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Anorexia and Bulimia

1) What is anorexia nervosa?

Anorexia nervosa (AN) is a psychiatric illness included within the eating disorders (ED), which causes multiple medical manifestations.

This is a serious and potentially fatal.

It is defined as a disorder characterized by the presence of an Intentional weight loss, induced and maintained by the same patient (International Classification of Diseases, 1992).

The American Academy of Psychiatry provides the following diagnostic criteria, published in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), 1994:

a) Refusal to maintain normal body weight at or above the minimum for your age and height.

b) that it can be a gain Terror still be far below the ideal weight.

c) Distortion of perception of weight and body image.

Improper influence or weight on self-image evaluation, or denial of the seriousness of the current weight.

d) In menárquicas postmenopausal women (who have already had the first rule), amenorrhea is defined as the absence of at least three consecutive menstrual cycles.

2) What is bulimia nervosa?

Bulimia nervosa (BN) is a psychiatric illness included within the eating disorders (ED), which causes multiple medical manifestations.

This is a serious and potentially fatal.

It is defined as a disorder characterized by the presence of an Intentional weight loss, induced and maintained by the same patient (International Classification of Diseases, 1992).

The American Academy of Psychiatry provides the following diagnostic criteria, published in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), 1994:

a) Recurrent episodes of binge eating.

b) recurrent and inappropriate compensatory behavior to prevent weight gain such as self-induced vomiting, laxatives, diuretics, fasting or excessive exercise.

c) The binge eating and compensatory behaviors occur at least twice a week for 3 months.

d) Self-evaluation is unduly influenced by body weight.

e) The changes described do not occur exclusively during episodes or phases of AN.

3) Causes of anorexia and bulimia

The causes of anorexia and bulimia remain unclear but are believed to be due to the interaction of 3 types of factors:

A / pre disposing factors:

-Individual: overweight, perfectionism and self-control, fear of aging, problems to be autonomous, low self esteem ..

-Gene: existence of a family of a member with a TCA multiplied from 2 to 20 times the risk of suffering from any of its members.

-Sociocultural: thinness ideals and prejudices against obesity, certain occupations and sports, poor eating habits, excessive parental concern for the figure, conflict (separation of parents, history of depression and alcoholism), low resolution of conflicts, poor

communication, overprotection, rigidity ...

B / precipitating factors:

-Puberty (physical and psychological changes), restrictive dieting, excessive exercise, poor assessment of the body, personal dissatisfaction, personal situation stressful, emotional disorders, anorexia nervosa before (in the case of bulimia).

C / perpetuating factors:

-Valuation negative body image.

-Social pressure.

-Return of stressful situations.

Perpetuating factors in anorexia nervosa:

-Complications of malnutrition.

-Social isolation.

-Fears: food, weight, shape, certain foods, etc..

Perpetuating factors in bulimia nervosa:

Cycle-binge-purge behavior.

-Return of anxiety.

-Other abnormal behaviors (substance abuse, self harm).

4) Biological Manifestations

1 - Endocrine:

Amenorrhea: absence of the rule at least three consecutive menstrual cycles.

, Hypogonadotropic hypogonadism: decreased sex hormones.

Euthyroid sick syndrome,: alteration of thyroid hormones as a mechanism for conservation in a situation of biological serious commitment.

-Increased GH IGF1 decline: lower levels of growth factor

-Hypercortisolism: increases in blood cortisol altered elimination.

-Hypoglycemia: liver glycogen depletion ("glucose storage").

-Hypercholesterolemia: increases cholesterol and reduce triglycerides by up to 50% of patients.

2 - Nutrition:

Patients with eating disorders can reach a state of severe caloric malnutrition with loss of body fat and involvement of the structural proteins.

Another common nutritional deficiency is the lack of zinc.

3 - Gastrointestinal

Dental abnormalities, parathyroid hypertrophy, esophageal erosions, delayed gastric emptying, dilatation of the small intestine and colon disorders abuse laxatives.

Liver damage from malnutrition.

4 - Cardiovascular:

Decreased heart rate (bradycardia) and blood pressure (hypotension).

Cardiac arrhythmias and electrolyte disturbances.

5 - electrolyte and kidney:

Decreased glomerular filtration along with changes such as decreased potassium, decreased or increased magnesium and phosphorus reduction.

Can lead to dehydration and kidney failure.

6 - Hosea:

Osteopenia and osteoporosis (lack of calcium in bones) by a deficiency of dietary calcium, protein and hypoestrogenism (low female sex hormones).

7 - Hematologic:

Pancytopenia (deficiency of blood cells) and immune system disorders (in charge of the defenses of our body against infection).

5) behavioral manifestations, psychological and emotional

Behavioral manifestations

-Restricted diet and / or presence of binge eating.

-Purging behaviors (vomiting, laxatives and diuretics).

-Changes in the way you eat and refusal of food types.

Obsessive behaviors, performance of rituals.

-Impulsive (lie, hide) and self-harm.

-Social isolation and family.

Psychological manifestations

-Excessive concern about the possibility of gaining weight.

-Constant erroneous thoughts about food, weight and shape.

-Overestimation of weight and dimensions

-Impoverishment of fantasy and creativity.

-Confusion with feelings of satiety / fullness.

Difficulties in concentration and memory failure.

-Thoughts incorrect generalization, dichotomy, and so on.

Frequently wrong thoughts:

-Polarization, "if I'll be too fat too thin."

-Selective abstraction: "If I say I'm more beautiful because I gained weight, is that I'm fat."

-Allocation of thought: "If people look at me is because he thinks I'm fat."

-Customization: "after eating I think we all look and see that I have gained."

Over-generalization: "All fat fat", "as I had a hard time at the party, I will always praise me wrong on all parties."

-Catastrophic: "I have not maintained the diet, do not do anything right"

-Magical thinking: "thinness equals happiness and success."

Emotional displays

-Changes in the character.

-Depressive features: emotional lability (crying, insomnia), suicidal ideation.

-Anxiety is rarely relaxed or comfortable.

-Can appear generalized phobia or social phobia.

6) Prognosis and mortality

We can not speak of healing before 4 years of evolution.

Anorexia Nervosa is a chronic disease often present with multiple relapses.

The chronicity is 20-25%.

Mortality is approximately 5.9%, of which 27% are due to suicide (200 times more frequent than in general population).

7) How to Detect the eating disorder

We must be aware of the following situations:

-The lower (90% of girls) try to eat fewer meals or skip some excuses.

He often complain of body image and is described as "fat."

Tendency to self-contempt and self-esteem.

-Begins to develop rituals: cut food into small pieces, the "tide" of the plate, eat slowly and in the end always says he is "full."

-Eat a lot of sneaking (in bulimia)

-Always go to the bathroom after meals (in bulimia)

-Special attention to the dancers, gymnasts, athletes, athletes and models.

-Start shopping weight loss products, laxatives ...

She appreciates physical weakness.

Her mood becomes irregular and tends to become irritable.

He delayed menstruation or removed.

What to do when it has been found

Anorexia and bulimia nervosa are two mental disorders with serious physical repercussions, and it is very difficult for the family alone can address the problem.

-See your primary care physician or, where appropriate, the pediatrician, so that it will be referred to a specialist will diagnose and prescribe appropriate treatment.

-Contact an association of patients and their families to receive more information, family counseling and support.

9) Prevention from the family

-Pay special attention to feeding their children.

-Try not to resort to fast food, bakery products and sweets.

These foods must conform in every case the exception not the rule.

-Values ​​to their children regardless of their weight.

If you do need to change their diet, but avoid negative remarks about a possible excess.

-Strengthen the esteem of their children.

Make them feel good and source of satisfaction for your environment.

Do not center their awards in physical matters.

-Help them develop their critical sense with regard to the fashion of thinness in advertising, where is usually identified always with success.

10) Identification signs pro-ANA and pro-MIA

Anorexia and bulimia nervosa are both serious mental disorders

Thus, adolescents who create these pages have developed two forms of identification:

The White Ribbon .- Many of them put a virtual white ribbon on pages who make, or stick it in their folders, as a symbol of protest of his "lifestyle" or as a form of recognition.

Bracelets .- The young pro-ANA placed a red string bracelet or left wrist, sometimes adorned with a red beads or pebbles, the pro-MIA, do the same but using the color purple.

This way they can recognize one another everywhere: a burger, the tail of a cinema, a pub or on the beach or pool.

If in doubt noted slyly raised the bracelet to see if the other does the same, in which case there is no place for doubt.

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