painful conviction of its own fullness, even despite the low weight amenorrhea.
The basis of the disease is relentless desire to lose weight, which is implemented by the patients diet, exercise, and sometimes enemas, laxatives, vomiting. As a result of weight-loss reconstructed metabolic processes, there is amenorrhea, mental changes occur. The patients on weight loss and fatigue do not pay attention. Go to the doctor they usually lead the relatives concerned about their significant weight loss. Only some of the patients have physical complaints caused by complications (damage to the musculoskeletal system as a result of physical activity, cardiovascular disorders due to starvation and hypokalemia).
Anorexia nervosa is relatively rare, in the U.S. - 15 cases per 100 000 population per year. Because the disease is chronic, the overall prevalence of anorexia nervosa higher - 0.1-0.7%. Ill mostly girls. The peak incidence occurs in childhood and adolescence, although onset in childhood as possible, and in adolescence. Painful belief in his own fullness and desire to lose weight do not usually have anorexia nervosa nature of obsession. Focusing on weight and shape is not contrary to domestic installations, and therefore is not accompanied by anxiety. Only in rare cases, anorexia nervosa combined with obsessive-compulsive disorder, and then we can find common in these patients, obsessions (fear of pollution, contamination, etc.), and rituals.
Many of the changes in personality and behavior in anorexia nervosa - a consequence of starvation, they may have any hungry person. This focus thoughts on food, slow chewing of food, depression, fatigue, decreased sexual activity, social isolation, cognitive impairment (inability to concentrate, low test scores on intelligence, impaired judgment). Approximately half of patients with anorexia nervosa are binge eating episodes followed by unloading. This type of behavior is more typical for impulsive, less fettered personalities. Some believe that it's not anorexia nervosa and bulimia nervosa, but the consensus here yet.
As shown by the long-term observation mortality in anorexia nervosa is 15% (in contrast to the traditionally accepted 5%). Approximately half of the cases the cause of death is suicide - it once again suggests that anorexia nervosa are expressed emotional distress, and that in each case to assess the risk of suicide.
Treatment of anorexia nervosa:
Emergency assistance is reduced primarily to the correction of fluid and electrolyte disorders. If the concentration of serum potassium is less than 3 mEq / L, the possible cardiac arrhythmias, including life-threatening. So make sure to compensate for a deficiency of potassium, and if for bulimia nervosa is enough potassium to give in, then anorexia - required in /.
Long-term treatment. The first step - to convince the patient and relatives in need of treatment and details of it. This may require much time and effort, because patients usually underestimate the danger of his condition. Nevertheless, this step is necessary because the involuntary treatment is difficult and often impossible.
Almost always - except for the early stages, when the weight loss even slightly - shows hospitalization in a specialized hospital. In the first inpatient rehabilitation start to weight loss. Typically used the method of compensation: if one day the patient put on weight, for example, 200 grams, then "a reward" him to give additional freedom (first allow for a little while out of the house, then meet with friends, to leave the department, etc.) . With the patient make an agreement, which determines what rewards corresponds to a daily weight gain. This agreement is then often discuss and, if necessary, change. It is important that patients themselves determine for themselves incentives. If the weight does not increase, then, the reward is not enough to look attractive and be more efficient. In one controlled trial, method of compensation in anorexia nervosa better rest, though he gives the best results yet in mild cases.
Tube feeding - a common method of treatment before - now rarely used because of the risk of aspiration pneumonia. After being discharged from hospital to long-term outpatient treatment. His goal - to achieve a healthy weight and maintaining it for at least 6 months.
The basis of patient treatment - psychotherapy, aimed at the psychological support, a distraction from the unrelenting thoughts about weight and shape, the resolution of everyday problems. Teenagers useful family therapy. Most patients with this approach continues to gain weight, but often a few months later a recurrence of anorexia, requiring re-hospitalization. Recover completely, fewer than half of the patients, although almost anything can work. A rare complication of therapy - Obesity (2% of patients).
