Nervous anorexia at children and teenagers – the violation of meal which is characterized by full or partial refusal of food for the purpose of decrease in body weight. At development of a disease the food instinct is broken, in thinking the supervaluable ideas about weight loss dominate. Patients miss meals, adhere to strict diets, are engaged in intensive physical exercises, provoke vomiting. Diagnostics includes consultation of the psychiatrist and gastroenterologist, psychodiagnostics. Treatment is based on cognitive and behavioral psychotherapy, is supplemented with medicamentous correction of food, emotional and behavioural violations.
Nervous anorexia at children and teenagers
The term "anorexia" has the Greek origin, means "lack of desires to food". Nervous anorexia is formed on the basis of mental deviations, the refusal of food is result of the distorted installations and values in combination with uncertainty, suggestibility, dependence on opinion of people around. Prevalence of a disease among boys and young men – 0,2-0,3%, among girls and girls – 0,9-4,3% that makes 90-95% of total number of patients. The peak of incidence falls on 12-15 years – age of active physiological maturing, change of a body. About 20% of cases come to an end with death, from them a half – as a result of a suicide.
The reasons of nervous anorexia at children
Psychogenic changes of eating habits arise at preschool, younger school and teenage age. The puberty period coinciding with teenage crisis of development becomes the most dangerous in respect of a disease debut – critical perception and assessment of is formed, emotional instability amplifies, appearance changes. Distinguish from risk factors of a disease:
- Genetic. There is a hereditary predisposition to a disease. In risk group children, whose close relatives have mental disorders: bulimia, psychogenic anorexia, schizophrenia and other endogenous psychoses.
- Biological. Development of pathology is promoted by the puberty which is followed by hormonal changes, affective instability earlier. At girls mammary glands and a fatty layer increase that becomes an additional provocative factor.
- Family. Frustration can be a form of a protest of the child against educational measures. At hyper guardianship, authoritarianism of parents meal becomes one of the few spheres for independence manifestation.
- Personal. Anorexias are more subject children with an inferiority complex, uncertainty, perfectionism, pedantry. Weight reduction becomes the proof of commitment, a condition of external appeal.
- Cultural. In modern society leanness is quite often presented as a symbol of beauty, sexual appeal. Girls seek to correspond to the standard "ideal of beauty", limiting themselves in food.
Basis of nervous anorexia is dysmorphophobia – the psychopathological syndrome which is characterized by existence of persuasive bredopodobny thoughts of ugliness, imperfection of own body. Ideas of the patient of corporal shortcomings do not correspond to reality, but change an emotional state and behavior. Experience of imaginary deficiency, excessive completeness, begins to define the maintenance of all spheres of life. The supervaluable idea of weight loss and rigid restrictions of food lead to distortion of a food instinct and instinct of self-preservation. At the physiological level protective mechanisms turn on: exchange processes are slowed down, the level of insulin, bilious acids, digestive enzymes decreases. The organism adapts under the minimum volumes and rare receipt of food. Process of digestion makes sick, heavy feeling in a stomach, dizziness, faints. In a heavy stage ability to processing of food is lost. The kakheksiya (condition of extreme exhaustion) with risk of a lethal outcome develops.
Nervous anorexia at children and teenagers is classified by features of a clinical current and stages of pathological process. Depending on the main symptoms allocate a syndrome with monothematic dysmorphophobia (the idea of excess weight), with bulimia (a periodic disinhibition of inclinations, a gluttony), with prevalence of bulimia and a vomitomaniya (with a periodic overeating, the subsequent provocation of vomiting dominates). On stages of development distinguish three types of anorexia:
- Initial. Proceeds within 3-4 years, debuts at preschool children, younger school students. Health is characterized by gradual change of interests of the child, shift of ideas of a beautiful body, appeal.
- Active. Develops at teenagers more often. Differs in the expressed aspiration to lose weight (restriction of food, the exhausting physical activities, reception diuretic, depletive, calling of vomiting). Body weight decreases by 30-50%.
- Kakhekticheskaya. Organism exhaustion, the expressed asthenic syndrome, violation of criticality of thinking is observed. In the absence of medical care the stage comes to the end with a lethal outcome.
Symptoms of nervous anorexia at children
The first symptoms of a disease – discontent with own body, keen interest in ways of weight loss. Ideas of beauty, health, appeal change. The child begins to admire the famous persons, heroes of movies having a thin, fragile constitution. The idea about the excess weight, ugliness is only formed. Thoughts carefully disappear from people around. In process of development the body of the patient changes, in a podrostnichestvo there are physiological transformations which are often followed by increase in a fatty layer. It becomes a starting factor to start active actions.
The teenager tries to miss imperceptibly reception of food, fanatically plays the sports promoting weight loss. At the initial stage there is desire to hide aspiration to loss of weight from adults, gradually the behavior becomes oppositional and negativistichny: refusals of meals become frequent, at arrangements and reproaches of parents there are irritability flashes, the conflicts are provoked. The child shows more and more selectivity in food, quite often creates own "diet". First of all excludes from a diet products with the high content of fats and carbohydrates. In the menu vegetables, fruit, the fat-free dairy products prevail. For reduction of feeling of hunger of the patient begins to smoke, use a lot of liquid (to drink water, coffee, teas), to take the medicine reducing appetite.
Constant emotional tension, depression, disforichnost (embitternment), discontent with is shown, fears are formed. At some teenagers the periods of a depression are replaced by a hypomania – the general activity and mood increases, at emotional lift control of behavior decreases. The disinhibition of inclinations is shown by gluttony attacks after which self-accusation, self-abasement develops, vomiting is sometimes provoked. In the somatic sphere adynamy symptoms (weakness, dizzinesses) and violations of work of digestive tract prevail (heartburn, nausea, pains in a stomach).
After reduction of weight by a third and more process of weight loss it is slowed down. The organism is exhausted that is shown hypo - or an adinamiya (decrease in physical activity), high fatigue, feeling of fatigue, dizzinesses, faints, decrease in critical function of thinking. The teenager continues to refuse the use of food, is incapable to estimate leanness, a condition of own health. The supervaluable/crazy thought of imperfection of a body remains. Organism dehydration develops, skin becomes pale, dry, epigastralny pains become frequent, at girls periods are broken or stop. Function of digestion of food is gradually lost, each reception makes feeling of weight, sick, heartburn, pains, long locks.
The request for medical care happens because of tendency of teenagers to hide displays of a disease out of time, at a stage of development of complications. The lack of nutrients leads to violation of work of all functional systems. Pubertatny development stops, back. B12 - scarce anemia, bradycardia, heart attacks, , osteosinging and osteoporosis (calcium loss), a hypothyroidism, caries develops. Against the background of decrease in immune protection there are various infections. Depressive, disforichesky, disturbing frustration, tendency to self-accusation and decrease in critical abilities increase risk of a suicide – to 50% of deaths is caused by suicides.
Children and teenagers are inclined to hide the true purposes of starvation, to deny existence of a disease. Such position complicates timely diagnostics, promotes errors of differentiation of nervous anorexia with somatic diseases. The address to profile experts – to the psychiatrist, the psychologist – usually happens 2-3 years later after a debut of the first symptoms. Methods of specific inspection are:
- Interview. The discussion can be led according to the scheme or in a free form. The doctor defines the patient's relation to own body, weight, commitment to diets or power supply systems. Parents are in addition interviewed, the expert specifies time of the beginning of symptoms, loss of weight for the last month, features of behavioural, emotional violations.
- Questionnaires. The specific diagnostic tools intended for identification of frustration of meal – the Scale of assessment of food behavior, Cognitive and behavioural patterns are used at nervous anorexia. Also questionnaires of a research of the emotional sphere, personal characteristics, self-assessments – a technique Dembo-Rubenstein, SMIL (MMIL), PDQ (Patokharakterologichesky Diagnostic Questionnaire) are applied.
- Projective tests. These methods allow to reveal the tendencies hidden, denied by the teenager at a conversation and filling of questionnaires – rejection of, the dominating ideas of weight loss, depressive and impulsive lines. The test of color elections (Lyusher's test), the drawing "Self-portrait", the pictural apperceptive test (PAT) is offered to patients.
Specific diagnostics is supplemented with laboratory tests (the general, biochemical blood test and urine, hepatic, kidney, hormonal tests), tool researches GITs. Nervous anorexia can proceed against the background of schizophrenia, at suspicion on psychotic frustration the research of the cognitive sphere, in particular – functions of thinking is conducted.
Treatment of nervous anorexia at children
Therapy of a disease has two directions: recovery of work of system of digestion with a gradual increase of weight and return to healthy eating habits. At the first stage fractional food, a bed rest, medicamentous elimination of vomiting, dehydration, locks is applied. On the second – psychotherapy, symptomatic treatment of psychopathological manifestations. On the third – transition to the normal mode of activity, control of a recurrence, end of psychotherapy. Specific treatment includes:
- Cognitive and behavioural therapy. Work with the psychotherapist takes 4-6 months. Correction of the negative, distorted representations, pathological emotions – fear, anger, alarm is carried out. The positive attitude towards itself, acceptance of a body is developed. At a stage of change of behavior the patient independently creates the menu including various products, including izbegayemy earlier (carbohydrate, high-calorific). In the personal diary of the patient notes the arising destructive thoughts and success of their replacement with positive, describes health.
- Family psychotherapy. The difficulties of the intra family relations provoked by a disease – the conflicts, a lie, emotional estrangement are discussed at sessions. The psychotherapist helps parents to understand mechanisms of anorexia, experience of the child. On a practical training ways of productive interaction – discussion of problems, cooperation are fulfilled. Mother and the father are connected to behavioural individual psychotherapy – learn to transfer gradually responsibility for regular acceptance of food to the teenager.
- Pharmacotherapy. Special medicines for elimination of psychogenic anorexia are absent, but knocking over of emotional and behavioural deviations allows to increase efficiency of psychotherapy and rehabilitation. The scheme of treatment is defined by a clinical picture of a disease, antidepressants, tranquilizers, neuroleptics, appetite stimulators are appointed (for example, antihistamines).
- Correction of a way of life. Patients visit consultations of nutritionists, group meetings of adherents of healthy nutrition. Teenagers are told about importance of the balanced diet, good fractional nutrition for preservation of health, beauty. In practice they learn to make the menu, share progress in fight against a disease. Parents help to replace the exhausting physical exercises with fascinating, interesting sports.
Forecast and prevention
The prospect of recovery depends on timeliness of diagnostics and treatment – the earlier professional help is given, the stage of restoration is shorter and the recurrence is less probable. According to statistical data, 50-70% of patients at regular preventive visits of the doctor recover, process of treatment takes 5-7 years. An effective way of prevention of anorexia – formation of healthy habits of food, positive relation to a body from early age. In education it is important to child to instill the values propagandizing health, physical force, dexterity, endurance.