Anorexia Nervosa is a psychiatric disorder included in eating disorders. It is an issue that we, as child psychiatrists, attach great importance to in terms of starting in adolescence or rapidly progressing and being diagnosed early.
Although the cause of Anorexia Nervosa cannot be clearly demonstrated, it is known that self-esteem, body image thoughts, environmental pressure and genetic factors each play a role in the development of this disease. .
This disease, which is seen in families with middle and high socioeconomic status, is important in that it is a psychiatric disorder that can result in death.
In anorectic patients, obsessive thoughts about food and compulsive eating behaviors are often persistent, needing to control their food and weight all day long.
Male anorectic patients have a higher incidence of other comorbid psychiatric disorders than females; female patients are also more perfectionist and dissatisfied with their bodies.
Anorectic children and adolescents are more likely to have growth retardation. Strict dieting and severe weight loss can lead to potentially fatal nutritional deficiencies. Other important complications of the disease; heart rhythm disorders, digestive system disorders, decrease in bone density, anemia, hormonal and electrolyte imbalances. Because anorectic patients deny their symptoms, the diagnosis is usually made with a family history, and the family also plays an important role in treatment.
In addition to administering drug therapy, in these patients, more than making the patient gain weight; Treatment is possible by carrying out individual, group and family psychotherapies together with a dietitian consultation.
Although the course of this disease is variable, some patients recover with early diagnosis. Most others show progressive trajectories, with a fluctuating life of weight gain or loss or progressive weight loss pursuits. Therefore, the treatment takes a long time, and long-term follow-up is required for immediate intervention and prevention of relapses.
HOW IS ANOREXIA NERVOSA DIAGNOSED?
Diagnosis of this disease can be difficult and late because these patients use mechanisms of hiding and denying their disease too often. It is not unusual for anorectic patients to seek professional help, therefore, these patients develop medical complications due to chronic malnutrition, and the patient’s visit to a psychiatrist is delayed as the treatment of medical conditions is emphasized by other doctors and the family.
At first diagnosis, patients have signs of severe weight loss. The individual is 85% below the normal weight for age and height, or BMI (body mass index = weight/height2) is 17.5 or less. When these losses occur in childhood and early adolescence, there is a delay in height growth. Second, these individuals are extremely afraid of gaining weight or being fat. Although they continue to lose weight, this fear and the ambition to lose weight continue. Third, the assessment and importance of body weight and shape in these patients has been distorted. They feel very fat in all or parts of their body, no matter how much they lose weight or are told they are thin. They constantly inspect their body or parts in front of a mirror, measure or weigh themselves constantly. Weight loss is seen as an impressive achievement and self-discipline, while weight gain is perceived as an unacceptable failure in self-control. Another important finding in the diagnosis of these patients is the absence of menstruation for at least three months. This is a result of weight loss and is in the form of amenorrhoea as a result of decreased production of sex hormones or delayed menstruation in girls who have not had their menstruation yet.
According to the psychiatric disorder classification DSM-4, there are two subtypes of Anorexia Nervosa. In the restricted type, patients primarily exhibit behaviors such as dieting, fasting, and excessive exercise. In the binge eating/purging type, the patient regularly engages in binge eating or purging. They try to get rid of what they eat in different ways, such as self-induced vomiting, use of laxatives, diuretics, and excessive use of enemas.
SYMPTOMS AND SYMPTOMS OF ANOREXIA NERVOSA
Anorexia Nervosa causes serious behavioral and psychological effects that affect a person’s whole life. This disease also affects other members of the family.
Weight loss in patients leads to social withdrawal and depression. These individuals become restless, easily angry, and unable to get along with others.
Serious sleep problems, fatigue and weakness during the day.
There is a decrease in their attention and a decrease in their concentration. These patients, who are very successful and have a perfectionist personality, have a significant decrease in their academic success at school due to their other preoccupations with food.
Obsessive thoughts about food and eating lead them to behave compulsively about food choice and eating rituals. While collecting new recipes, they can always deal with cooking for others, they can cook without diet oil, they divide the bites or eat for a long time while eating the amount of food they gradually reduce. All they do is lose weight.
Hair loss, flaking on the skin, constipation, abdominal pain, inability to tolerate cold; Physical symptoms and laboratory findings such as anemia, hypotension, edema in the whole body, decrease in bone density, heart rhythm disorders, deterioration in kidney functions can be detected in blood tests.
THERAPY OF ANOREXIA NERVOSA
Although treatment can be continued on an outpatient basis, inpatient treatment is often required. In patients with weight loss, organ deficiencies, malnutrition, nasogastric nutrition or intravenous nutrition is initiated. It is necessary to reach the desired target weight in a week by limiting the eating patterns and times, physical activities, discontinuing the laxatives and diuretics used externally by the patient. The treatment goal is arranged in the form of individualized treatment with psychiatric therapies. Individual therapy, family therapy, cognitive behavioral therapy, group therapies, analytical psychotherapies may work. These patients require a multidisciplinary approach. The medical doctor, dietitian, clinical nurse, and psychiatrist work together in coordination. Various psychotropic drugs can be used in drug treatment according to coexisting psychiatric disorders.
It is a disease with a high mortality rate among psychiatric disorders. Serious nutritional disorders, suicide, heart problems, electrolyte imbalances are the main causes of death. Early diagnosis and initiation of treatment significantly affect the course. The longer the symptoms and the obsessive thoughts and behaviors continue, the more difficult the treatment becomes.
PREVENTION OF DISEASE
Information programs about nutrition and obesity prevention addressed to the public should be treated with care, body image and food advertisements and words used in the media should be carefully chosen, and even expert opinion and control should be provided. Information about eating disorders can be given in schools, fashion schools where body image is more important. Supportive advertising and information should be made to provide people’s own appearance and image, that being too thin is not a good thing. These briefings should be made especially to adolescents so that they can create their own body images and identities.
Selcen ESENYEL
Child Psychiatry Specialist
