Anorexia: therapeutic diet during the recovery period. Treatment of anorexia

Anorexia in men has its own characteristics:

• Anorexia in men is often associated with various mental disorders - schizophrenia, neuroses.
• Men do not talk about their desire to lose weight. They are more secretive, unlike women who are constantly discussing ways to lose weight.
• Men are more purposeful, they firmly adhere to the word given to themselves to refuse certain products. They are less likely to have food breakdowns.
• A large percentage of sick men refuse food for ideological reasons. They are supporters of cleansing the body, raw food, veganism, sun-eating or other nutrition systems.
• Anorexia affects not only young men who strive to meet the standards of beauty, but also men over 40, who are fond of cleansing the body and various spiritual practices. You can often hear phrases from them that “food is a hindrance to spiritual development”, “refusal of food prolongs life and purifies the spirit”.
• Asthenic and schizoid features predominate in the character of patients, in contrast to women, who are characterized by hysterical features.
• Crazy ideas about imaginary fullness sometimes serve as a distraction for a man. At the same time, he tends to ignore real physical flaws, sometimes disfiguring his appearance.

Factors that provoke anorexia in men

• Growing up in an incomplete family in an atmosphere of excessive guardianship from the mother's side. The boy is afraid that with weight gain he will grow up and lose the love of his relatives. By staying thin, he tries to avoid the responsibilities and hardships of adulthood. Such men continue to live with their parents into adulthood.
• Critical statements from others regarding excess weight. This can cause psychological trauma.
• Participation in certain sports requiring tight control over body weight - sports dancing, ballet, running, jumping, figure skating.
• Professions related to show business- Singers, actors, fashion models. People engaged in these professions sometimes pay excessive attention to their appearance, which causes thoughts about their own imperfection and excess weight.
• Self-punishment. Boys and men wear themselves out by reducing their feelings of guilt for unrevealed aggression towards their father or forbidden sexual desire.
• Schizophrenia in one of the parents, the tendency to which is inherited. The risk of anorexia nervosa is high in young men whose parents suffered from anorexia, phobia, anxiety depression, psychosis.
• Homosexuality. In specialized publications, a cult of lean male bodies is created, which encourages young men to refuse food.

Manifestations of anorexia in men and women are very similar. In 70% of patients, the onset of the disease occurs at the age of 10-14 years. If parents failed to notice and stop them, then the symptoms slowly increase.

• Painful attention to one's appearance.
• Tendency to eat normally once and then starve for weeks.
• Tendency to hide food. To reassure relatives that the patient is "eating normally", he may hide or throw away his portion of food.
• Decreased sexual interest and potency, which is analogous to female amenorrhea (absence of menstruation).
• Traditional ways to lose weight - refusal to eat, excessive physical exercise and vomiting, enemas, colon therapy. However, painful attachment to vomiting is less common than in women.
• Unmotivated aggression. Rude attitude towards close people, especially to parents.
• Refusal to be photographed. Patients argue it by the fact that in the photographs their "completeness" is more noticeable.
• Hypochondria. A man is overly worried about his health, he suspects that he has serious illnesses. Natural sensations (especially the feeling of filling the stomach) seem painful to him.
• Changes in appearance appear after a few months - weight loss (up to 50% of body weight), dry skin, hair loss.
• The tendency to alcoholism is an attempt to cope with emotions and drown out thoughts about food and weight loss.

At first, losing weight causes euphoria. There is lightness and a feeling of victory when it was possible to curb appetite, which causes deep satisfaction in the patient. Over time, the appetite disappears, and the body's resources are depleted. Vigor is replaced by irritability and chronic fatigue. The way of thinking changes, crazy ideas are formed that cannot be corrected. The body becomes painfully thin, but the man continues to perceive himself as fat. Malnutrition of the brain affects the ability to think sensibly and process information. Prolonged abstinence from food leads to organic brain damage.

Men with anorexia do not perceive their condition as a problem. They justify fasting in every possible way by cleansing the body and striving for enlightenment. Their relatives are more likely to seek medical help. If this does not happen in time, then the man ends up in the hospital with cachexia (extreme exhaustion) or in a psychiatric hospital with an exacerbation of mental illness.

Treatment of anorexia in men includes psychotherapy, drug treatment, and reflexology. Together, these measures lead to recovery of more than 80% of patients.

1. Psychotherapy is an essential part of the treatment. It allows you to correct the thinking of the patient and helps to eliminate the psychological trauma that led to the eating disorder. With anorexia in men have proven their effectiveness:

• psychoanalysis;
• behavioral therapy;
• family psychotherapy with relatives of the patient.

2. Drug treatment. Medicines can only be prescribed by a doctor, and the dosage depends on the severity of the symptoms of the disease.

• Antipsychotics Clozapine, Olanzapine are used for the first 6 months of treatment. They promote weight gain and reduce delusions about fullness. The dose of the drug is determined individually. After reaching the therapeutic effect, it is gradually reduced. If an exacerbation occurs, then the dose is increased to the initial one.
• Atypical antipsychotics Risperidone, Risset eliminate the negative manifestations of the disease, but do not reduce performance, do not interfere with work and study. Take drugs constantly or only when symptoms of the disease occur. Treatment with atypical drugs can last from 6 months to one and a half years.
• Vitamin preparations. B vitamins normalize the functioning of the nervous system, helping to eradicate the root cause of the disease. Vitamins A and E improve the production of hormones, contribute to the restoration of the skin and its appendages, as well as the mucous membranes of internal organs.

3. Reflexology(acupuncture). During sessions, reflex points are affected, which stimulates appetite and restores impaired metabolism.

4. Trainings on the organization of a healthy diet. Special training programs will help the patient to create a menu in such a way that all the nutrients enter the body and there is no discomfort.

5. Intravenous nutrition or the introduction of food through a tube. These methods are applied at an extreme degree of exhaustion in patients who categorically refuse food.

Anorexia in a child, what to do?

Anorexia in a child is a more common problem than is commonly believed. 30% of girls aged 9-11 limit themselves in food and follow a diet in order to lose weight. Every 10th has a high risk of developing anorexia (in boys, this figure is 4-6 times lower). However, in childhood, the psyche is better influenced by early stages Parents can help their child avoid developing the disease while staying lean.

Causes of anorexia in a child

• Parents feed the child, forcing them to eat too large portions. The result is an aversion to food.
• Monotonous nutrition, which forms a negative attitude towards food.
• Transferred heavy infectious diseases- diphtheria, hepatitis, tuberculosis.
• Psycho-emotional stresses - sharp acclimatization, death of a loved one, divorce of parents.
• The abundance of harmful and sweet foods in the diet disrupts digestion and metabolism.
• Excessive guardianship and control by parents. It often occurs in single-parent families where a child is brought up without a father by his mother and grandmother.
• Dissatisfaction with their appearance, which is often based on criticism from parents and ridicule from peers.
• Hereditary predisposition to mental illness.

What are the signs of anorexia in a child?

• Eating disorders - refusal to eat or a certain set of foods (potatoes, cereals, meat, sweets).
• Physical signs - weight loss, dry skin, sunken eyes, bruising under the eyes.
• Behavioral changes - sleep disturbances, irritability, frequent tantrums, poor academic performance.

What to do if you notice signs of anorexia in a child?

• Make eating an enjoyable experience. Create comfort in the kitchen. While the child is eating, take a few minutes to sit next to him, ask how the day went, what was the most pleasant event today.
• Start eating healthy as a family. For example, instead of pies, cook baked apples with cottage cheese, instead of frying potatoes or fish, bake them in foil. Focus not on the fact that this is losing weight, but that proper nutrition is the basis of beauty, health and vigor. Slimness is just a pleasant consequence of a healthy lifestyle.
• Observe family rituals related to food. Bake the meat grandma's recipe, marinate the fish, as is customary in your family. Share these secrets with your child. Rituals make the child aware of being part of the group and give a sense of security.
• Go shopping together. Make a rule: everyone buys a new, preferably "healthy" product. It could be yogurt exotic fruit, a new kind of cheese. Then at home you can try it and decide whose choice is better. Thus, you instill in the child the idea that healthy food brings pleasure.
• Don't insist on yours. Give your child a choice, strive for a compromise. This applies to all aspects of life. A child who is overly controlled in everything takes control of what is left for him - his food. Avoid categorical requirements. If you think it's cold outside, then don't yell for your daughter to put on a hat, but offer the child an acceptable choice: headband, hat, or hood. The same applies to food. Ask what the child will be, offering a choice of 2-3 acceptable dishes. If the daughter flatly refuses dinner, move the dinner to more late time.
• Involve your child in the cooking process. Watch cooking shows together, choose recipes on the Internet that you would like to try. There are plenty of tasty and healthy low-calorie meals that do not increase the risk of gaining weight.
• Encourage dancing and sports. Regular physical training increases appetite and contributes to the production of endorphins - “happiness hormones”. It is desirable that the child engages in for his own pleasure, as professional activities aimed at winning competitions can provoke a desire for weight loss and cause anorexia and bulimia.
• Consult a beautician or fitness trainer if the child is dissatisfied with their appearance and weight. Children often ignore the advice of their parents, but listen to the opinions of unfamiliar experts. Such specialists will help to create a program proper nutrition, which improves skin condition and prevents weight gain.
• Listen carefully to the child. Avoid categorical judgments and do not deny problems: “Don't talk nonsense. You are of normal weight. Argument your arguments. Together, calculate the formula for the ideal weight, find the minimum and maximum values ​​\u200b\u200bfor this age. Promise to help in the fight for the ideals of beauty and stick to your word. Better cook baby diet soup than a rebellious daughter fundamentally skips a meal consisting of a high-calorie roast.
• Find areas where your child can fulfill himself. He should feel successful, useful and irreplaceable. To generate interest in various types activities, visit a variety of events with your child: exhibitions, competitions of dance groups and sports. Encourage him to try his hand at a wide variety of sections and circles. Genuinely praise every small accomplishment. Then the idea will take root in a teenager that success and positive emotions can be associated not only with physical attractiveness. And new acquaintances and vivid impressions will distract from thoughts about the imperfection of your body.
• Help your child to get complete and versatile information. If your child wants to stick to a diet, then find detailed instructions on this topic. Be sure to read the contraindications together, read about the dangers and consequences of this diet. For example, it has been proven that supporters of protein diets are at risk of getting cancer. The more your child knows, the better he will be protected. So, from a misunderstanding of the danger of the problem, many girls are persistently looking for advice on the Internet “how to get anorexia?”. In their view, this is not a serious mental illness, but an easy path to beauty.

Remember that if within 1-2 months you have not been able to correct the child's eating behavior, then seek the advice of a psychologist.

How to avoid relapse of anorexia?

Relapses of anorexia after treatment occur in 32% of patients. The most dangerous are the first six months, when patients are highly tempted to refuse food and return to old habits and the old way of thinking. There is also a risk that in an attempt to stifle their appetite, such people will become addicted to alcohol or drug use. That is why relatives should pay maximum attention, try to fill their life with new impressions.

How to avoid relapse of anorexia?

Scientists agree that anorexia is a chronic disease characterized by periods of calm and relapses. This food addiction is compared with diabetes mellitus: a person must constantly monitor his condition, follow preventive measures, and when the first signs of the disease appear, start drug treatment. Only in this way is it possible to stop the return of anorexia in time and prevent a relapse.

Treatment of anorexia is a combination of psychological, medical and therapeutic measures aimed at ridding the patient of a severe mental disorder, which, without proper therapy, can lead to the death of the patient.

What is this disease and what methods of its treatment exist? What type of therapy is most effective? Is it possible to defeat the disease on your own at home? The answers to these and other questions can be found by reading the following article.

Anorexia and its varieties

Anorexia is a severe mental disorder characterized by a complete or partial refusal to eat due to various reasons. Literally, the term means "no appetite." Often speaking about this disease, it is anorexia nervosa that is meant, which is characterized by purposeful and deliberate weight loss below allowable rate, caused by dissatisfaction with one's own body, the desire to get closer to world standards of beauty or an ideal created by oneself.

But there are other types of this disease that occur under the influence of certain factors on a person: mental, symptomatic and drug anorexia, primary and secondary, true and false, neurogenic, atypical and senile.

Anorexia is diagnosed in children, adolescents, men, girls and women.

There are several stages in the development of this disease. At the initial stages, with timely qualified treatment, patients almost always recover; at the last stages, a person usually dies due to the irreversibility of the processes occurring in the body, severe exhaustion and degeneration of internal organs that are unable to fully perform their functions.

Therefore, it is extremely important to diagnose this disease in a close and dear person in time in order to provide him with timely medical care, take the necessary measures to treat such a mental disorder and put all his strength into his recovery.

In addition, anorexia is considered a recurrent disease, that is, getting rid of it does not give any guarantee that it will not reappear. In order to protect your loved ones from relapse, you must follow preventive measures and be sensitive to changes in the behavior of a loved one.

Treatment of anorexia nervosa

Usually, the treatment of this disease is complex, the main purpose of which is to identify the causes that provoked the development of anorexia and their eradication. The factors that caused the appearance of the disease can be both physiological and psychological. Based on this, the doctor will build the most appropriate therapy for each individual patient.

Treatment of anorexia in most cases does not require hospitalization, therapeutic methods can be performed on an outpatient basis. However, it is extremely important before starting to make sure that the patient really wants to be cured, is aware of the gravity of his situation and does not deny the fact that he has a serious problem. Otherwise, a full recovery should not be expected. Such treatment will only draw all the juices and money out of you, and will not bring the desired result.

Treatment for anorexia includes:

• drug treatment;
• therapeutic diet food.

If the disease has developed against the background of any physiological diseases, then for high-quality treatment it is necessary to first get rid of the physical disease, and then treat its consequences. For this, various pills and medications are usually used, which will be aimed at eliminating the cause that provoked the onset of anorexia.

The psychological causes, against which the disease developed, are eliminated with the help of psychotherapeutic methods. Such treatment is aimed at changing the patient's lifestyle, a positive perception of himself, increasing self-esteem, forming an adequate attitude to food, to the people around him, setting new goals and priorities.

In the early stages of detecting this disease, its treatment can be limited only to psychotherapeutic methods. But if the disease has already entered an advanced stage, then complex treatment by various methods will be needed:

• drug therapy aimed at restoring damaged internal organs and body systems;
• treatment with drugs for weight gain: vitamin and mineral complexes, antidepressants, sedatives and antihistamines, as well as anorexia pills;
• psychotherapeutic impact;
• medical diet.

by the most the best treatment anorexia is a combination of therapeutic treatment, family therapy, psychotherapy and drug restoration of destroyed organs and systems.

When may you need hospitalization for anorexia:

• despite treatment, body weight continues to decline;
• BMI is thirty percent below the established norm;
• arrhythmia and bradycardia;
• depression with suicidal ideation;
• hypokalemia;
• significantly reduced blood pressure.

Psychotherapeutic methods of treatment of anorexia

One of the psychotherapeutic methods of influencing a patient with anorexia is a change in lifestyle. This aspect includes:

• regular meals and promotion of healthy eating;
• planning a dietary menu and drawing up a treatment plan;
• visiting a psychologist or support group to relieve emotional stress and stress;
• decrease in physical activity until the doctor allows a complex of medical procedures after stabilization and normalization of weight;
• refusal to constantly weigh.

The support of relatives and friends during this period is extremely important, therefore, family psychotherapy is very common, especially for the treatment of adolescent patients.

Medical treatments for anorexia

It is very important at the stage of treatment of this disease not only to get rid of internal psychological reasons its occurrence, but also restore normal weight, normalize nutrition, and saturate the body with various useful substances.

It is also necessary to attend to the restoration of internal organs and systems destroyed by the disease, which is typical for the later stages of anorexia. In all these cases, treatment is used using various medications.

In a hospital, droppers are often used to restore the body's water and electrolyte balance. At home, various medicines containing vitamins and useful and. Often this is, especially, as well as preparations containing, and.

Typically, antidepressants and neuroleptics, as well as sedatives and antihistamines, are prescribed to treat such a severe mental disorder.

Often, in the treatment of anorexia, drugs are prescribed that improve appetite, help restore and normalize metabolism and body weight.

Of the antihistamines, cyproheptadine is usually prescribed, which stimulates appetite. Also, drugs for anorexia that affect the increase in appetite are frenolon, elenium and others.

Taking antidepressants and antipsychotics will help get rid of the depressive conditions that often accompany this disease. But they should also be used in complex therapy, which includes consultations with a psychologist and psychotherapist. The list of banned antidepressants includes fluoxetine, a drug that many patients use to reduce appetite, thereby provoking the development and progression of anorexia.

Therapeutic nutrition for anorexia and dietary supplements

Restoring normal weight is not in a hurry, in general, the way out of anorexia is quite long and painstaking. It is necessary to start normalizing and stabilizing the patient's weight only when he has already undergone a short course of psychotherapy and eating will not become something out of the ordinary for him.

They usually start with a small amount of calories, which gradually increase to 2000-3500 calories per day.

Sometimes parenteral or intravenous nutrition is used, but only when the patient cannot eat food for various reasons: muscle weakness, heart rhythm disturbances, seizures, bleeding from the mouth, coma.

The lack of vitamins and minerals also negatively affects the health of the patient. Therefore, it is advisable to use nutritional supplements that will restore the balance. useful substances in organism:

• poly vitamin complexes containing and, ascorbic acid, as well as trace elements which contain, calcium, and;
• , in large quantities contained in fatty varieties of fish, such as or, as well as in;
• coenzyme Q-10;
• 5-HTP or 5-hydroxytryptophan, which should not be taken concomitantly with antidepressants;
• creatine;
• probiotics, lacto- and bifidobacteria, acidophilus.

In therapeutic dietary nutrition in the treatment of anorexia, it is worth adhering to some rules:

1. Do not drink alcohol, nicotine and.
2. Drink a large amount of refined or mineral per day, approximately 1.5-2 liters.
3. Protein food should only be of high quality. As a source, it is best to use natural ingredients: eggs, meat, dairy products, protein and vegetable shakes. However, it is worth knowing that protein foods should not be introduced at the initial stages, but gradually, since it is considered difficult for the body.
4. Eliminate refined sugars from your daily diet: sweet soda, sweets, and so on.

Treatment of anorexia at home

Often, anorexia is treated on an outpatient basis, at home. Such therapy includes:

• support of relatives and friends;
• diet food;
• medicinal preparations;
• folk remedies.

At the initial stage, such a set of measures will quickly save the victim from this terrible disease.

Psychological family assistance consists in regular communication with the patient, helping him to realize the severity of the problem and thereby help in a speedy recovery. Relatives, like no other, will contribute to understanding how to overcome the disease, they will make you feel that he is not alone and that he can always find support in them. It is in their power to find activities for the patient that will help not think about controlling body weight. And all this will happen under their sensitive and vigilant control of his eating behavior: checking the regularity of eating food, her.

For a complete cure, it is necessary that all metabolic processes in the body are restored, and a balanced therapeutic diet will help in this.

Traditional medicine can also help with such a disease. The use of various decoctions of herbs, infusions of dandelion roots, nettle leaves and fruits helps to stimulate appetite, stabilize the nervous system and calm.

Different types of therapy for anorexia

most popular and effective method in the treatment of this disease is cognitive behavioral therapy. Its goal is to replace distorted and negative beliefs with real and positive thoughts. This treatment method helps to overcome your fears and set new goals in life.

Other types of therapy include:

1. Family therapy, which is aimed primarily at helping parents and loved ones of a sick person in realizing the seriousness of the problem and finding ways to overcome it, as well as providing support to the patient on the path to recovery.
2. The Maudsley method is one of the varieties of family therapy, suitable primarily for the therapy of adolescents and young people, which consists in the complete control of the patient's normal restorative nutrition by the parents.
3. Hypnosis, which helps to get rid of depression and stress, return to good nutrition, increase one's self-esteem and a positive attitude towards oneself.

Anorexia and pregnancy

After complete recovery, the level of sex hormones in the body stabilizes and the menstrual cycle returns. But in the last stages of the disease, this process is irreversible.

This disease carries risks for pregnant women, or those who are trying to conceive a child. Often this affects the condition of the fetus: the child is born very premature and with birth defects.

Complications and prevention of anorexia

With anorexia, the likelihood of the following complications is high:

• arrhythmia and heart failure;
• anemia, hypokalemia, osteoporosis;
• level up ;
• hormonal failure leading to amenorrhea, infertility and growth retardation;
• dehydration and swelling of the limbs;
• malfunctions of the thyroid gland;
• exhaustion of the body, caries, impaired mental processes;
• fatal outcome.

Forced vomiting leads to:

• prolapse of the rectum;
• rupture of the esophagus;
• weakening of the rectal walls;
• swallowing problems.

It is difficult to predict recovery from such a disease, since in each individual case this leads to various consequences. Most often, the rehabilitation period takes from four to seven years. And about twenty-five percent of those who get sick never fully recover. In addition, there is always the possibility of a relapse, even in those people who have recovered from anorexia.

In severe stages, this disease leads to death from dystrophy of internal organs and suicide.

A healthy and positive family environment is essential to prevent relapse. Relatives and friends should not focus on food, weight problems and ideal forms. It is best to devote lunch hours to relaxation and family joys.

Finally

A disease such as anorexia requires long-term and serious treatment. The most effective in this case will be complex therapy with the use of psychotherapeutic, drug and folk methods treatment, as well as dietary nutrition. Prevention of the disease is reduced to the prevention of possible relapses and constant monitoring of the patient who has been ill.

Before talking about such a complex and somewhat mysterious, not yet fully understood disease as anorexia nervosa, it is important to provide some statistics. The prevalence of anorexia nervosa is 1.2% in women and 0.29% in men. At the same time, about 80% of patients are girls aged 12 to 24 years. By the way, this is the most promising age in which the formation of personality and worldview takes place, professional and creative talents are discovered.

Currently, there is a tendency towards an increase in cases of anorexia nervosa: in recent years, the number of patients has almost doubled. The risk group for this disease is most often teenage girls who do not suffer from anorexia in its purest form, but, having optimal healthy weight and height parameters, strive to reduce body weight and express ideas of dissatisfaction with their appearance.

In Russia, a study was conducted identifying cases of anorexia nervosa. The study was conducted in three major universities in the country, according to the data obtained, 46% of students had symptoms of an eating disorder. And despite the fact that these young people were not diagnosed with anorexia nervosa, they already have a tendency to this disease. This is a kind of fertile ground for the development of a complex disease.

Medical care for anorexia nervosa

Patients with anorexia nervosa rarely seek medical attention. Unfortunately, only 1-2% of patients with this pathology are covered by medical care. And the thing is that people themselves suffering from anorexia nervosa often do not consider themselves sick, moreover, they tend to hide the symptoms from their relatives and friends, even when the situation has gone far.

The mortality rate due to anorexia nervosa is one of the highest for psychiatric diseases. According to studies conducted by the American Journal of Psychiatry, the overall mortality rate for anorexia nervosa is 4%. It should be noted that it is rather difficult to compile an objective picture of relative mortality due to anorexia, since often the cause of death is organ and multiple organ failure (suicidal attempts play an important role).

The statistics speak for themselves, really anorexia nervosa is a deadly disease that requires increased attention to itself, due to the constant increase in the number of patients.

The role of a dietitian in the treatment of patients with anorexia nervosa

Anorexia nervosa is a mental illness, according to the ICD-10 classification it belongs to the class “Mental disorders and behavioral disorders” and has the code F50.0, respectively, the treatment of this disease is supervised by psychiatrists and psychotherapists. However, the role of a dietitian is no less significant in the treatment of patients with anorexia nervosa.

Firstly, a dietitian may be the first person to whom the patient or relatives of the patient will turn, and here it will be important to choose the right tactics and outline the course of treatment.

Secondly, at the anorectic, cachectic stage of the disease, the selection of a diet, specific foods, the required amount of nutrients, the appointment of enteral nutrition should be carried out by a dietitian. At the stage of reduction of anorexia nervosa, a nutritionist may generally be the only specialist who sees this patient.

Anorexia nervosa according to ICD-10

Mental and behavioral disorders (F00-F99)

Anorexia nervosa (F50.0)

A disorder characterized by intentional weight loss caused and maintained by the patient. The disorder tends to be more common in adolescent girls and young women, but it can affect adolescent boys and young men, as well as children approaching puberty and older women (up to the onset of menopause). The disorder is associated with a specific psychopathological fear of obesity and body sagging, which becomes an obsession, and patients set a low body weight limit for themselves. As a rule, there are various secondary endocrine and metabolic disorders and functional disorders. Symptoms include dietary restriction, excessive exercise, emetics, laxatives, diuretics, and appetite suppressants.

A bit of theory. Theoretical data regarding anorexia

Before speaking directly about the dietary correction of this category of patients, it is important to pay attention to theoretical data regarding anorexia.

Anorexia nervosa is a pathological eating disorder characterized by intentional weight loss induced and sustained by the patient in order to lose weight and maintain weight loss. Often, patients have a dysmorphophobic syndrome, characterized by fear of gaining excess weight and obsessive thoughts about their appearance. Patients sharply limit themselves in nutrition or completely refuse food, increase physical activity, take laxatives and diuretics, and induce vomiting after eating.

The probable causes and risk factors for this condition can be divided into several groups:

1. Biological:
   • violation of serotonin metabolism (like depressive states);
   • physiological features of the constitution, for example, a tendency to be overweight;
   • individual characteristics of the hormonal sphere;
2. Psychological:
   • a certain type of personality - perfectionism, sensitivity, "closedness" of a person;
   • subordination, a sense of helplessness, a feeling of lack of control over the situation;
   • low self-esteem;
   • feeling of inferiority;
   • feeling of inadequacy to society, etc.;
3. Family:
   • psychological problems in the family - misunderstanding on the part of adults, insufficient attention from loved ones, the difficult nature of parents or a loved one, depressive moods in the family, frequent quarrels in the family, divorce of parents, etc .;
   • an eating disorder in one of the relatives;
   • suicide of a relative;
   • any addictions - drug addiction, alcoholism, etc. - from relatives;
4. Social:
   • stressful events - the death of a loved one, rape, etc.;
   • the influence of others - statements of loved ones, colleagues, friends, classmates about the need to reduce weight or praise when the weight is reduced;
   • the influence of the media - an emphasis on harmony as the main criterion of beauty, propaganda of "model" thinness, the equation of harmony and human success.

Symptoms of anorexia nervosa can be divided into two large groups:

1. Physiological signs and symptoms:
   • weight loss from 10% of the initial body weight;
   • a sharp decrease in subcutaneous fat, to its complete absence;
   • body mass index of 17.5 and below;
   • changes in the general blood test - a decrease in hemoglobin, leukocytes, platelets, erythrocytes, as well as ESR;
   • changes in the biochemical analysis of blood - a decrease in cholesterol, total protein, albumin, sodium, potassium, chloride, calcium; fasting glucose level is reduced;
   • dysfunction of the autonomic nervous system - dizziness, fainting, palpitations, asthma attacks, increased sweating;
   • amenorrhea of ​​3 months or more;
   • constipation;
   • decrease in turgor and elasticity of the skin;
   • pallor of the skin, cyanotic staining of the fingers;
   • sparse hair, intense hair loss;
   • poor cold tolerance due to impaired thermoregulation;
   • heart rhythm disturbances;
   • violations of the structure of the teeth;
   • endocrine status disorders - hypogonadism, a decrease in the level of estrogen in the blood;
   • tendency to hypotension;
   • disorders of the digestive system - belching, heartburn, nausea, vomiting, pain in the epigastric region, violation of the absorption function of the intestine;
   • dehydration;
   • osteoporosis;
   • protein-free edema.
2. Psychological and emotional signs and symptoms of anorexia:
   • Refusal of food - complete or partial.
   • Statements about the absence of hunger - at the onset of the disease, hunger is preserved, but patients drown out this feeling, trying not to pay attention to it, with the progression of this condition, hunger is really not felt by patients.
   • Pathological fear of gaining weight.
   • Lies about eating enough. In this matter, patients are very inventive, they can hide food, throw it away, give it to animals, etc. It is important that in the first stages of recovery all meals take place under the supervision of either a medical professional or an interested relative.
   • Disorder in the perception of impulses from food - the patient literally does not understand whether he is full or not, cannot predict the amount of food he needs to be satiated.
   • Disorder of the body schema to delusional beliefs. Often patients with anorexia nervosa, having a pronounced underweight, tend to consider themselves too obese.
   • Typical anorectic behavior - the patient says that he does not feel hunger, while he shows interest in food, feels pleasure when someone eats in his presence; prepares food, while not eating it himself, offers to eat more, etc.
   • Social isolation.
   • Irritability and irascibility.
   • Decreased mood, sometimes lack of emotions.
   • Decreased libido.
   • The use of laxatives, diuretics.
   • Physical hyperactivity with the aim of losing weight or maintaining it. All eaten patients try to "work out", that is, to use up all the calories received witheating food.
   • Increased interest in various diets, weight loss products. Often they know a lot of the smallest subtleties regarding weight loss.

Dialogue with the patient

If a patient who is suspected of having this pathology gets an appointment with a dietitian, here are a few questions to ask him:

• Weight dynamics - "Was there any weight loss for Lately, was there excess weight that preceded the change in weight, what weight would you like to have?
• "Your actions taken to change, maintain or control weight."
• "Your nutrition for the moment." You can be asked to give an example of eating in the last 1-2 days, or to describe a typical day in terms of nutrition.
• "Do you use laxatives, diuretics, or other drugs for weight control?"
• "Do you induce vomiting after eating?"
• "Tell me about your physical activity."
• “Are you familiar with the states of lack of control over what you eat?”
• “Are you on or have you ever followed a weight loss diet?”
• “How are things with the menstrual cycle?”
• "Tell me about your family - addictions, the state of weight of close relatives."

Remember that the patient does not necessarily answer all questions sincerely, it may take time to establish contact. In any case, try not to give negative assessments of the patient's weight, do not criticize for appearance.

Criteria for Anorexia Nervosa

The American Psychiatric Association suggests the following criteria for anorexia nervosa:

• refusal to maintain weight in the minimum allowable values ​​for a given height and age;
• a strong fear of weight gain and fullness, even if the patient is currently underweight;
• denial of the seriousness of the severity of their condition;
• the disappearance of menstruation, at least three cycles.

stages of the disease. The dynamics of the development of anorexia nervosa

The dynamics of the development of anorexia nervosa includes several stages:

1. The primary stage, in some sources it is called dysmorphomaniac. This is a definite start of the disease. During this period, thoughts and ideas about one's own inferiority, inferiority due to completeness, often imaginary, predominate. It can be seen that the patient is depressed, anxious, looks at himself in the mirror for a long time. The trigger for the development of anorexia can be someone's comment about weight, and if it falls on "favorable" soil, malnutrition develops.
   At this stage, a feeling of hunger is preserved, for which a person may feel shame. Eating restrictions begin, the search for a way to reduce weight, possibly inducing vomiting.
   As a rule, at this stage, few of the patient's relatives experience anxiety, far from everyone, even from the immediate environment, can notice the changes that occur with the patient. Some may even praise the desire to lose weight, which will only strengthen the commitment to their idea for an anorexic. For example, a girl, doing ballroom dancing, must always be in a certain form; if the coach expresses the idea that she needs to lose weight, and then praises her for the result achieved in this, this may well be the start for the development of anorexia.
2. anorectic stage. There are vegetative disorders. The diet becomes longer, more rigid, episodes of complete refusal of food are possible, while the patient convinces others that he is not hungry. Patients exhaust themselves with physical exertion. Weight is reduced by 20-30% of the original. There is euphoria.
3. cachectic stage. Dystrophy of internal organs occurs, often it is irreversible and leads to disruption of the work of all organs and systems of the body. Weight loss reaches 50 percent or more. There is increased pigmentation of the skin, intense hair loss, tooth decay.
4. The reduction of anorexia nervosa can last up to several years, depending on the degree of disturbance that has occurred in the body and the psychological characteristics of the patient. As a rule, it replaces the anorexic stage or interrupts it.

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Dietary correction

Before starting treatment, it is necessary to assess the actual state at the moment. It is important to assess the patient's nutritional status, height, weight, body composition, functional state of organs and systems, in particular, it is important for the doctor to understand the functionality of the patient's digestive system.

1. Urgent help

Emergency assistance is associated with the correction of water and electrolyte balance and the fight against cachexia. For this, parenteral and enteral nutrition are used.

Treatment is carried out jointly with psychiatrists, general practitioners, if necessary, intensive care physicians and specialized specialists are involved in the treatment.

The next stage of treatment is longer and largely determines whether anorexia recurs or a person can return to normal life.

At this stage, many patients with anorexia require the help of a psychotherapist. This can be individual work or work in a group, it is important to support close people with no criticism and the support of all specialists who work with the patient at the moment, including a dietitian.

2. Recovery

During the recovery phase, when the patient's life is not in danger, the nutritionist should change the directive approach to a non-directive one. During this period, it is important to create an environment of acceptance and trust for the patient. It is important to avoid harsh criticism of the patient and respect him and his present condition. It may be necessary to exercise patience in working with some patients.

Meetings with patients should be regular, with a frequency of 2-4 times a month, this is necessary, since the recommendations should be relevant at the moment and not outstrip the patient's capabilities, both psychological and physiological.

Motivation for lifestyle changes and psychological analysis at this stage is done by a psychotherapist or psychologist, but it is also important for a nutritionist to understand at what stage of readiness for changes the patient is, therefore the best option There will be a joint work of a dietitian and a psychotherapist.

It is important that the recommendations are individual for each patient, both from a psychological and physiological point of view. For example, I was treated by a patient who had suffered from anorexia for five years, at the recovery stage she could not eat standard amounts of food (about 250 g), as she felt heaviness in the abdomen. Another example: a girl after several years of anorexia could not eat jam, because she considered this product to be high in calories and its use made her feel guilty, which could cause a relapse of the disease. By the way, other confectionery did not evoke those emotions in her.

3. What the patient should not know

It is not necessary to devote patients with anorexia to the intricacies of calculating the caloric content of the diet, the amount of proteins, fats and carbohydrates during the day, as this can provoke a desire to control weight and reduce food volumes.

4. Features of the purpose of the diet

Recommendations should begin with a discussion of the diet. It should be frequent and fractional. It is necessary to clearly prescribe the time of meals so that the patient does not have questions and doubts about this. The time of meals is set by the doctor based on the wishes of the patient, taking into account employment and the possibility of eating at certain hours.

• grain products - cereals, cereal side dishes, grain bread, cookies, etc .;
• any fresh or cooked vegetables, vegetable juices;
• fruits and berries in any form, freshly squeezed juices;
• protein products - meat, poultry, fish, eggs, soy products, legumes;
• dairy products - cheese, cottage cheese, sour-milk drinks, milk;
• fats - vegetable oils and dressings based on them, butter, margarine.

The nutritionist must make all the necessary calculations of the patient's energy needs and, based on them, draw up an approximate balanced menu. But, as I already said, the patient has the last word, it is important to get his consent and take into account all his wishes. Otherwise, unfortunately, the work of a doctor will not make sense. As an example, I would like to tell the story of one of my patients who suffered from anorexia for about seven years.

After treatment by a psychiatrist and work with a psychotherapist, the girl stopped tracking her weight and did not seek to reduce it. At the time when she turned to me, she already had experience working with a nutritionist. The doctor made for her a diet that fully meets her physiological needs and is balanced in terms of essential nutrients. But, unfortunately, the patient could not follow the recommendations. The fact is that, firstly, she could not eat meat and poultry, as she experienced heaviness in the epigastric region after eating them; secondly, she could not follow the regimen prescribed by the nutritionist, since at the appointed hours she simply did not have access to food, she was in training; thirdly, the menu suggested that the patient herself would cook her own food, but at that time she could not do this, as she again began to be haunted by thoughts about the calorie content of food, extra fat, simple carbohydrates in their composition and the consequences of their use.

5. More specific

Another equally important advice for dietitians who advise patients diagnosed with anorexia nervosa is to give the patient clear recommendations for the first time with a specific amount, weight of dishes and foods. Since patients with anorexia literally "do not know how" to eat. Listing the composition of the menu, one should not be limited to the names of dishes: “For lunch - meatballs with sauce, vegetable stew, compote, etc.”. It is necessary to explain what meatballs should be made of, what their weight should be, what sauce can be used for them, etc. In further work, it is not necessary to explain in such detail the composition of the prescribed diet.

Some patients are not ready to accept the recommendations of a nutritionist and think about their diet, then close relatives can take on this task. That is why it is also important for them to tell in detail about the necessary diet.

6. To the taste of the patient

If at the time of working with the patient he is ready to eat only a very limited set of products, the doctor draws up a menu based on this list, but says that in the future this menu will need to be expanded. You can ask the patient to prepare a list of several items for the next meeting - what else he could include in his diet.

Dear nutritionists, do not be embarrassed that the patient's diet will be somewhat poor, maybe monotonous and not always consist of them. useful products. Patients need time to be ready for drastic changes in their diet. It is much more correct and beneficial for the patient to take gradual steps, but with the steps that he can and wants to take at the moment, than to receive directives from a nutritionist that he is unable to follow.

To correct dietary deficiencies, along with the usual food, enteral mixtures can be used (taken in the form of a siping). It is better that they fall into the hands of the patient without information on calorie content. You can also use modular mixtures to correct certain nutrients, and vitamin-mineral complexes.

It must be remembered that the introduction of a separate meal in the form of an enteral mixture by sipping should be agreed with the patient's relatives, since the transfer to artificial nutrition is carried out only if the patient refuses to take natural food. It is quite difficult to refuse artificial nutrition in the future, especially in this category of patients.

7. Protein in the diet of the patient

Anorexia can lead to protein-energy malnutrition or become its symptom in an advanced stage. That is why protein is one of the most important nutrients that the patient must receive regularly with food.

The consumption of a sufficient amount of protein in this disease is prevented by two frequently occurring conditions: 1) the patient's refusal from foods rich in protein, for example, animal meat, poultry; 2) food intake in a minimum amount. Moreover, traditional nutrition cannot fully meet the patient's needs for basic nutrients, including dietary protein, and may not be fully absorbed by patients with various pathological conditions.

Currently used in dietetics modern technologies therapeutic nutrition of patients with anorexia - correction of the diet with specialized food products with dry protein composite mixtures (SBCS) (the technology was developed at the Research Institute of Nutrition). The introduction of additional protein into the composition of food products makes it possible to effectively and without the participation of the patient increase the nutritional value of the diet. On the basis of the Order of the Ministry of Health of Russia dated June 21, 2013 No. 395n “On approval of the norms of therapeutic nutrition”, dry composite protein mixtures were introduced into the average daily set of products per patient. The inclusion of SBCS in the composition of ready-made meals at the stage of their preparation is determined by a significant reduction in the risk of developing protein-energy malnutrition during the development of the disease.

It is important to note that due to the use of SBCS, the the nutritional value diet of the patient, while the amount of food consumed does not increase. This circumstance is especially important for patients with anorexia nervosa - people who do not agree at first to receive normal serving sizes.

Before introducing easily digestible protein into dietary meals, it is necessary to conduct a personal calculation of the required amount of protein for each patient. The appointment of a mixture of protein composite dry to patients is carried out by a dietitian according to the following algorithm:

• It is necessary to measure the body weight, height of the patient, determine the body mass index.
• Assess the severity of protein metabolism disorders according to laboratory diagnostics (protein level, albumin, lymphocyte count).
• Conduct a nutritional status assessment with a note in the outpatient card (medical history).
• In violation of nutritional status (BMI< 19) определить суточную потребность в СБКС согласно расчету потребности в белках, жирах, углеводах, калорийности на первом этапе лечения в расчете на существующую массу тела, далее по мере адаптации пациента к назначенной диете суточный объем СБКС увеличивается постепенно и доводится до потребности белка на долженствующую массу тела.
• During the control measurement of BMI, a redistribution is carried outthe daily requirement until the individual body weight and BMI determined for each patient is reached.
• The calculation of the patient's need for SBCS should be recorded in the outpatient card or medical history.

Behind the mask...

As noted earlier, patients with anorexia nervosa can be very resourceful and hide their desire to lose weight from loved ones for a long time. For example, in clinical practice, I have had cases when a patient gave out a pathological desire to lose weight for vegetarianism, he excluded many foods from his diet and severely limited portions of dishes. During the day, the patient ate approximately 20-30 g of cheese, explaining such a small amount of food by the lack of hunger. If he was offered to eat other foods, he replied that they were tasteless. Interestingly, this was a young man whose parents had gone through a divorce a few months before the onset of the disease.

The reason for the sharp decrease in the amount of food in another patient was a tendency to constipation. She limited her diet to 1-2 fruits a day, saying that "it's easier for her." During a detailed conversation, it turned out that she considers herself complete and sees the need to reduce weight by 10-15 kg. The patient's BMI at the time of examination was 18.4.

Special approach

In conclusion, I would like to touch on a delicate issue - the attitude of society towards patients with anorexia nervosa. It is important that society and we doctors do not label them mentally ill. For many patients with whom they have to work, the debut of anorexia was preceded by a life drama, for some, the disease became the only way to attract attention, the opportunity to control at least something, as it seems to them, to control, at least to enjoy something, at least for something. then respect yourself. Of course, they chose the wrong path, and our task is to help them return to the right track and come to a normal, fulfilling life.

• “After vomiting, I feel a moment of pleasure that I don’t get anywhere else.”
• "I can be offended easily."
• "I suffered a lot."
• "What's going on in my life is very unfair."
• “Something is wrong with me” (considers herself unattractive).
• "Insults hurt me."
• “I don’t know what to do… I won’t succeed.”

Prevention of anorexia nervosa

It is important to prevent the further growth of this disease, and work should be carried out at the state level.

Firstly, it is worth limiting the mass propaganda of model thinness and banning some Internet resources that promote painful harmony and, moreover, give advice on its implementation.

Secondly, work should be carried out with the parents of adolescents, since for many the trigger is the unfavorable psychological climate in the family.

Thirdly, it is worth banning the showing of people with anorexia on central television channels, since great attention to these patients increases the number of new cases of the disease.

Fourthly, to create a hotline for anorexia patients and their relatives, where specialists could give recommendations on where to go with this pathology and provide psychological support at all stages of the disease. It is also necessary to open various support centers for patients with anorexia nervosa. This is especially important during the recovery period and will help prevent relapses of this condition.

Anorexia- This is a mental illness that manifests itself in a violation of eating behavior, in which a person deliberately severely restricts himself in food. There is such a restriction, and sometimes even a refusal of food, against the background of a distorted idea of ​​​​the patient with anorexia about his own body (figure, weight) and a stubborn desire to lose weight by any means.

With anorexia, a person often strives not to achieve a certain weight value, but to an external manifestation of the result - a decrease in the volume of the figure. The goal can be pursued both by restriction (starvation) and by cleansing (taking emetic, laxative, etc.).

Affected by the disease, mainly women aged 14 - 25 years, less often - women aged 30-35 years. Also, in recent years, males are increasingly observed among patients. Most often, anorexia develops during a period of hormonal disruptions or experiencing stressful situations.

Types of anorexia, depending on the causes of its occurrence:

1. nervous;
2. symptomatic;
3. mental;
4. medical.

The most common type of anorexia is nervous. The most rare is psychic anorexia.

Causes

Each of the varieties of the disease develops as a result of various reasons. Mental anorexia is the result of a mental illness such as schizophrenia, paranoia, or depression. The reasons for the development of other forms of the disease can be physiological and psychological factors. Physiological factors are mainly the cause of the development of symptomatic and drug-induced anorexia. Physiological causes of anorexia include:

• violation of the level of brain hormones (decrease in the content of serotonin, norepinephrine and an increase in cortisol);
• development of somatic diseases of organs;
• abuse medicines mainly antidepressants.

The psychological causes of the anorexia disease give rise to its most common form - the nervous one. These include:

• the desire to control your life;
• the desire to meet the requirements of the surrounding world;
• perfectionism;
• an inferiority complex instilled at an early age as a result of improper upbringing;
• psychological trauma;
• physical or sexual abuse.

Anorexia appears under the influence of both the patient's own desire for ideals and the provocation of this desire by others.

Symptoms and signs of anorexia

The patient himself does not recognize the existence of the problem and hides the disease from himself and others. However, according to a number of signs, anorexia can be determined. Symptoms of anorexia can manifest in both physical and behavioral signs.

Physical signs of anorexia include:

• permanent and significant weight loss;
• dry irritated skin, brittle hair and nails;
• bloating, digestive problems;
• dizziness, fainting;
• deterioration of the brain - absent-mindedness, forgetfulness, slowing down the reaction rate;
• violation menstrual cycle;
• violation of sexual functions.

Often, in order to hide the manifestation of the disease, an anorexic patient may wear baggy clothes. Problems with digestion, skin or menstruation, as well as weight loss, can be explained by past illness. In this case, it is worth paying close attention to the behavior of the patient. The list of behavioral signs of anorexia includes:

• dissatisfaction with their weight, although it may be within or below normal;
• constant diet, miscalculation of calories and foods that can not be eaten;
• weight control - weighing at least 2-3 times a day;
• reading all labels on products;
• refusal to eat under various pretexts (“I just had lunch”, “I feel bad”, etc.);
• refusal to eat in public places;
• getting pleasure from the feeling of hunger;
• special ways of eating (food is chewed and not swallowed, cleansing the body after eating);
• isolation, loss of sociability;
• heavy physical exercise after every meal.

The first physiological symptoms of anorexia are manifested in the form of significant weight loss (not due to illness) in a short period and a deterioration in well-being (dizziness). An alarming signal is a weight loss of 20% of body weight.

At what weight anorexia begins is determined individually for each person. To do this, it is enough to calculate the body mass index, which is defined as the ratio of weight in kilograms to height in meters squared (55 kg / 1.702 m = 19.03). The body mass index in the range from 18.5 to 25 is considered the norm, the critical indicator is at the level of 17.5. It is not difficult to calculate how many kilograms anorexia begins, it is enough to know your height and understand that the disease develops with a body mass index of 17.5 and below.

In order to understand how anorexia begins, you need to understand the mental nature and causes of the disease. In some cases, anorexia can be instilled in a child who is constantly reproached for not being slim enough. And later, already at a conscious age, such a person can get into a similar stressful situation, which will give impetus to the development of the disease.

Often, the first symptoms of anorexia are behavioral and appearance the patient as a result of experiencing a stressful period or in an attempt to take control of his life. In search of a distraction or goal of control, patients choose their own weight. Changing it for the "better" side gives a sense of control over one of the areas of one's life, brings confidence and satisfaction in the form of being able to wear smaller clothes.

Stages of the disease

There are three stages of anorexia nervosa: primary, anorexic, cachectic. During the primary stage of the anorexia disease, the symptoms of its development are the active expression of dissatisfaction with one's body and the intention to correct it. The first signals of the disease also appear in the form of aversion of the patient to food and refusal to eat.

The anorexic stage is characterized by the fact that the disease passes into the active phase. The patient begins to actively lose weight, losing from 20% to 50% of his body weight. Used in this different ways. The most common form in which anorexia manifests itself in the second stage is bulimia - the absorption of food and the immediate provocation of vomiting.

Signs of anorexia in the third, cachectic stage are manifested in uncontrolled weight loss, organ dystrophy, problems with the cardiovascular and circulatory systems. The general condition of the body worsens. This is the most dangerous stage of the disease, which is difficult to cope with. In some cases, anorexia in the third stage of development can be fatal.

Treatment

In case of detection of signs of the development of the disease, it is necessary to immediately consult a doctor. Depending on the symptoms of anorexia, the treatment will be different.

The first and main step towards recovery is the recognition by the patient himself that he has anorexia and the manifestation of a desire to fight it. Depending on the stage of the disease, treatment may include: medical procedures, psychological assistance, dietary nutrition.

In the early stages of the disease, anorexics with the help of psychological methods will help to realize the problem, reassess ideals and life goals, form a new attitude towards oneself and one's body. The basis of dietary nutrition is a gradual increase in portions, the number of meals and the inclusion of more foods in the diet. The main task of treatment at the first and second stages of anorexia is the normalization of body weight, metabolism and the establishment of harmony between the patient and his body.

Most often, the treatment of anorexia takes place on an outpatient basis with the support of the patient by relatives. The exceptions are the categorical refusal to necessary techniques food, suicidal mood of the patient and the third stage of the disease. Often in such cases, there is a need for parenteral nutrition of the anorexic (intravenous administration of nutrients).

In the third stage of anorexia, the tasks of treatment include restoring the functioning of organs, gaining weight to a level above critically small, correcting internal installations and seeing yourself sick. On average, the duration of such treatment can be from three to eight months, and about 1.5 years for a full course of recovery from anorexia.

Diet for anorexia

A disease such as anorexia begins with a diet and is treated with it. The only difference is that, in contrast to the strict restrictions that provoked the disease, dietary nutrition in the treatment of anorexia should be balanced and clearly calculated, because. too large a portion or excessive restriction can lead to a loss of the accumulated result. Depending on the individual indicators of each patient, a professional nutritionist prescribes a nutrition menu for anorexia.

However, at home, for nutrition with anorexia at an early stage, the menu can be compiled independently, guided by the principles of treating the disease. The basis of dietary nutrition in the case of this disease is the gradual restoration of body weight. Therefore, for the menu for anorexia, a high-calorie diet with a gradual introduction of complex foods into the diet is perfect.

To gain weight, nutrition for anorexia should consist of the following steps:

1. the first week - the resumption of the regularity of meals, liquid and semi-liquid low calorie meals in small portions (mild soups, broths, cereals, mashed potatoes);
2. the second week - elements of a raw food diet (apple and carrot purees, berries, bananas) are added to the menu for anorexia;
3. the third week - low-fat boiled fish appears on the menu, chopped meat can be added to the broth, boiled cereals in milk, freshly squeezed fruit (except citrus) and vegetable juices are used with the addition of water;
4. fourth week - with a favorable perception by the stomach of all the introduced dishes, you can add vegetable salads, bread, boiled meat, some spices.

Nutrition for anorexia should be very careful, in order to avoid rejection of food by the stomach. In the event of such a rejection, the diet is resumed from the diet of the second week.

Anorexia drugs

The list of necessary drugs for anorexia includes antidepressants and mild antipsychotics. The patient is prescribed a number of drugs that calm the nervous system and improve appetite, as well as vitamin complexes (vitamin B12, vitamin C, iron, calcium) that help restore metabolism and normal body weight. Anorexia pills that increase appetite include Elenium, Frenolon, and so on.

Psychotherapy and dietary nutrition will help to consolidate the effect of the treatment of anorexia with pills and vitamins. Psychotherapeutic methods of treatment will help to eradicate the disease in the mind of the patient. Diet food will allow you to gradually return to a normal diet.

Anorexia in men

First of all, anorexia develops in young guys at the age of puberty. During this period, all the complexes and pain points of a young man are most aggravated. Close attention is paid to the appearance and compliance with its modern standards of beauty. Often, it is at this age that psychological traumas received in childhood due to excess weight from peers and parents “emerge”.

Anorexia also occurs in men professionally involved in sports, engaged in modeling and show business. In such areas of activity, excess weight can be a reason for job loss. For them, anorexia plays the role of a panacea for unwanted pounds.

A patient with anorexia (especially a man) will not recognize the existence of a problem. He considers the unnatural thinness of the body an achievement of the goal. Because of this feature, it is rarely possible to diagnose the disease in the early stages. Outwardly, it becomes noticeable after 2-3 years of development, when the exhaustion of the body manifests itself.

Pregnancy with anorexia

Pregnancy and anorexia are incompatible processes. The development of such an eating disorder during pregnancy can lead to irreversible consequences: miscarriage, the birth of a small child, the birth of a child with serious illnesses.

When unplanned pregnancy with anorexia, the patient must immediately report her illness to doctors if she wants to save the life of the child. In this case, with the constant supervision of specialists, there are great chances for a successful pregnancy.

If a woman with anorexia is planning her pregnancy, she also cannot do without the help of doctors. Since a healthy balance of hormones in the body is necessary for the conception of a fetus, the first thing to do is to restore menstruation after anorexia. For normal conception and pregnancy, the level of the female hormone estrogen and the state of the whole organism of the mother must be normal. That is why it is important to completely cure anorexia in the early stages, in order to avoid irreversible consequences. Then it will be possible to lead a normal life of a healthy person.

Consequences of anorexia

Anorexia is dangerous because, by limiting the amount of nutrients entering the body, it negatively affects all organs and systems. Dehydration of the body leads to a deterioration in general well-being, dry skin, brittle hair and nails, kidney problems (renal failure).

Exhaustion of the body negatively affects the work of the brain - a patient with anorexia is not able to make decisions quickly, is inhibited in reaction, forgetful. The attitude of such a person to various kinds of life situations also changes. He is not always able to adequately respond to stressful situations or jokes. Preoccupation with a diet destroys all other interests and leads to the loss of friends and communication.

The impact of anorexia on the oral cavity is reflected in disease and tooth decay. In the organs of the gastrointestinal tract, the disease leaves its traces first of all. They manifest themselves in gastritis, stomach ulcers, bloating and bowel problems.

With constant starvation, diseases of the cardiovascular and circulatory systems develop. Anorexia causes blood anemia, arrhythmia, and can lead to cardiac arrest. Often with a disease such as anorexia, patients have diabetes mellitus.

As a result of the disease, the hormonal balance in the body is disturbed. This leads to serious violations of the menstrual cycle in women, up to infertility. High levels of cortisol (a stress hormone) and low levels of calcium in the blood lead to a decrease in skeletal bone density, resulting in osteopenia and osteoporosis.

It is important to remember that by contacting doctors in the early stages of the disease, most of the consequences can be avoided or reversed. This will allow you to lead a normal life after recovery from anorexia, without serious health problems. That is why it is necessary to pay attention to the signs of the disease in time and take the necessary measures.

Anorexia is a disease manifested by a persistent desire to lose weight, regardless of the initial weight to the minimum numbers, to the detriment of one's own health and often ends in death.

Most often, girls and adolescent girls suffer from anorexia, starting from 8-9 years old, with a peak at 14-18 years old. Among young men, patients with anorexia are also found, but much less often: for one anorexic boy, there are, on average, 75 pathologically losing weight girls.

A study on the causes and consequences of anorexia was carried out at the Department of Psychiatry of the Peoples' Friendship University of Russia (Moscow).

How Anorexia Occurs

Anorexia is closely related to dysmorphomania. In adolescence, sometimes a little earlier or later, girls (girls) become dissatisfied with their appearance - they are usually upset by the excessive roundness of the emerging body and the apparent overweight. According to these girls, it is easy to correct the situation by simply limiting food intake. It becomes an obsessive or overvalued idea, sometimes even delusional. However, at the initial stage, even relatives do not see anything alarming in this, because the standards of beauty recognized today do not allow overweight. Yes, and doctors always associate excess weight with the development of various diseases, including cardiovascular diseases. And the fact that a girl strives to be beautiful and healthy is normal. And everything would be fine if a fine line was observed and the facts were not distorted.

Where is this edge?

Become slim and healthy - good idea. But this can be achieved in several ways:

1. limiting the use of any food;

2. eating rationally;

It's great if points 2 and 3 are observed at the same time. This will really help to bring the weight back to normal and lay the foundations for health and longevity. Why do some girls choose the first item? The point that is the most destructive for a young, just emerging organism?

When is it time to sound the alarm?

As statistics show, such patients get to a psychiatrist only 3-4 years after the start of a strict diet, or rather, fasting. And it's already too late. By this time, the girls are in the stage of severe cachexia with pronounced somatic disorders:

• they do not have periods (even if they used to have them);
• the digestive tract is not able to digest ordinary food;
• in the blood - severe anemia, accompanied by tissue respiratory failure;
• the bone marrow reduces the production of all blood cells in proportion to the weight lost, which is expressed
• ancytopenia, which is almost impossible to treat at present;
• heart rhythm is disturbed - the heart beats less than 60 beats per minute;
• the level of estrogens and calcium decreases, which is expressed by osteoporosis and a tendency to fractures;
• nerve cells atrophy - convulsions, neuropathies, and sensitivity disorders appear.

Girls die from multiple organ failure, sudden ventricular fibrillation, respiratory failure. This death is not easy.

Why is anorexia dangerous?

If the patient's weight has decreased by more than a third of the age norm, then the return point has been passed. No efforts of doctors will help to return women's health and beauty. The disease will gradually progress. It flows in waves, aggravating in spring and autumn, and death occurs in one of the exacerbations - 5% of anorexia patients die per year.

If the weight has not reached a critical level, then the life and health of the girl must be fought for. Every third patient can be saved. They will be able to return to a normal life by organizing a balanced diet and starting to lead a healthy lifestyle.

30% of patients with anorexia will not be able to return to a normal life, even if they manage to return to their normal weight. Multiple organ failure and endocrine disorders will result in amenorrhea and complete infertility. And another third of patients will suffer several relapses of anorexia, which, most likely, will end in complete disability or death.

How to get rid of anorexia?

Unfortunately, a person suffering from anorexia does not consider himself ill. On the contrary, he thinks that he has superpowers and does what few people succeed in - controls his appetite. Therefore, he himself will never ask for help. Only close people can save him.

If you notice such a girl next to you - torturing herself with hunger in order to correct her figure, then pay attention to this to her relatives. The only thing that can quickly save a person is a consultation with a good psychoneurologist or, alternatively, a complete change of activity with the placement of a person in extreme conditions(a long hike, participation in an experiment, sports competitions). With an anorexic, there must be people nearby who you can rely on and who are not indifferent not only to life, but also to the fate of a person. The way out of anorexia is difficult and lengthy, but it is possible, and the sooner the operation to save a person is started, the better.

To date, more people die from anorexia than from all other mental illnesses. And this is a disaster.