Anorexia nervosa

| From a nutritional point of view, anorexia nervosa is an eating behavior that deviates from the normal way of eating and from the guidelines of a healthy diet. From a psychological point of view, it is a serious distortion that the person has of their body image.

Anorexia nervosa from a medical point of view, is a disease that causes serious alterations in all tissues and systems of the body, including alterations in growth and endocrinological systems (or hormones), and so severe that they can lead to death.

Anorexia nervosa preferentially affects female adolescents.

What is anorexia nervosa

The anorexia nervosa It is considered to be a disorder that has a psychological predisposition, characterized by an alteration in the perception of body image together with affective deficiencies and a low level of self-esteem. On this altered base, sociocultural factors are added, such as the cult of the body that our society has and that punishes obesity and equates thinness with harmony, beauty, prestige and success. In any case, there would be biological factors such as the low activity of the brain noradrenergic and serotonergic systems that could explain why these people have an altered self-perception of their body and adopt an altered eating behavior that leads to serious complications and death.

Genetic factors also contribute to the development of anorexia nervosa, as there are more cases of anorexia nervosa in families with an already affected member.

To adapt the real body image to the ideal body image, the individual is subjected to very strict dietary guidelines that, in many cases, are accompanied by intense physical exercise and taking drugs (laxatives, diuretics, amphetamines). In addition, they tend to avoid eating with their families or with other people. They also progressively reduce their social life, isolate themselves and stop having friends, while losing interest in everything around them except for work or studies. In some cases there may be bulimia behaviors in a patient with anorexia.

Food restriction leads to great weight loss, malnutrition, osteoporosis, growth arrest, and endocrine disorders such as amenorrhea, among others. On the other hand, self-induced vomiting and taking drugs to force weight loss lead to fluid and electrolyte alterations, impaired kidney function, and cardiac arrhythmias.

There is no test that diagnoses a person as anorexic. The diagnosis of anorexia nervosa is made based on criteria of medical consensus, such as the criteria established by the American Psychiatric Association or the criteria of the World Health Organization. The key to the diagnosis of anorexia nervosa according to these criteria is the serious disorder in the perception of body image, the great refusal to maintain a normal weight and the behaviors to achieve it such as voluntary food restriction, self-induction of vomiting and intake of drugs to lose weight. weight loss becomes really very important, with a body mass index of less than 17.5 kg / m2.

Treatment

The treatment of anorexia nervosa must be multifactorial and shared by several specialists, including specialists in mental health (psychologists and psychiatrists) and specialists in the area of ​​nutrition (doctors and nutritionists). Before indicating any type of psychiatric treatment or change of diet, a blood test will be performed to detect metabolic or endocrinological alterations that require specific treatment, such as low levels of potassium or protein in the blood, or hormone disorders. The electrocardiogram can reveal heart rhythm disturbances.

We must bear in mind that anorexia nervosa is a slow-onset disorder, therefore the clinical and analytical findings are usually related to the intensity of weight loss and the time of evolution of the disease, to which the consequences are associated derived from purgative behaviors (self-induced vomiting, use of diuretics or laxatives). Clinical and analytical alterations usually revert when regaining an adequate weight and can be treated and controlled on an outpatient basis. However, in severe cases, with significant alterations in potassium or calcium, compromised cardiac or renal function, the concomitant presence of some type of infection, etc. they can force the hospitalization of the patient.

Treatment of anorexia nervosa will include pharmacological, psychological and nutritional measures. Regarding pharmacological treatment, there is no curative psychotropic drug for anorexia nervosa, and some of them may even be contraindicated (this is the case with antidepressants in case of heart rhythm disturbances). Therefore, psychological treatment is very useful, which should seek the following objectives:

• Correct distortions in the perception of one's own body and normalize body image.
• Treat any possible anxiety that may exist.
• Eliminate avoidance behaviors at mealtime.
• Solve possible family conflicts.
• Improve self-esteem.

The psychological intervention can be carried out individually or in a group; and a therapeutic intervention with the family is also recommended.

The most important objectives in the diet to be followed in these patients are, firstly, the correction of malnutrition and its consequences, and then restructuring eating habits. The psychological and psychiatric treatment must complement the nutritional treatment since in the first moments the person, although he will accept intellectually that he needs to gain weight, will resist at all costs to increase the caloric intake and will be able to continue to secretly discard the food that is supplied to him. This is going to be the most important point to get your weight back to normal.

To plan nutritional treatment, first a food survey should be carried out in order to detect the lack of some food. Through the food survey we can also have an idea of ​​the intake of calories and nutrients, know the frequency and type of meals that the patient eats, what foods he rejects, what foods are his favorites; All of this will facilitate the elaboration of the most appropriate feeding pattern for that individual.

Secondly, we must act by giving the patient maximum information about the seriousness of their clinical situation, about the consequences that malnutrition and excessive weight loss have on health, about what a balanced diet is, or what it means to have a healthy diet. ideal weight.

Third, with the information obtained from the food survey, we will prepare the food plan. We will start the new dietary pattern with foods that are not excessively caloric and that are not "rejected" or "feared" by the patient, to later gradually introduce the rest of the foods. However, we should not want a significant weight gain in a short space of time. Medical complications have been described as a consequence of a rapid replacement of the state of malnutrition in the first moments of treatment. Thus, the first measures are aimed at stopping weight loss, subsequently establishing gains of between half and a kilo of weight per week, and leaving for later phases to set the final weight that must be achieved. Oral supplements (iron, potassium, calcium, etc.) will only be used if they are lacking. Regarding the contribution of vitamins, their use would be limited to specific deficiencies, on the other hand infrequent.

Meals must be supervised at all times and supported by the psychologist and psychiatrist. Precisely, one of the greatest difficulties is when one tries to increase the consumption of calories, so at that moment the support of the psychiatrist or psychologist is usually necessary.

The nutritional recommendations will be the following:

• Establish a regular meal schedule.
• Establish a fractional distribution throughout the day, for example, 5 or 6 small-volume intakes per day.
• Always sit at the table to eat.
• Eating in company: friends or family.
• Avoid monotony in the presentation of food. Make the presentation of food as attractive as possible.
• Favor a relaxed and comfortable environment during meals.

Throughout this process, constant psychological support is required, as well as taking extreme care of the individual's state of mind. The collaboration of the other members of the family will also be very important throughout the process.

Regular physical activity of moderate intensity is not contraindicated.

Finally, once we achieve a change in the eating pattern, the fourth step will be to monitor the individual in the long term to assess how their body weight is evolving, if they have understood how they should eat, and to check that they no longer have food to eat. those to "fear." Recurrences in an individual with recovered anorexia nervosa are common. About 20-50% of patients recover completely, 25% partially improve and the other 25% develop forms resistant to treatment.

This disease should not be neglected since the mortality rate ranges between 5-20%, with death generally being secondary to a suicide attempt or as a consequence of extreme malnutrition.

There is no measure to prevent the appearance of anorexic behavior. But yes in the early detection of it. Signs of alarm and suspicion are the young woman with some of the following circumstances: practice of restrictive diets with any excuse, amenorrhea, progressive weight loss despite an apparent "normal" intake, unexplained changes in mood, irritability, tendency to isolation social behavior, perfectionist behavior, excessive responsibility for their age, insecurity, shyness, low self-esteem, doing excessive physical exercise, or having a family history of eating disorders.