to understand the it is already in Portuguesethe most lethal of psychiatric illnesses, I usually make an analogy with an admirable rose, which, at the height of its splendor, in crimson color, starts to consume itself, undoing itself in petals of a perfect life.
Like the fading flower, anorexic girls let life fade away in a steep slope of the hands of the scale.
This dire situation, but also the exciting process of recognition, treatment and recovery, is described in my recent book “When beauty becomes obsession”Published by the São José dos Pinhais School of Public Health (2021).
A portrait of anorexia
Anorexia nervosa affects 0.5 to 1% of the population, especially adolescents between 12 and 15 years old. The majority (90%) are female..
When the problem affects adults, those with professions that value aesthetics and the body predominate. I’m talking about models, actresses, dancers, jockeys, gymnasts and digital influencers.
The term anorexia comes from the Greek and means something like “without hunger”. But, in fact, it is inadequate, as patients – at least in the early stages of the disease – feeling of hunger, but deny that feelingrepelling all forms of food.
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Thus, anorexia nervosa is characterized by a drastic reduction in food intake (which leads to extreme weight loss), an intense fear of gaining weight or keeping the weight within the normal range, in addition to the interruption of body image (even severely emaciated, anorexics become perceived as fat, “flabby”).
In some cases, patients may have isolated episodes of binge eating followed by purging behaviors to avoid weight gain, such as self-induced vomiting and the use of laxatives, diuretics and weight loss drugs.
The main signs of anorexia nervosa
In practice, patients with the disease can be recognized due to some behaviors:
- Different diet: Some foods are gradually avoided and, later, whole groups are excluded (fats, carbohydrates, meat and dairy products). Sometimes the diet is restricted to sugar-free foods, diet chewing gum, and some types of fruit and vegetable drinks. Daily calorie intake can be as low as 100 to 200 calories.
- Food rituals: Food is divided into small pieces and separated according to color, size and texture.
- Excessive slowness to eat: The meal can last up to two hours.
- Interest in cooking: Many patients prepare sophisticated, high-calorie meals for family members.
- Verification rituals: there is frequent measurement and weighing
- Distance behavior: The person tends to hide under loose clothing
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What’s behind anorexia?
There is no single known cause for the development of anorexia nervosa.
Is that the disease is caused by a combination of biological, psychological and environmental factors.
Studies suggest, for example, that genetics may play a role, as people with first-degree parents with anorexia nervosa are 10 times more likely to develop it.
Now, as psychological vulnerability factors, we see traits of inflexibility, perfectionism and rigidity.
The anorexic patients represent that stereotype of perfect girls: top students in the class, best dancers, well-behaved, organized and punctual.
+ READ ALSO: Restriction to the table increases risk of eating disorder
As environmental factors related to the genesis of anorexia we can mention:
- Family factors: there is excessive emphasis on issues related to weight and body shape, in addition to dysfunctional eating behavior (restrictive or compulsive)
- Influence of the media and social networks: these spaces glorify unattainable thinness standards as ideals of beauty and based on images of unreal bodies, digitally manipulated through filters and editions. Thus, thinness is considered a synonym of self-fulfillment and power, a passport to success – certainly grounded in sandy soil .
Complications related to anorexia
The disease is associated with a myriad of complications, which may be due to malnutrition or inadequate compensatory methods, an example of inducing vomiting; use of laxatives, diuretics, weight loss drugs, insulin and thyroid hormones; breastfeeding with the intention of losing weight, among others.
We can understand that, in order to guarantee survival, the body engages in a kind of self-cannibalism, starting to consume its own muscles, bones, brain mass and organs.
As a result, patients with anorexia present, among other complications:
- Decreased gray matter in the brain, with cognitive impairment
- Decreased bone mineral density, which can lead to osteoporosis
- Mitral valve prolapse of the heart, with palpitations
- Muscle pain, weakness and paralysis
- Constipation and delayed gastric emptying
- Thin and brittle hair
- Dry, yellow skin covered with lanugo (a thin layer of hair over the entire body)
- fertility changes
- changes in sodium and potassium levels, which can lead to potentially fatal cardiac arrhythmias
Such changes are usually reversed with weight regain and maintenance of improved nutritional status.
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Anorexia nervosa can be fatal
It should be noted that anorexia nervosa is the most lethal psychiatric illness – death rates reach a staggering 18%.
One of the main causes is suicide. To get an idea, the rates are 18 times higher than in the general population. Approximately 50% of adult patients report suicidal ideation, and up to 26% attempt to take their own life.
Renal and cardiovascular complications are also largely responsible for the high incidence of mortality in this group.
According to the Academy of Eating Disorders, the risk of premature death for a woman with anorexia nervosa is 6 to 12 times greater than that of the general population.
Most patients (70-90%) also have other psychiatric disorders, such as depression, anxiety disorders, ADHD, alcohol and substance use disorders, and personality disorders.
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How is anorexia treated?
It should be multidisciplinary, with a team specialized in eating disorders. The time must be composed of: nutritionists, psychologists, psychiatrists, clinicians and physical educators.
A psychotherapy is a fundamental pillar, and behavioral behavioral therapy (CBT) is indicated for adults, and family-based therapy (FBT) is aimed at children and adolescents.
The idea is to normalize eating behavior and improve acceptance and satisfaction with weight and body shape, valuing aspects of life that go beyond appearance.
Also very important is the nutritional guidancein order to assist in the process of acceptance of all types of food and to monitor adequate caloric intake for weight recovery and maintenance.
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Sometimes, the drug treatment it is also necessary, especially to treat comorbidities – such as anxiety and depression.
Hospital treatment is indicated for critical cases, when, for example, BMI (body mass index) is below 14, suicidal behavior is noticed, there are cycles of uncontrollable binge and purgation and serious complications.
Through early recognition and treatment, it is possible to give life back to patients. The prognosis is usually favorable: about 50% of them have complete remission of symptoms.
For 30%, there is a fluctuating course – that is, they oscillate between improvements and relapses. And 20% progress to the severe and refractory course of the disease.
In view of this, the message I would like to reinforce is: take care of your essence, because appearance, in the end, fades.
*Christina de Almeida dos Santos is a psychiatrist, member of the Academy for Eating Disorders and International Consultant on Eating Disorders at Kusnacht Practice- Switzerland