Anorexia nervosa (AN) - a disease characterized by a change in feeding behavior and which is typical of a deliberate refusal to eat or use a variety of techniques to reduce the amount of nutrients entering the body (use of laxatives and diuretics drugs, violent vomiting).These methods are used for the purpose of correction and appearance and, as a rule, lead to a significant endocrine and somatic pathologies.
- 1 Causes
- 2 pathogenesis of the disease
- 3 Epidemiology disease
- 4 Signs of anorexia
- 5 Diagnostics
- 6 Treatment of anorexia
- 7 prognosis
undoubtedly the role of hereditary predisposition to this disease development: both girls in a pair of identical twins disease anorexia appears in 50% of cases;two sisters who are not twins, pathology occurs in 20%.Also important are the psychological characteristics of a person's physical and mental development, social factors, the flow of the process of education in the family.Particularl
Most often the disease develops at puberty, iewhen there are significant reorganization of the endocrine system and hormonal levels. bulimic anorexia shape is formed in connection with the existing features of the functioning of the hypothalamus and pituitary.
terms of Freudian occurrence of this disease is treated as an unconscious attempt to escape from the sexual life and craving a return to childhood.
pathogenesis of the disease
suffering from anorexia suffer due formation Dismorphomania (painful confidence in the presence of a certain imaginary lack of) and BDD (excessive concerns and concerns that minor drawback).The development of these disorders, forcing the patient to give up meals or induce vomiting immediately after eating.
Thus in some cases, may develop bulimia nervosa, which is a variant of anorexia.In this type of pathology is characterized by alternating episodes of long fasting with bouts of overeating that people consciously control is not able to and during which there is absorption of very large volumes and amounts of nutrients, and then artificial induction of vomiting and gastric lavage.
prolonged starvation leads to the subsequent development of malnutrition and various secondary disorders of the nervous and endocrine systems, as well metabolism.As a result of reduced production of gonadotropic hormones of the pituitary produces a change in the menstrual cycle until the complete termination.Characteristic of anorexia nervosa the level of secretion of hormones is fully consistent with the level that is normal for girls, located in the pre-adolescent.It is also typical of ON will be: reduction of the concentration of potassium ions in the blood serum, the development of dehydration and disorders of acid-base balance within the cell.As a result of fluid and electrolyte changes in patients dying suddenly.
This pathology is most prevalent in the north of Europe, where its frequency is about four cases per hundred thousand population .The incidence of anorexia nervosa is the highest in young girls, where she is about one percent for the period from age 16 to 18 years.Since the middle of the last (20th century), marked increase in the incidence of this pathology was observed, which is associated with a change in the perception of the human body, the formation of new criteria for the ideal and the popularization of the fragile body type.
According to the latest surveys conducted among girls high school, about 45% of them seriously believe that have excess weight, while excessive body weight (based on medical examinations) has only 5% of the total.In Western countries, about 10% of girls fifteen vomiting used as a method of changing body weight, and 10% used drugs that promote anorexia, about 5% taking laxatives drugs.In today's world of anorexia nervosa is one of the main reasons for reducing the mass in girls and young women.
Signs of anorexia
As a rule, the disease is most often diagnosed in young women.This is mainly those who learn in ballet studios, athletes, students of colleges and universities.Risk of developing anorexia are girls who have a slight excess body weight. on how the disease is detected and diagnosed more often on stage expressed underweight, due to existing pathology Hiding, simulating eating followed by vomiting or taking laxatives and diuretics.
disease has the following periods of development:
- Stage initial manifestations, which is characterized by the formation of painful self-presence of a certain lack of an imaginary (Dismorphomania);
- anorectic stage which continues until the loss of 25% to 50% of the initial body weight.For it is characteristic of a wide spectrum of clinical symptoms and secondary disorders of many organs and systems.Almost all women suffer from this disease in others insist that they have no appetite, but they are willing to discuss the food, love it to cook and entertain others.For patients and is characterized by the division of all products: good (fruits and vegetables) and bad (this category includes all containing fats and carbohydrates).Most patients can not stand the feeling of hunger, and eat, and then stimulate the gag reflex, some patients causes vomiting due to overeating (bulimia) emerging attacks.Later, as the disease progresses, vomiting becomes habitual in nature, as in patients after gastric emptying and washing the feeling of lightness and fun. Those patients who often cause vomiting, blisters appear on the skin characteristic of the index and middle fingers.Furthermore, as a result of constant contact with acidic gastric contents into the mouth there is damage to and destruction of tooth enamel at the initial stage of anorexia nervosa.In the second stage, virtually all patients have the use of laxatives and diuretics.Also, almost all the girls there is amenorrhea (missing menstrual period).By reducing the volume of fluid in the bloodstream and the ratio of electrolyte disturbances in the blood appears reduction in heart rate and blood pressure.Due to the use of non-nutritive products arises chronic lack of glucose in blood serum and tissue cells, which leads to a variety of disorders, especially of suffering of brain cells.However, despite the progressive reduction in body weight and the development of overt signs of all kinds of disorders, such patients are able to maintain a sufficiently long time, intellectually and locomotor activity is not affected, that is the main difference from anorexia other diseases in which there is also a pronounced weight loss;
- stage of cachexia, which occurs more than 50% of the original with the weight loss.Characterized by complete loss of critical patient perceptions of their own appearance and condition, subcutaneous fat disappears completely, there are edema, caused by a critical decrease in the level of protein in the body, and there are significant changes in electrolyte balance.If untreated, this condition is the cause of the onset of death.
indication for emergency hospitalization the patient with anorexia nervosa is the appearance of her sudden weakness and the cessation of normal activities, which indicates the development of a critical level of electrolyte disorders, life-threatening.
diagnostic criteria for anorexia nervosa are:
- Fleeing in fear of a possible increase in weight, which does not pass even after the body weight significantly reduced;
- restlessness sick about how it looks, health, and possible serious pathological changes are not counted;
- patient refuses to hold the weight in numbers that exceed the minimum acceptable level for this growth and the age category;
- emergence of amenorrhea.
diagnostic criteria for bulimia nervosa:
- Frequent recurrent bouts of overeating (twice a week for at least three months) - eating a large volume of food in a short period of time;
- During these episodes of binge eating is characterized by eating food that is easily digestible and contains a large amount of calories (about 5000);
- Loss of control while eating and imperceptible to the patient eating it in large quantities.
Treatment of anorexia
primary therapy prescribed by the physician-psihatr.Relief kaheksicheskogo state is carried out in a psychiatric hospital, with complete isolation from the immediate environment.This adequately controlled by diet and, if necessary, feeding the patient is carried out by intravenous administration.
frequency of deaths in this pathology is up to 10%.Lethal outcome occurs as a result of infection, sepsis, bowel necrosis, due to complications in the treatment, resulting in depression formed at suicide.Approximately 50% of patients the disease lasts for five years.Recovery occurs most often in the range from 6 to 12 years from disease onset. Complete recovery only occurs in 60% of human patients.