Eating disorders: what they are, symptoms, treatment

What are Eating Disorders?

Eating disorders (also called eating disorders or eating disorders) are a group of complex psychogenically mediated pathologies (anorexia, bulimia, orthorexia, binge eating disorder, compulsive urge to exercise etc.), which manifests itself in a person with problems with nutrition, weight and appearance.

Weight, however, is not a significant clinical marker. eating disordersbecause the disease can even affect people with normal body weight.

Eating disorders, if not treated promptly and with adequate methods, can become a permanent disease and seriously jeopardize the health of all organs and systems. organism (cardiovascular, gastrointestinal, endocrine, hematological, skeletal, central nervous system, dermatology, etc.) and, in severe cases, lead to of death. Mortality among people with anorexia nervosa

5-10 times higherthan in healthy people of the same age and sex.

These disorders are currently an important public health problem, as the age of onset has been gradually decreasing in recent decades. anorexia and bulimia, as a result of which diseases are increasingly diagnosed before the onset of menstruation, up to 8-9 years in girls.

The disease more affects not only adolescents, but also children before they reach puberty, which has much more serious consequences for their body and psyche. Early onset of the disease can lead to a higher risk of irreversible damage due to malnutrition, especially in tissues that have not yet reached full maturity, such as bones and central nervous system.

Given the complexity of the problem, early intervention is of particular importance; it is extremely important that specialists with different specializations (psychiatrists, pediatricians, psychologists, nutritionists, specialists in internal medicine) actively cooperated with each other for the purposes of early diagnosis and adoption operational measures.

According to official estimates, 95,9% people with eating disorders account for women. The incidence of anorexia nervosa is at least 8 new cases per 100,000 people per year among women, while in men it ranges from 0.02 to 1.4 new cases. Concerning bulimia, Every year per 100 thousand people has to 12 new cases among women and about 0.8 new cases among men.

Causes and risk factors

We're talking about risk factors, not causes.

In fact, these are disorders of complex etiology, in which genetic, biological and psychosocial factors interact with each other in pathogenesis.

In the consensus document on eating disorders prepared by the Higher Sanitary Institute in cooperation with the association “USL Umbria 2”, the following were noted as predisposing factors disorders:

• genetic predisposition;
• depression, drug addiction, alcoholism;
• possible adverse / traumatic events, chronic childhood illnesses and early feeding difficulties;
• increased socio-cultural pressure in relation to thinness (models, gymnasts, dancers, etc.);
• idealization of thinness;
• dissatisfaction with the appearance;
• low self-esteem and perfectionism;
• negative emotional states.

Signs and symptoms

Common signs of eating disorders include problems with food intake, weight and appearance. However, each option manifests itself in a specific way.

Anorexia nervosa

This is a psychiatric pathology with the highest mortality (the risk of death in these patients during the first 10 years from the onset of the disease is 10 times higher than in the general population of the same age).

People who suffer from anorexia nervosa are afraid of gaining weight and have consistent behaviors that interferes with weight gain, through extreme dieting, vomiting, or very intense physical loads.

The onset is gradual and insidious, with a gradual reduction in food intake. Reducing calorie intake consists of reducing portions and / or eliminating certain foods.

In the first period, we observe a phase of subjective well-being associated with weight loss, improved image, a sense of omnipotence, which gives the ability to control hunger; later, fears about the lines and shapes of the body become obsessive.

The fear of losing weight does not decrease with weight loss, it usually increases in parallel with weight loss.

Usually resort to excessive physical exertion (compulsive / obsessive), constant monitoring with a mirror, clothing size and weights, counting calories, eating for several hours, and / or chopping food into small pieces.

Obsessive-compulsive symptoms are also exacerbated by decreased calorie intake and weight loss.

Affected people absolutely deny that they are in a dangerous condition for their health and life and are against any treatment.

Self-esteem is influenced by physical fitness and weight, in which weight loss is a sign of self-discipline, an increase is perceived as a loss of control. As a rule, they come under pressure from family members for clinical examination when they observe weight loss.

To lose weight, in addition to avoiding food intake, patients can resort to the following methods:

• compulsive physical training;
• resort to taking laxatives, anorexigenic drugs, diuretics;
• provoke vomiting.

People with anorexia nervosa have:

• extreme thinness with the disappearance of body fat and muscle atrophy;
• dry, wrinkled skin, the appearance of fluff on the face and limbs; decrease in sebaceous production and sweat; yellowish color of the skin;
• bluish hands and feet due to exposure to cold (acrocyanosis);
• scars or calluses on the back of the fingers (Russell's sign), from continually placing the fingers in the throat to induce vomiting;
• dull and thinning hair;
• teeth with opaque enamel, caries and erosion, inflammation of the gums, enlargement of the parotid glands (due to frequent self-induced vomiting and subsequent acidity in the mouth);
• bradycardia (slowing heart rate), arrhythmia, tachycardia of the heart and hypotension;
• stomach cramps, delayed gastric emptying;
• constipation, hemorrhoids, rectal prolapse;
• sleep changes;
• amenorrhea (disappearance menstrual cycle, at least 3 consecutive cycles) or violations menstrual cycle;
• loss of sexual interest;
• osteoporosis and an increased risk of fractures;
• memory loss, difficulty concentrating;
• depression (possible suicidal thoughts), self-harm behavior, anxiety, obsessive compulsive disorder;
• possible rapid fluctuations in electrolyte levels, with important consequences for the heart (up to cardiac arrest).

Bulimia

The main feature that distinguishes bulimia nervosa from anorexia, is the presence of repetitive overeating.

This causes episodes in which a large amount of food is consumed in a short period of time (bulimic crises in solitude, planned, characteristic rate of food intake). It is preceded by states of dysphoric mood, interpersonal stressful conditions, a feeling of dissatisfaction with the weight and shape of the body, a feeling of emptiness and loneliness. After overeating, there may be a short-term reduction in dysphoria, but they usually follow a depressive and self-critical mood.

People with bulimia use repetitive compensatory actions to prevent weight gain, such as such as spontaneous vomiting, abuse of laxatives, diuretics or other drugs, and excessive physical load.

A bulimic crisis is accompanied by a feeling of loss of control; feelings of alienation, some report similar experiences of derealization and depersonalization.

Often the onset of the illness is associated with a history of eating restriction or after an emotional trauma in which the person is unable to cope with feelings of loss or frustration.

Binge eating and compensatory behavior occurs on average once a week for three months.

Spontaneous vomiting (80-90%) reduces feelings of physical discomfort, in addition to fear of gaining weight.

Uncontrolled absorption of large amounts of food (compulsive overeating)

Binge eating is characterized by repeated episodes of compulsive eating for a limited period of time and lack of control over food while eating (for example, feeling like you cannot stop eating or that you cannot control what or how much you eat).

Binge eating episodes are associated with at least three of the following symptoms:

• Eat much faster than usual;
• Eat until you feel a painful feeling of overcrowding;
• Eat a lot without feeling hungry;
• Eat alone because of embarrassment about the amount of food you swallowed;
• Feel self-disgust, depression, or intense guilt after eating too much.

Binge eating is distressing, uncomfortable, and has occurred, on average, at least once a week for the past six months, without compensatory behavior or disorders.

Restrictive eating behavior

Restrictive eating behaviors are common in adolescence, however, they can also occur in adults.

This is an eating disorder (for example, a pronounced lack of interest in food; avoidance based on sensory characteristics of food; concern about the unpleasant consequences of food intake), which is manifested by a constant inability to adequately assess the contribution of nutrition. As a result, this provokes:

• Significant weight loss or, in children, an inability to achieve expected weight or height;
• Significant nutritional deficiencies
• Dependence on enteral nutrition or oral nutritional supplements;
• Explicit interference with psychosocial functioning.

This disorder encompasses many disorders that are referred to in other terms: for example, functional dysphagia, hysterical lump or suffocating phobia (inability to eat solid food due to fear of choking); selective eating disorder (restricting food to several foods, always the same, usually carbohydrates, such as bread-pasta-pizza); nervous orthorexia (obsessive desire to eat right, eat only healthy food); food neophobia (phobic avoidance of any new food).

Rumination disorder

Mericism or rumination disorder is characterized by repeated regurgitation of food over a period of at least 1 month. Regurgitation is the regurgitation of food from the esophagus or stomach.

Re-regurgitation is not associated with gastrointestinal distress or other medical conditions (eg, gastroesophageal reflux, hypertrophic pyloric stenosis); it does not appear exclusively during anorexia nervosa, bulimia nervosa, a binge eating disorder, or restrictive eating behavior.

If symptoms occur in the process of mental retardation or pervasive developmental disorder, or intellectual disability and others developmental neurological disorders, they themselves are serious enough to warrant further clinical Attention.

Pica

Cicero is an eating disorder characterized by persistent ingestion of inedible substances for a period of at least 1 month. Substances commonly taken vary by age and availability, and may include wood, paper (xylophagia), soap, earth (geophagy), ice (pagophagy).

The consumption of these substances does not correspond to the level of individual development.

This eating behavior is not part of culturally or socially accepted normative practice. It may be associated with mental retardation or chronic psychotic disorders with long-term institutionalization

If eating behavior occurs in the context of another mental disorder (intellectual disability, autism disorder) spectrum, schizophrenia) or a medical condition (including pregnancy), it is severe enough and requires further clinical attention.

Complications

Eating disorders can have serious health consequences, most commonly in anorexia nervosa, due to the consequences malnutrition (affecting all organs and systems of the body) and elimination behavior (gastrointestinal tract, electrolytes, function kidneys).

Women with eating disorders have greater perinatal complications and are at increased risk of developing postpartum depression.

For these reasons, the assessment of medical complications requires specialists in this field.

Anorexia, in the long term can cause:

• endocrine disorders (reproductive system, thyroid gland, stress hormones and growth hormone);
• specific nutritional deficiencies: lack of vitamins, lack of amino acids or essential fatty acids;
• metabolic changes (hypoglycemia, hypercholesterolemia, hyperazotemia, ketosis, ketonuria, hyperuricemia, etc.);
• fertility problems and decreased libido;
• cardiovascular disorders (bradycardia and arrhythmias);
• changes in the skin and appendages;
• osteoarticular complications (osteopenia and osteoporosis with subsequent fragility of bones and an increased risk of fractures);
• hematological changes (microcytic and hypochromic anemia due to iron deficiency, leukopenia with a decrease in neutrophils);
• an electrolyte imbalance (especially important reductions in potassium, with a risk of cardiac arrest);
• depression (possibly suicidal ideation).

Bulimia may cause:

• erosion of enamel, cariesgum problems;
• water retention, swelling of the lower extremities, bloating;
• spicy gastritis, gastroesophageal reflux, swallowing disorders due to damage to the esophagus;
• decreased potassium levels;
• amenorrhea or irregular menstrual cycles.

Treatment of eating disorders

Nutritional rehabilitation for eating disorders at every level of treatment, both outpatient and intensive treatment, partial or complete hospitalization, should be carried out as part of a comprehensive interdisciplinary approach that includes the combination of psychiatric / psychotherapeutic nutritional treatment, in addition to nutritional complications, with a specific psychopathology of eating disorders and general psychopathology that can be present.

Interdisciplinary intervention is indicated, particularly when the psychopathology of an eating disorder coexists with a state of malnutrition or overeating.

During treatment, it must be constantly borne in mind that malnutrition and its complications, if any, contribute to the maintenance of the psychopathology of an eating disorder and prevent psychiatric / psychotherapeutic treatment and vice versa, if weight recovery and elimination of dietary restrictions are not associated with an improvement in psychopathology, there is a high likelihood relapse.

Depending on the intensity of the treatment, the interdisciplinary team may include the following professional specialists: doctors (psychiatrists / pediatric neuropsychiatrists, nutritionists, therapists, pediatricians, endocrinologists), nutritionists, psychologists, nurses, professional educators, psychiatric rehabilitation specialists and physiotherapists.

Having clinicians of different specialties has the advantage of making it easier to manage difficult patients with serious medical and psychiatric problems associated with an eating disorder behavior. In addition, this approach can appropriately address both the psychopathology of the eating disorder and calorie restriction and cognitive dietary restriction, as well as physical, psychiatric and nutritional complications that ultimately arise.

In fact, people with eating disorders should receive interventions aimed at both psychiatric and psychological aspects, as well as nutritional, physical and socio-ecological Aspects. These interventions should also be rejected based on age, type of disorder, as well as on the basis of clinical assessment and the presence of other pathologies in the patient.