manifest and what to do if you or a loved one is sick

Eating disorders: what they are, how to recognize them and treat them

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Eating disorders are common and dangerous diseases. However, changes in eating habits and attitudes towards the body are often not perceived by either the sick person or their loved ones as a serious threat to health. Shame and guilt (for example, shame about body appearance or guilt for overeating) - frequent companions of disorders - can prevent a person from seeking help from doctors or family and leave him alone with a serious problem.

Eating disorders (EDs) are mental disorders that manifest themselves in disrupted eating habits and distorted perception of one's own body. A person with an eating disorder may overeat or refuse to eat at all, eat inedible foods, aggressively “cleanse” the body, exercise excessively to lose weight or, conversely, gain muscle mass (even if this is not necessary for medical reasons). In a person with an eating disorder, thoughts about food, the body, its shape and weight can gradually crowd out everything else.

The most famous and dangerous eating disorders are anorexia and bulimia, but the list of disorders is not limited to them. The latest edition of the International Classification of Diseases (ICD-11) includes psychogenic overeating, binge eating, rumination and restrictive eating behavior.

It is difficult to distinguish a sick person from a healthy one. As a rule, a person hides the symptoms of the disease even from loved ones. Fear, shame, guilt, anxiety (for example, fear or anxiety due to changes in weight, shame for inducing vomiting, guilt for an attack of overeating), painful control over oneself and one’s diet make patients remain silent and not seek help.

To diagnose eating disorder, it is necessary to exclude the possibility of diseases of a physiological nature - problems with the gastrointestinal tract, neurological and hormonal imbalances. For example, a person may vomit because he has a stomach ulcer and because he feels shame for binge eating (one of the symptoms of bulimia, a mental illness). At the same time, as eating disorder progresses, real physiological problems arise: metabolism is disrupted, the kidneys and heart fail, and the digestive organs can seriously suffer. And most often it is necessary to treat both the mental disorder and its physiological consequences.

regular “cleansing” (inducing vomiting, taking diuretics or laxatives);

self-harm;

suicidal thoughts.

The duration of outpatient treatment depends on the patient’s condition and usually takes from a month to six months.

Psychotherapy for eating disorder

Elizaveta Balabanova, a medical psychologist and full member of the All-Russian Professional Psychotherapeutic League, explains how psychotherapy works when hospitalization is not needed. Elizaveta works as a psychodynamic therapist (psychodynamic therapy is based on psychoanalysis and is aimed at making the patient aware of how his life experiences and internal conflicts affect life in the present, process them and, with the help of a psychotherapist, find new patterns of behavior and ways of reacting to the outside world) .

“The eating disorder itself is only a symptom. Almost always it is observed as part of a serious neurosis - depressive syndrome, anxiety-phobic disorder, and so on.

Binge eating in the vast majority of cases helps to numb anxiety, and therefore high levels of stress, depression and anxiety contribute to eating disorders. Why? Because [according to the theory of psychoanalysis] when a person is born, the food that his mother gives him is the only source of peace for him. In a severe neurotic state, the psyche mechanically seeks consolation in that early experience. If we talk about anorexia, then there is also the so-called neurosis of perfection with non-acceptance of one’s own body (and one’s own psyche at the same time).

Any mental disorders at the physical level are corrected slowly, so a person needs to tune in to regular long-term work. In eating disorders, it’s not about food, so the psychotherapist is faced with the task of finding out the cause of the distortions and understanding at what stage of mental development the failure occurred.”

How to tell if you have an eating disorder

You are ashamed of being hungry, of eating too much, of how your body looks. You are afraid of weight gain, bouts of overeating or lack of food during times of great stress. Your body and your diet may seem disgusting to you. (typical for all RPP)

After eating, you try to get rid of what you ate - induce vomiting, take a laxative or diuretic. This happens all the time (typical for bulimia, anorexia)

You try to eat alone because in company you feel embarrassed and ashamed of your eating habits. For example, you are afraid that you will be judged for eating too much (typical for all RPP)

You do not feel hunger or fullness, or you constantly suppress them by force of will for a long time (typical for anorexia, bulimia, psychogenic overeating)

Meals become ritualistic: you sort the food on your plate, count the number of calories or nutrients in each serving, and carefully chew each bite. (typical for all disorders, more often - bulimia, anorexia, psychogenic overeating)

You train until exhaustion, without looking back at how your body feels - overcoming severe pain, ignoring fatigue and general malaise (typical for anorexia, bulimia)

You have been eating inedible foods for a long time (a month or longer) (typical for pike)

You feel like you have to tightly control your eating habits or you feel completely out of control when eating. For example, you eat strictly on a schedule or go crazy eating everything you can find around you (typical for all RPP)

You began to notice weakness, problems with the gastrointestinal tract (pain, constipation, diarrhea), blood vessels in your eyes began to burst for no apparent reason, or convulsions began to appear. Women may experience menstrual irregularities

Your weight changes noticeably too often. Normal weight change when changing diet is 0.5-1 kg per week or 5%-10% of initial weight per month (typical for all disorders)

If you find yourself with at least two signs from the list, do not be afraid to contact a psychotherapist or psychiatrist - it is important to stop the development of the disorder as early as possible.

What should you do if you think someone close to you is sick?

Learn what eating disorders are, pay attention to the one your loved one is diagnosed with/you suspect.

Stay calm, do not expose yourself and your loved one to panic and intrusive sudden care - this can violate trust.

Talk gently with your loved one about how and what he eats and how he feels. Do not put pressure and demand to tell more than what you have already heard. A person may not be ready for this.

Discuss with your loved one the perception of the body: how you both imagine its normal state, what forms you consider healthy, how nutrition helps with this. This will help you better understand your loved one, and help him trust you. Don't suggest that a person is unhealthy or point out behaviors that you think are healthy.

Offer to contact you for help. Let your loved one know that no matter what help they need, you are always there. There is no need to impose (for example, offering to keep a food diary, cook and monitor every meal). Under no circumstances force him to eat or refuse food.

Don't blame yourself. An eating disorder can be triggered by many things. If you are a parent or partner and feel you have made mistakes that may have affected your loved one, ask for forgiveness and change your behavior.

7. Discuss the possibility of treatment with a psychotherapist. Therapy is necessary to treat eating disorders. In most cases, eating disorders are accompanied by other mental disorders. Depression and anxiety disorders are the most common ones. Psychotherapy can help deal with the emotions that underlie these conditions.

8. Discuss the possibility of hospital treatment. In some cases this may be necessary. Eating disorders pose a threat to both emotional and physical well-being. At the clinic, specialists will be able to take care of your loved one’s nutrition and appropriate psychotherapy methods.

9. Help your loved one choose a clinic. On the websites of private and budget hospitals, as a rule, there are treatment programs, and over the phone, specialists can quickly tell you about the timing and methods of treating eating disorder. Typically, hospitalization in Russia is preceded by a consultation with a psychiatrist. Visit it together or find out about its results if your loved one does not mind.

10. Contact only qualified centers and doctors with medical training. Evidence-based medicine has managed to find effective methods of working with eating disorders. Help from untrained doctors, spiritual centers and people practicing alternative medicine can cost your loved one their life.