Hypothermia may persist after anorexia
anorexia (Anorexia nervosa, anorexia): Most common form of eating disorder with deliberately induced weight loss - of at least 15% of the initial weight or a body mass index of 17.5 and below - due to extreme reduction in food intake. Anorexia has increased dramatically in recent years. Around 1% of girls and women between the ages of 10 and 25 are affected, but also - with an increasing trend - young men, children before puberty and women up to menopause. Anorexia is a very serious disease and the mortality rate is high, especially if therapeutic help is not sought quickly or if therapy does not work for the person affected.
- Weight loss is triggered by compulsive fasting, often aided by provoked vomiting or the use of laxatives.
- Weight loss is hidden by loose clothing. Those affected avoid showing themselves in underwear, swimwear, or naked.
- Subjectively believed and often expressed fear of being too fat - but still very preoccupied with the subject of food. It is typical that the sick like to cook for others, but then do not eat anything themselves.
- Increased physical activity to burn extra calories.
- The absence of menstruation in the early stages of the disease, regression of the breasts (femininity is "starved away"), freezing up to hypothermia.
- Arrhythmias and low heart rate, edema
- Downy hair on arms and legs
- Increased susceptibility to infection
- Low blood pressure.
This 21-year-old patient has reached a life-threatening stage of anorexia with a body weight of 39 kg. Despite her life-threatening underweight, she described herself as "still too fat in some places" at the hospital admission. The inpatient therapy was successful and the patient was discharged after 4 months with a weight of 48 kg.
Georg Thieme Verlag, Stuttgart
When to the doctor
On the same day, if the person concerned has lost significant weight recently and has become extremely underweight or serious secondary problems occur such as severe freezing, infections, constipation, apathy (indifference) or circulatory disorders.
In the next few days, if the eating behavior has changed noticeably or other leading complaints become noticeable.
According to today's understanding, the following factors are considered to be the cause of anorexia:
Personality-related factors. Anorexics are described by psychologists as performance-oriented, perfectionist personalities with a pronounced need for harmony. At the same time, they suffer from poor self-esteem, they find it difficult to talk about their feelings. During puberty, an identity disorder occurs because new tasks such as accepting femininity or leaving the parental home are experienced as strange and overwhelming.
Family factors. The eating disorder can express an (unconscious) protest against performance expectations, strict regulations, sibling rivalry or excessive, fearful control by parents. It is also noticeable that mothers of daughters with eating disorders often have eating problems themselves. In addition, roles are often reversed in families: the daughter takes on tasks at an early stage that the parents should take on (Parentification). So you will z. B. Transferring responsibility for younger siblings from an early age.
Socio-cultural factors. The slimness ideal of our society promotes the pathological fixation on weight, figure and food. Girls and young women, in whose living environment slimness is emphasized or defined as a prerequisite for recognition (e.g. models, dancers, stewardesses), are particularly at risk. A particularly high risk factor for developing anorexia is the parents' constant dissatisfaction with their own weight. When parents celebrate weight loss diets, talk disparagingly about "fat" or even suffer from a (latent) eating disorder, they pass this negative attitude towards their own body on to their children.
Course. Often times, anorexia begins with a fast during puberty. But even when the desired weight is reached, the sick continue to starve. Your body awareness is disturbed, you continue to feel too fat - even if you are already extremely emaciated. Others perceive weight loss as a solution to previous problems or as a “victory” of the spirit over the body.
At least at the beginning of the disease, the patients retain their natural feeling of hunger. Therefore it is not an appetite disorder. They find it euphoric not to give in to hunger.
In order to keep reducing body weight, calories are meticulously counted, meals are skipped and food portions are reduced to a minimum. A tomato or crispbread eaten in small quantities throughout the day is often all an anorexic young woman allows herself. In addition, exercise ensures further calorie consumption. Often times, patients take appetite suppressants, laxatives, or diuretics to help them lose weight. Sometimes food utilization is also prevented by self-induced vomiting (transition from anorexia to bulimia).
Many anorexics become more and more isolated from their environment as the disease progresses. At the same time, they do everything they can to hide their illness by wearing oversized clothing, avoiding eating with others or explaining their lack of appetite at meals by saying that they have already eaten.
An integral part of anorexia is that Body schema disorder, also known as body awareness disorder, body dysmorphic disorder, body image disorder, body dysmorphic disorder or syndrome of perceived ugliness. Anorexics do not notice the life-threatening emaciation of their body with the extreme muscle wasting in the thighs and arms. On the contrary - individual body parts such as thighs, stomach or hips are still perceived as too fat even with a weight of 40 kg and are constantly viewed critically.
That's what the doctor does
Part of the disease is that those affected rarely seek medical help themselves. Usually it is the parents or other people close to them who urge a visit to the doctor. It is important to see a doctor who is familiar to the person concerned. By the way, paediatricians are also suitable contacts. The diagnosis is usually simple through the clear findings of the physical examination, but other causes of emaciation, such as a tumor or an acute psychiatric illness, are excluded to be on the safe side. After the diagnosis of “anorexia”, the person affected is usually referred to a hospital or a special clinic - also to temporarily remove the sick from their previous environment.
In the early stages of therapy, neuroleptics are often given because of their arousal-suppressing and antipsychotic effects.
Psychotherapy. Psychotherapy begins in order to normalize eating behavior, to resolve the body schema disorder or to resolve (family) conflicts. Special clinics that offer and combine different methods have proven themselves. Behavioral therapy in combination with exercise and / or other body-oriented therapies, art therapy and family therapy can help to overcome anorexia. Relaxation techniques and self-confidence training have also proven their worth. The treatment of anorexia is difficult and protracted, since practically all sufferers lack insight into the disease. As a rule, inpatient and subsequent outpatient psychotherapy of at least one year are necessary.
Clear rules are important here: Doctors, therapists and patients conclude a therapy contract on weight goals to be achieved in stages, behavioral measures and the consequences of non-compliance.
For further outpatient treatment, there are B. therapeutic residential communities that are supervised by a psychologist or social worker. They close the gap between hospital stay (intensive therapy, but no possibility of continuing work or training during this time) and outpatient therapy (few therapy hours per week, no interruption in everyday life).
The shorter the duration of the illness and the less pronounced the accompanying illnesses, the better the chances of recovery. About 25% of those affected completely overcome their anorexia after a timely (and consistently persevered) therapy.
But: Up to 20% of the sick die from the consequences of extreme malnutrition. In addition, about half of the anorexic people who receive therapy retain obsessive-compulsive behavior or latent eating disorders, and about a third develop severe psychiatric illnesses or even thoughts of attempting suicide in later years. The relapse rate is also high: like all addicts, anorexics are potentially at risk, especially in crisis situations.
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The family plays a crucial role in the success of anorexia therapy. On the other hand, it is often the ground on which the disease could develop in the first place. Whatever triggered the anorexia - parents, relatives or partners are almost always stunned when faced with the question: "What did we do wrong?"
If parents want to help their anorexic child, they must first of all seek help themselves. It is of secondary importance whether this takes place in the context of preliminary discussions for a planned family therapy, in a marriage and family counseling center or with a psychotherapeutically qualified doctor or psychologist. The decisive factor is an open discussion of the disease and professional support during the child's first months of treatment. Self-help groups also provide good support here.
Specialist therapists also advise not to “ramble on the symptoms” too much, but rather to take an interest in the general life questions, interests and tasks that preoccupy the young people. The sick person needs space for feelings as well as the possibility to feel joy in non-performance related activities, talents and personal idiosyncrasies. It is important to strengthen the self-confidence of the sick child.
- www.hungrig-online.de - Website of the Hungrig-Online e. V., Buckenhof: Offers a discussion forum as well as a lot of information for those affected, relatives and experts. Highly recommended.
- www.bundesfachverbandessstoerungen.de - Website of the Federal Association of Eating Disorders e. V., Munich: Good address offer for outpatient and inpatient facilities. Offers those affected and their relatives the opportunity to turn to member institutions for professional help.
- www.cinderella-rat-bei-essstoerungen.de - Website of the action group Eating and Anorexia Cinderella e. V., Munich: Initiative that provides advice on eating disorders and provides addresses of local self-help groups, psychotherapists and clinics nationwide.
- www.magersucht.de - Detailed, very informative website of a self-help group of the association Self-Help for Eating Disorders e. V., Frankfurt.
- www.ANAD-pathways.de - website of the ANAD association (Anorexia Nervosa and Associated Disorders) e. V. pathways, Munich: Advice center, especially for those with eating disorders. Very helpful, offers direct contact with experts. Highly recommended for those affected and their families.
- M. Gerlinghoff et al .: Anorexia and Bulimia. Understand and cope. Beltz, 2001. One of the - now many - guides on the subject, factual and serious.
- Federal Center for Health Education (BZgA): Eating disorders. Good advice for parents, partners, siblings, relatives, teachers and caregivers. Can be obtained free of charge from the BzgA, 51101 Cologne, Fax: (0221) 8992257 or via the Internet: www.bzga.de under the heading Information materials / order.
- M. Hornbacher: Alice in Hungerland. Living with bulimia and anorexia. Ullstein Taschenbuch, 2001. Autobiography described as authentic and helpful by those affected.
AuthorsDr. med. Arne Schäffler, Gisela Finke in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:53
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