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What is anorexia?

Anorexia nervosa is a set of serious disorders of eating that includes periods of deprivation of food (anorexia), alternate times with compulsive periods of food intake and purging (bulimia), associated both periods to other unspecified eating disorders.
Diagnosed persons of anorexia nervosa have a rate much lower than those corresponding to their age, height and sex (BMI) body mass and body weight (under 18-19 is considered underweight and 17 severe underweight). Low body weight is caused in more than 50% of the patients, in addition to by food deprivation, by the abuse of laxatives or diuretics, uncontrolled generation of self-induced vomiting, and strenuous exercise session in order to lose weight.
In all cases the patients they are not usually able to recognize his problem of extreme thinness, given that are not aware of their status, categorically denying their status, and even isolated from nearby people because they believe that they want to make them "more bloat", and that the problem of vision of reality has its environment and not them.
This disease is very rare appearance before puberty and usually affect a greater percentage to the girls, although increasingly it is more anticipating the age of onset and comparing the percentage of cases among both sexes. On average, is considered that anorexia nervosa appears around the age of 17. The more early is the age of onset and more early detection and treatment, better prognosis of healing there. Over the 40 years it is uncommon. Its prevalence has been established in one case per 100 to 250 people.

Types of anorexia

Differentiate two types of anorexia, observed in both groups of patients a small percentage who has a single isolated episode, one much higher percentage adopts an alternative and fluctuating pattern of weight gain and relapse, and a last group does not exceed the first episode and develops chronic deterioration over the years.
Regardless of the type of anorexia nervosa developed, various studies have shown that these patients usually present patterns of depression and anxiety prior to the development of the disorder, which remain or even increase, throughout the illness, and persist in a significant percentage, once overcome anorexia, especially depression.

Restrictive anorexia nervosa

It's a clinical picture where patients achieves a low weight through very restrictive diets, very prolonged fasting, and abundant high intensity exercise. These patients do not resort to compulsive binge eating and subsequent purges.

Anorexia nervosa purgative/compulsive

They are patients who turn in a timely or systematic way to bingeing or purging (vomiting, laxatives, diuretics...). There is a sub-group that binge eating but yes they resort to the purge in a systematic way. Due to the loss of control of the impulses of this group, these individuals are more susceptible to suffer greater emotional variability, and to succumb to the consumption of addictive substances (alcohol, tobacco, etc).

Causes and risk factors for anorexia

It is extremely difficult to establish common parameters responsible of this eating disorder due to its psychological component and the great variation of signs and symptoms among some patients and others.
Developed studies have tried to determine the pathogenesis (origin of Pathology) disease have not been conclusive, pointing as the sum of some of these risk factors:

Individual factors

He has spoken of a possible genetic component linked to the presence of the 5HT-2A gene, found in a large number of patients diagnosed with this disorder activated by situations of malnutrition and food. Various twin concordance studies support this possible genetic component.
Detected an increase in the activity serotoninergic which seems to be closely linked to the decrease of food intake and changes in behavior. Also observed, through Imaging tests, anatomical and metabolic alterations in patients with anorexia, which could be linked to the presence of the disease.
Finally, the presence of this disease with such as major depression or obsessive-compulsive disorder-psychiatric disorders has been associated predominantly.

Family factors

Presence of alcohol or psychiatric disorders in relatives of the first degree (parents and siblings).

Cultural factors

Unattainable standards of beauty imposed by society and an excessive cult of the body.
In addition to these factors, the onset of restrictive diets is a precipitating factor in the disease.

Symptoms of anorexia

There are certain signs and symptoms that make you suspect that a person may be suffering from anorexia nervosa, however, diagnosis, treatment and follow-up always must be done by a health practitioner. These signs are:
Signs of anorexia
  • Excessive weight loss in a short space of time.
  • Constant feeling of obesity not founded and strong desire to continue slimming, with active control (repeatedly take a look in the mirror, weigh yourself several times a day, count calories...).
  • Retardation of growth and development (in children and adolescents).
  • Disorders of menstruation or absence of this.
  • Realization of constant and excessive exercise.
  • Employment of loose clothing, mainly pants.
  • Avoiding meals in the company.
  • Escape from the table after eating.
  • Hide the food to not eat it (splitting into small pieces and spread it by the dish, throw it down, hide it...).
  • Progressive isolation and loss of social ties.
  • Mood disorders with a tendency to depression and anxiety.
  • Obsession with the caloric content of everything it consumes, taking only foods low in calories.
  • Employment not controlled diuretics and laxatives.
  • Low self-esteem.
Symptoms of anorexia
In a clinical setting the main symptoms of anorexia nervosa are:
  • Dryness of the skin, with the possibility of cracks.
  • Appearance of fine hair (lanugo) on cheeks, back, thighs and forearms.
  • Yellow pigmentation in the skin, mainly in the soles of the feet and the palms of the hands. This is because an increase of carotene in blood (precursor of vitamin A) by a disorder in your metabolism.
  • Cold extremities.
  • Brittle nails and hair loss.
  • Hypertrophy of glands salivary glands Parotid and submandibular glands.
  • Dental alterations, prone to corrosion in the presence of caries and dental enamel. This is especially evident in patients who are purged through the induction of vomiting.
  • Gastrointestinal disorders: flatulence, bloating, abdominal pain and constipation (except if laxatives that can cause diarrhoea that alter the electrolyte balance are used).
  • Cardiovascular disorders: low pressure (hypotension), lowering of the heart rate (bradycardia), changes in heart rhythm (arrhythmias), etc.
  • Kidney disorders: indicative of malfunction. You can find potassium levels low (hypokalemia), elevated levels of compounds derived from nitrogen (azotemia), and elevation of serum creatinine levels.
  • Blood count: low levels of red blood cells (anemia) and white blood cells (leukopenia).
  • Biochemical levels: low levels of glucose (hypoglycaemia), increased triglyceride, transaminase and general proteinogram and cholesterol (hypercholesterolemia). If the patient, often also use laxatives, enemas, or is autoinduce vomiting, there are other specific parameters altered.

Diagnosis of anorexia

Diagnosis of anorexia

The diagnosis of this disease is based on:
  • An interview with the patient and their closest family environment, and review your medical history and family history.
  • A physical examination and evaluation of heart rate, blood pressure and respiratory rate.
  • Additional clinical tests: complete blood count, biochemistry, etc.
According to the diagnostic and Statistical Manual of mental disorders (DSM-IV) of the American Psychiatric society, the four leading from the anorexia nervosa diagnostic criteria are:
  • Emphatic rejection to achieve and maintain a body weight equal to or greater than the normal minimum value considered according to age and size. In general, the weight is less than 85% of the minimum corresponding to age and size.
  • Pathological terror to the weight gain and the conversion in an obese person.
  • Alteration of the self-perception of weight and body silhouette, with exaggeration of its importance on the ability of self-assessment, and denial of the risks posed by a low body weight maintained.
  • Amenorrhea in women pospuberales (disappearance of at least three menstrual cycles).

Key in the diagnosis of anorexia

The 10th version of the international statistical classification of diseases and other problems of health (ICD-10) remains approximately the same criteria of diagnosis of anorexia, although a little more expanded, indicating:
  • Significant weight loss achieved through avoidance of foods "that get fatter", and two or more of the following symptoms: self induced vomiting, use of laxatives, excessive exercise, use of diuretics or appetite suppressants.
  • Specific psychopathology with idea overrated and obsessive horror towards fatness or sagging, which implies that the patient is impose a threshold of low weight not justified.
  • The presence of disorders in the hypothalamus-pituitary-gonadal axis that are manifested in the male as a lack of interest in sex and impotence and, in women, such as amenorrhea. There may be high levels of GH and cortisol, abnormalities in the secretion of insulin, and changes in the peripheral metabolism of thyroid hormone.
  • In the case of prepubertal onset, growth is interrupted, with lack or total absence of the development of breasts and appearance of primary amenorrhoea in girls and, in the case of children, the genitals remain juvenile.
With recovery, these symptoms are reversed and continue with the normal pubertal development, except for delayed menarche.

Treatment of anorexia

Once evaluated the diagnostic parameters previously described, and discarded other psychiatric and organic pathologies, we proceed to treatment and patient follow-up. The process of treatment of anorexia nervosa is multidisciplinary, specifying a coordinated action of the doctor's family, psychiatrist, psychologist, endocrine and gynecologist. The main points of the treatment are:
  • Modification of eating habits of the patient: you need a "re-education" of the patient in their eating habits. Therefore begins with a diet relatively low in calories (1,000-1,500 calories per day) is increasing progressively to achieve the caloric needs of the patient, respecting personal space for not pressing him, but not allowing that you eat alone, and watching do the five fundamental daily meals.
  • Regular weight control: increases weekly 250-500 grams must be detected despite the naked person or in underwear (avoiding the tare weight of the garments and possible deceptions of the patient).
  • Restriction of physical exercise: initially removed completely and re-injected very gradually.
  • Regular analytical controls to prevent organic complications.
  • Drug therapy: focuses mainly on the depressive or anxious anorexia component. It is a treatment individualised and constrained to the requirements and the psychological status of the patient.
  • Psychotherapy: is used either isolated or combined, behavioral therapy, Psychoanalytical, interpersonal and group.
The monitoring of treatment may be combined between the treating physician and mental health unit. In the event that ambulatory monitoring has failed, and provided that the patient has a good family support, good predisposition toward treatment and tolerate therapy in group, you can try therapy in day hospitals, being a completely contraindicated option if the patient shows tendency to suicide, substance abuse or severe medical complications.
The patient may be hospitalised in case of manifest risk to his life, very serious psychological disturbance (suicide, other psychiatric disorders, etc.), or if the family situation is very unfavorable. Once started the treatment the prognosis is very variable, but they are considered indicative of good prognosis capacity of early acceptance of disease by the patient, the appearance and diagnosis for short-term disease, a good family support, and the absence of psychiatric antecedents in the family.

Prevention of anorexia

Early detection and put in the hands of specialists to follow an appropriate treatment are the best weapons to combat anorexia, once the disease is established. However, it is best to prevent its emergence with the broadcasting of programmes of prevention and promotion of health in the family, educational and social fields that would reduce the number of people who develop eating disorders whose consequences can impact your health irreversibly.

Prevent anorexia from childhood

Here are some clues that will help you prevent anorexia on your children or relatives of young:
  • Teach children from small, both at home and at school, the importance of correct eating habits.
  • Eating family whenever possible, making the time of food in a pleasant meeting in which are exchanged the experiences of the day.
  • Menus should be varied and include all types of food needed for proper nutrition.
  • Unless there are health reasons, the child's diet foods, not should be excluded because all are necessary in its fair measure, though Yes you should limit consumption of sweets and desserts industrial, replacing them, to the extent possible, with other acts at home.
  • Try different vegetables and fruits until you find which you like the most. Even if you don't like cauliflower, maybe they love you spinach.
  • Establish regular meal hours. Better if the food is distributed in four or five shots throughout the day (breakfast, lunch, lunch, snack and dinner).
  • Fostering self-esteem. It is important that you know your capabilities and limitations, and learn to feel at ease with itself. This will prevent future complex.
  • Reinforce their autonomy and encourage you to have their own opinions and be less vulnerable to the messages from the media and advertising that convey the idea that having a perfect body is synonymous with success and happiness, forgetting the values of people.
  • Discuss with the child these messages about aesthetics and power broadcasting media, reasoning what is true and what not, and taught to value health above aesthetic constraints.
  • Not propose goals, neither academic nor sporting, exceeding their capacities, to avoid frustration.
  • Encourage you to exercise regularly. It is good for your health and help you to keep in shape.
  • Facilitate their social relations and participation in extracurricular activities, excursions, cultural visits scheduled by the school, etc. If you feel socially integrated, it is difficult to grow up thinking that you will be rejected for failing to meet a few specific canons of beauty.
  • Establish good communication within the family environment, to make the child feel more secure, and be able to seek the advice and assistance of their own family when faced with situations that are difficult or stressful.

Prevention of anorexia in adolescence

  • The majority of the cases of anorexia occur in women aged between 14 and 18 years of age. Young people who have received a false message that exalts thinness as the representation of the success, happiness, right and natural. The desire to change the physical appearance does not mean that you suffer a mental illness, but yes increases the chances of developing an eating disorder when it becomes an obsession and misconduct are adopted. Adolescence is a particularly vulnerable phase because the personality is not enough formed, hence the importance of establishing anorexia prevention programmes, to prevent the development of this and other eating disorders.
  • Educators in touch with teens play a very important role in the early detection of eating disorders, and must notify relatives if you look emotional disturbances or changes in behavior or appearance of the young.
  • If the young person needs to lose weight for health reasons, you should always do so under medical supervision and with the knowledge of the parents. If they observed that the desire to lose weight is unjustified or that the young man begins to reduce the amount of food without reason, they should immediately consult a specialist.
  • Family members should avoid making derogatory comments about the physical appearance of others. You can criticize a bad action or the bad character of someone, but not mocking ugliness or fatness.
  • In this same line, you must teach adolescent to appreciate the virtues of others instead of judging them by their appearance.
  • Promote the integration and coexistence among people from different social and cultural fields, helps adolescents understand that being different does not mean to be worse or better.
  • Enhance your self-esteem that you assess their qualities and capabilities and not be ashamed of its limitations.
  • A positive family environment, without falling into the overprotection, will provide teen safety and support necessary to overcome its problems.

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Health and Wellness