anorexia

Anorexia: description

Patients with anorexia (anorexia or anorexia nervosa) have the morbid desire to continue to reduce their body weight. Getting into the disease is often a diet. Over time, however, thoughts about one’s own body weight increasingly determine the entire everyday life of those affected. Although they are only skin and bones, they feel too thick and they continue to lose weight.

Anorexia is one of the eating disorders associated with bulimia and binge eating disorder. The heavy weight loss is the most obvious symptom of anorexia. Ultimately, however, it is only the externally visible sign of a profound mental disorder. To cure the disease, it is not enough just to eat again.

Addictive urge

The disease has an addictive character: the urge to go hungry is almost irresistible to the patients. The special kick is to have the greatest possible control over their needs and their body. For outsiders, this is hardly comprehensible.

Anorexics also have long no disease insight. It is difficult for them to admit that they have problematic eating habits. They therefore often resist therapy.

Anorexia nervosa is a serious mental illness. Some sufferers die as a result of malnutrition or suicide.

Who is affected by anorexia?

Anorexia usually occurs for the first time in early youth. However, the age limit is shifting further and further down. By now, children are already getting sick. Most anorexics are female and between 15 and 25 years old. But boys and men are also developing anorexia.

Anorexia: symptoms

Main symptoms of anorexia are the significant, self-induced weight loss, a pronounced fear of weight gain despite underweight and a distorted perception of the own body.

Since malnutrition affects many important bodily functions, numerous physical complaints also occur.

weight loss

The heavy weight loss is the most noticeable anorexia indication. Those affected avoid calorie-rich foods and deal extensively with the content of food. In some cases, anorexic people reduce their meals so much that at times they only consume water.

Some sufferers also try to reduce their weight through excessive exercise. Some also use laxatives or dehydrators to lose weight.

The desire for more and more weight loss and the constant weight control eventually determine the entire thinking and the complete everyday life of those affected. A stagnation of the weight or even a weight gain they evaluate as heavy setbacks, whereupon they intensify their efforts.

underweight

Anorexics lose on average 40 to 50 percent of their original weight. According to the clinical diagnostic guidelines, a body mass index (BMI) of 17.5 and above is an anorexia indication in adults. That’s 15 percent less than the normal weight. For children and adolescents other limits apply, as the body mass index can not be calculated with the usual formula.

Cachexia: Life-threatening underweight

If the emaciation is massive, it is also called a cachexia. In such an underweight underweight the fat reserves of the body are largely used up and it was already degraded larger amounts of muscle mass. The body is then extremely weakened – a life-threatening condition.

A cachexia is visible from the outside at this stage. The contours of the bones are prominent, the eyes are deep, the cheeks are hollow. Most patients try to hide these typical anorexia signs. They wear garments in several layers that cover the body as much as possible.

Distorted body image

Anorexics make their own body distorted. Despite their underweight, many consider themselves fat. This phenomenon is referred to by physicians as body schema disorder. Outsiders may find it hard to understand that those affected are actually overweight when looking in the mirror.

Neither assurances from others, nor objective weight measurements like the BMI can convince them of their factual underweight. The body disorder is a serious problem that can only be overcome by professional help over a longer period of time.

If one speaks openly about their thinness, they often react irritably.

Constant occupation with your own weight

A very characteristic sign of anorexia is the constant study of one’s own weight and nutrition. Anorexic people are in a panic anxiety and too fat to be. This does not necessarily mean they lose their appetite. Rather, their whole thinking revolves around the topics of food and diets. They are busy with recipes and like to cook for others.

Constant control

Affected people know the calorie content of most foods and pay close attention to how many calories they absorb daily from the diet. Anorexia is ultimately an attempt to maintain control of yourself and your body.

Enduring and overcoming the feeling of hunger is an anorexia success. To consume food will eventually be torture, because food means loss of control and a guilty conscience.

Starving as normal

Anorexics feel no weight as too low. Starvation becomes an addiction and the reduction of food becomes a kind of race with oneself. The feeling of hunger becomes normal, the feeling of satiety is unpleasant. At some point, weight loss is so threatening that patients have to be hospitalized.

Physical (somatic) anorexia symptoms

Anorexia damages the entire body. Due to malnutrition, it reduces its energy consumption to the essentials of life. This affects all organ systems. The following list shows the variety of physical consequences of anorexia:

• slowed heartbeat (bradycardia), as well as cardiac arrhythmia
• low blood pressure (hypotension)
• Constipation (constipation)
• Freezing and hypothermia (hypothermia)
• Lack of red and white blood cells and platelets (pancytopenia)
• dry skin
• hair loss
• fluffy hair (Lanugo hair) instead of normal body hair
• in women: suspension of menstruation (amenorrhea), infertility
• sexual listlessness (loss of libido)
• Disruption of the electrolyte and vitamin balance
• Decrease in bone mass (osteoporosis)
• Renal dysfunction
• Liver dysfunction
• difficulty concentrating
• Developmental delay in children and adolescents
• Brain wasting (brain atrophy)

Hormonal disorders

One result of anorexia is hormonal imbalance. Due to malnutrition, the body can not produce enough hormones. In girls and women, the heavy underweight leads to the suspension of menstruation (amenorrhea) and the loss of sexual desire (loss of libido).

Evolutionary biology can make sense: A woman with anorexia would not be able to deliver a child, which is why the body prevents pregnancy by the lack of sex hormones. Boys and men also suffer from loss of libido and often potency due to anorexia.

Excessive performance orientation

Anorexics are often intelligent and very performance-oriented people who try to do as perfect as possible tasks. They are particularly ambitious in sports or at school. However, they increasingly withdraw from social life. This self-desired social isolation is a serious warning sign.

Mood swings and depression

Very often anorexics also suffer from strong mood swings and depressive moodiness. These anorexia symptoms can be the result of malnutrition and constant internal pressure for weight loss. Mental disorders that often occur simultaneously with anorexia are depression, anxiety disorders, obsessive-compulsive disorder, and addictions and personality disorders.

Anorexia: causes and risk factors

To the exact causes of anorexia there are so far only assumptions. However, it is clear that the disease Anorexia nervosa is not due to a single trigger, but the reasons for anorexia are diverse.

Biochemical, psychological and socio-cultural factors that mutually reinforce one another contribute to the development of anorexia.

Biological factors

Disturbed stress processing

Newer scientific hypotheses assume that malfunctioning stress is the main cause of anorexia. Such disorders may have genetic causes, be already created by influences in the womb, or be influenced or reinforced by early experiences. Anorexia does not start when the first symptoms appear, but much earlier.

Genetic factors

The genes seem to play a crucial role in anorexia. So the disease occurs frequently in some families. Twin studies also show a clear correlation between the genetic makeup of a person and the occurrence of anorexia.

In dizygotic twins, every tenth anorexia develops when the other becomes ill. With identical twins it is even every second. How exactly the genes affect the risk of disease, however, is unclear.

Disturbed messenger metabolism

As with many mental illnesses, the messenger metabolism in the brain is disturbed even in anorexic patients. Among them, the level of the neurotransmitter serotonin is increased. The messenger affects eating behavior and satiety.

In animal experiments it could be shown that serotonin increases satiety and thus appetite suppressing effect. An elevated level could make it easier for anorexic people to abstain from eating.

Serotonin has even more effects: it lifts the mood and triggers happiness. This could also make it easier for people with anorexia – or even spur it on. Both effects also confirm people who fast over a longer period, for example, religious reasons.

Serotonin might help maintain the anorexic behavior. The typical symptoms of eating disorder such as fear of weight gain and body disorder can not be explained.

Mental causes

Desire for control

Anorexics often say in conversations with therapists that the desire to control their own body is one of the biggest motivations for starvation. This need for control is lived out through the strict diet.

Psychologists interpret anorexia as the expression of an internal conflict that can not otherwise be overcome. In science, there are several theories that describe possible anorexia causes in early childhood. Traumatic experiences – for example, the divorce of the parents or the death of a family member – are often mentioned mental causes.

puberty

At the beginning of puberty girls have the highest risk of developing anorexia. Some experts suspect that a general overstrain in this phase of life full of upheavals can trigger anorexia.

Growing up, becoming a woman seems threatening to some girls. Therefore, they also reject the change of their child’s body to that of an adult woman. The heavy weight loss here often has the desired effect: Due to the extreme starvation is often the rule and the narrow figure is more like a child rather than a woman.

High entitlement to benefits

Anorexia is more common in middle and upper class families. Those affected are usually remarkably intelligent, ambitious and perfectionist people. Typical are extreme discipline and a high demand on one’s own body.

Both also correspond to the prevailing values. In anorexic patients, these ideals, which are already taught from kindergarten age, can fuel the disease.

Weak self-esteem

Anorexics are often not very self-confident. The apparent control over your own body strengthens the self-confidence initially – the patients feel more confident and stronger.

Starvation is rewarded in this way, which in turn strengthens the eating disordered behavior. If stressful factors such as a problematic relationship with the parents or tension in the circle of friends, a move or the divorce of the parents, can trigger anorexia in this difficult life situation.

Sociological causes

Anorexia as a means of pressure

The refusal to eat can also be used in conflict situations as an instrument of power over the parents. The child quickly realizes that parents worry about their starving child. At the same time, the food intake of the parents can hardly be enforced.

The child thus achieves a position of power from which it can put the parents under pressure. Refusing to eat as a means of pressure is particularly noticeable when there are many unresolved conflicts in the family. But it is only one of many possible anorexia causes.

Western beauty ideal

The Western ideal of beauty is currently propagating unnaturally slender bodies. The pressure to be lean is reinforced by very thin role models from the media. The weight of models is below normal weight. Through this distorted body ideal, children and adolescents gain an unrealistic picture of how thin or fat a human normally is.

Ongoing teasing and negative comments about the character can trigger anorexia in the context of this general “slimming delusion”. Conversely, everyone today receives praise and admiration when he has lost weight. A diet is then often the “entry-level drug” in anorexia.

Since women are judged more by their appearance than men, they are even more exposed to the ideal of beauty. This may explain why women are so much more likely to suffer from anorexia than men. But even in men, the external appearance is increasingly in the foreground. They too are now increasingly affected by anorexia.

Anorexia: examinations and diagnosis

If an anorexia is suspected, the pediatrician or family doctor is a good first point of contact. He can first assess the extent of the threat by examining the patient and determining blood levels.

A typical feature of anorexia is the lack of disease insight. In many cases it is not the person concerned who seeks medical or psychological help, but the relatives who are worried.

anamnesis

At the beginning of every medical or psychological consultation is an anamnesis interview. In this interview, the patient reports on his personal history of anorexia, possible physical complaints and previous illnesses. For example, if anorexia is suspected, the doctor might ask the following questions:

• Do you feel too fat?
• What’s your weight?
• How much weight did you lose in the last four weeks?
• Are you intentionally trying to lower your weight, for example, through excessive exercise or inadequate nutrition?
• What is your desired weight?
• Has the menstrual period failed?
• Do you have other physical complaints such as weakness, dizziness or heart stumbling?

Physical examination

Following the conversation, the physical examination follows. The doctor gets a general overview of the general physical condition. In particular, he will listen to the heart and stomach with the stethoscope.

Body mass index

As an objective measure of the underweight, the physician determines the body mass index or BMI. Underweight starts at a BMI of less than 17.5. The BMI of anorexic people is often far below.

blood tests

The physician also receives important information about the general physical condition by determining various blood values. With the blood test, for example, the function of the liver, kidneys and blood formation can be checked and dangerous disturbances in the salt balance (electrolyte balance) can be detected.

Malnutrition can damage any organ system in the body. Therefore, it depends on the specific complaints, which further investigations the doctor still performs.

Psychological investigations

Anorexia is a mental illness. Therefore the mental symptoms are decisive for the diagnosis. They are recorded in the form of various questionnaires and clinical interviews.

Eating Disorder Inventory (EDI)

A professional questionnaire on eating disorders such as anorexia and bulimia is Garner’s Eating Disorder Inventory (EDI). The current EDI covers 91 questions that capture typical psychological characteristics of anorexia and bulimia patients. They can be divided into the eleven following categories:

• Slimming strivings – z. B .: “I am terribly afraid to increase.”
• Bulimia – z. B .: “I stuff myself with food.”
• Dissatisfaction with the body – z. B .: “I think my hips are too wide.”
• Self-doubt: “I do not think much of myself.”
• Perfectionism – z. B .: “Only best performances are good enough in my family.”
• Distrust – eg. B: “I find it difficult to express my feelings to others.”
• Interoceptive perception – eg. B .: “I have feelings that I can hardly name.”
• Fear of growing up – eg. B .: “I wish I could return to the security of childhood.”
• Asceticism – eg. B .: “My physical needs are embarrassing for me.”
• Impulse regulation and social insecurity – eg: “I experience considerable mood swings”

Diagnostic interviews

Psychotherapists often use the Diagnostic Interview for Mental Disorders (DIPS) or the Structured Clinical Interview for DSM-IV (SKID) for diagnosis. They can be used to detect eating disorders as well as other psychiatric illnesses.

He asks questions that the patient freely answers. The therapist classifies the answers with a points system.

Diagnostic criteria of anorexia

Anorexia is diagnosed if the following four symptoms are present:

• Underweight (at least 15 percent below normal weight)
• self-induced weight loss
• Body image disorder
• Disturbances in the hormone balance (endocrine disorders)

Anorexia test for self-assessment

The most well-known anorexia self-assessment test is the Eating Attitude Test (EAT) by Garner and Garfinkel. The EAT includes 26 questions about eating habits as well as attitude regarding figure and weight. They are answered on a scale starting from “always” and grading to “never”.

Examples of questions are:

• “I avoid eating, even when I’m hungry.”
• “I especially avoid food with many carbohydrates.”
• “Other people find me too thin.”
• “I feel the need to vomit when I have eaten.”
• “I’m obsessed with getting thinner.”

Anorexia tests on the Internet

Self-tests on the internet also ask about typical patterns of thinking and eating disorder behavior. Such online tests for anorexia can not replace a medical or psychological examination. But you can provide a first orientation, if the eating behavior is disturbed.

Anorexia: treatment

Anorexia is more than an out-of-control ideal of beauty. It is a very serious and life-threatening disease that almost always requires professional treatment.

The main goals of anorexia treatment are

• Normalization of weight,
• Change in eating behavior,
• Restore a normal perception of the body as well
• Therapy of individual and familial problems

Anorexia is associated with both physical and emotional symptoms. For this reason, the treatment is usually done in collaboration of a multi-professional team. Such a team includes physicians, psychologists, dieticians, and possibly other specialists.

Inpatient treatment

Anorexic people can be cared for on an outpatient, inpatient or semi-stationary basis. However, in most cases inpatient treatment is required in an anorexia-specific clinic.

This is especially true for patients with a body weight of less than 75 percent of normal weight, a life-threatening physical condition or suicidal ideation due to depression. The goal is a long-term change in behavior and not just a short-term increase in weight.

Normalization of weight

At the beginning of treatment, the individual target weight is usually set. For a successful course of therapy, patients should increase between 500 and 1000 grams per week.

In addition, a treatment plan is created that is tailored to individual needs. Patients who leave the clinic before reaching normal weight are more at risk of relapsing, according to studies. Control of weight is therefore an important part of the therapy.

Learning to eat normally

Anorexics need to learn a normal way of dealing with food again. Therefore, dietary advice, cooking classes, grocery shopping and an individual meal plan are part of the program in many clinics.

In order to motivate patients to eat, they also work with operant conditioning. This means that desired behavior – in this case food – is rewarded or non-compliance is punished. A reward or punishment can be for example the permission or the prohibition of visit.

psychotherapy

Especially successful for the treatment of anorexia seems the “focal psychodynamic therapy”. This evolution of psychoanalysis has been tailored specifically to people with anorexia. It treats the causes of anorexia and helps patients cope with everyday life. The focus here is the handling of emotions.

Above all, the individual triggers for this disease are explored. Without the mental roots of the disease to treat, the risk of relapse is very high.

Therefore, treatment for anorexia includes regular psychotherapeutic hours in individual and / or group sessions. The psychotherapeutic sessions also work to consolidate a realistic body image.

group therapy

Group therapy is a useful aid in anorexia. Patients can share their experiences with other sufferers and see that they are not alone with the problem.

family therapy

In particular, in young patients, family therapy can again be very effective, because the anorexics for healing need the support of the family.

The family members are often overwhelmed with the disease. Good guidance and a family contact help both the patient to find their way home and the family members to deal with the situation.

drugs

So far, there is no drug that successfully supports weight gain. In many cases, in addition to anorexia, there are other psychological disorders, such as depression or obsessive-compulsive disorder. These disorders can be treated with medication.

Lack of disease insight

Since people with anorexia often have no disease insight, many sufferers are not in treatment.

In acute danger to life and lack of treatment preparedness of the patient, patients can be sent to a court order against their will in a hospital.

A strong underweight and the associated lack of electrolyte (for example, potassium or sodium) require an emergency force-feeding in an emergency to keep patients alive.

Anorexia: course and prognosis

Anorexia nervosa can vary very individually. The sooner the disease is treated and the younger the patients, the better the chances of recovery.

The prognosis also depends largely on how low the weight is, how long the patient is anorexic and what physical and mental resources he has. The support of the social environment and especially the family is extremely important for the recovery of the anorexic.

Not everyone is healed

However, some of the anorexics are not completely cured. It is estimated that half of the anorexics have life-long struggles with the disease. Even after weight normalization, many sufferers continue to be skeptical about weight and shape.

Change to bulimia

About 20 percent of those affected develop anorexia nervosa, based on anorexia nervosa: bulimia (eating-crushing addiction). This is an eating disorder in which food cravings are taken in food cravings and then vomited again.

Physical and emotional long-term consequences

It is not surprising that anorexia, which begins as early as infancy or early adolescence, has particularly serious consequences: Significant developmental delays, both physical and mental, are a typical consequence of malnutrition. The onset of puberty is delayed and growth is disrupted.

The physical effects of anorexia are often serious because malnutrition damages all organs. The body does not always recover completely.

risk of death

Anorexia is a very dangerous mental illness. In some patients, the disease is fatal – either because of massive deficiency symptoms or because of suicide as a result of concomitant depression.

Recovery is a lengthy process with progress, but often with regression. Even after a hospital stay, a longer therapeutic care is necessary. But the good news is: the effort is worth it.

Anorexia: What is “Pro Ana”?

“Pro Ana” is an Internet movement that does not consider anorexia nervosa (Anorexia nervosa) to be an illness, but glorifies it as a lifestyle of its own choosing. Especially on the internet, girls talk about how they can lose even more weight in order to live up to their “ideal body image.” Despite the danger of their lives, young people encourage each other to eat as little as possible.

The movement “Pro Ana” was created in the USA and can be found in German forums since around 2001. “Ana” stands for anorexia (anorexia), “pro” clarifies the commitment to anorexia. Anorexics who visit Pro Ana sites are aware that they are under the anorexia diagnosis.

But they do not want to be healed of their anorexia, but they want to get even thinner. The anorexic body they understand as a desirable beauty ideal – a life-threatening attitude.

Access to these websites is often only possible with a password. Particularly tough “Pro Ana” forums allow individuals to go through a kind of application process before entering the online community to avoid unwanted guests.

Religious style

Anorexia is practiced on “Pro Ana” sites similar to a religion. For example, on “Pro Ana” pages, there are ten commandments of anorexia: “1. If I’m not skinny, I’m not attractive. 2. Being thin is more important than being healthy. 3. I have to do everything to look thinner, etc. “

In addition, there is a creed, which illustrates the morbid world view of anorexics (“I believe in a world that consists only of black and white, the loss of weight, the forgiveness of sins, the rejection of the flesh and a life full of hunger “).

Photos of Magervorbildern

The “Pro Ana” pages are also used to show photos of heavily emaciated actors and other celebrities. Partially the anorexics also upload photos of their own body. Anorexia sufferers share their daily “successes” and report how much they have lost weight and how little food they have eaten. The increase in weight is considered failure.

Corresponding websites are also available for bulimia. These are called “Pro-Mia”. Bulimia, like anorexia, is an eating disorder. In contrast to anorexia, people suffering from bulimia suffer from eating and vomiting attacks.

Anonymous exchange

Anonymous contact on the Internet allows anorexics to interact freely. The problem is that the anorectics feel confirmed by other anorexics in their behavior. The “Pro Ana” internet sites are visited and used by many. Estimates suggest that 40 percent of adolescents with anorexia visit Pro Ana sites.

We feel

The exchange among like-minded people creates a we-feeling. Die Anhänger der Bewegung fühlen sich als außergewöhnliche Menschen, die stark genug sind, dem Hungergefühl zu widerstehen und ihren Körper zu kontrollieren.

Es entsteht zudem ein starker Konkurrenzdruck unter den Anhängern. Jeder möchte noch dünner sein als die anderen und beweisen, wie willensstark er ist.

Zudem erhalten Magersüchtige Informationen, wie sie die Krankheit vor ihren Eltern verheimlichen und noch schneller abnehmen können. Es werden auch Tipps gegeben, wie man Gewichtsmessungen beim Arzt verfälschen kann.

Schutzmaßnahmen

Diese Aufrechterhaltung der Erkrankung hat schwere gesundheitliche Auswirkungen und kann tödlich enden. Seit 2006 prüft das von den Ländern 1997 gegründete jugendschutz.net „Pro Ana“-Seiten und ließ einige davon sperren. Es ist jedoch schwierig, das Angebot im Internet zu kontrollieren, auch, weil immer wieder neue Seiten entstehen.

Inzwischen gibt es auch App-Versionen von „Pro Ana“ für das Handy. Der Austausch per Handy kann nicht kontrolliert werden. Magersüchtige können damit rund um die Uhr Kontakt halten. Der Druck, nicht zu essen, besteht somit Tag und Nacht.

Pro Ana verbieten?

Es gab ausführliche Debatten darüber, ob „Pro Ana“-Internetseiten verboten werden sollten. Für das Verbot der „Pro Ana“-Seiten spricht die Gefahr, dass

• an Magersucht erkrankte Menschen durch die Inhalte dazu motiviert werden, die Essstörung aufrechtzuerhalten bzw. zu verschlimmern
• die Seiten einen Schlankheitswettbewerb schaffen und ungesunde Methoden fördern, um Gewicht zu reduzieren
• die Magersucht als ein positiver Lebensstil dargestellt und die Disziplin zu Hungern wie eine Religion verherrlicht wird

Recht auf Meinungsaustausch?

Besucher der „Pro Ana“-Seiten haben dagegen argumentiert, dass sie das Recht haben, sich mit anderen auszutauschen, denen es ebenso ergeht, wie ihnen selbst.

Zweifellos benötigen Menschen, die der „Pro Ana“-Bewegung folgen, dringend psychologische und ärztliche Hilfe. Es ist jedoch nicht möglich, den Austausch der Mitglieder zu unterbinden. Es ist auch fraglich, ob ein Verbot den erwünschten Effekt bringen oder vielmehr der Magersucht-Bewegung noch einen stärkeren Reiz geben würde.

Additional information:

Books:

• Gemeinsam die Magersucht besiegen: Ein Leitfaden für Betroffene, Freunde und Angehörige (Janet Treasure und June Alexander, 2014, Beltz)
• Essstörungen. Hilfe bei Anorexie, Bulimie und Binge-Eating (Anke Nolte, 2013, Stiftung Warentest)

guidelines:

• S3-Leitlinie “Essstörungen, Diagnostik und Therapie” der Deutschen Gesellschaft für Psychosomatische Medizin und Psychotherapie und das Deutsche Kollegium für Psychosomatische Medizin (Stand: 2010)

Support Groups:

Beratungsstelle für Essstörungen Cinderella e.V.: https://www.cinderella-beratung.de/