Founder and director of the Clinic for Eating Disorders, psychologist, expert on eating disorders, author of methods for treating anorexia, bulimia, compulsive overeating.

Treatment for Eating Disorders and the Path to Recovery

How to Beat an Eating Disorder and Regain Your Confidence

Many patients treated for anorexia and bulimia are convinced that they will never be able to become happy, that they will constantly be forced to sit on strict diets in order to be slim and beautiful, that they will never get rid of suffering, pain, constant fatigue from racing for a thin and athletic figure. But it is not so. The main thing to remember is that nothing is impossible, and that everything is in your hands.The help of a qualified therapist, a specialist in eating disorders, support from loved ones and work on yourself can save you from depressive thoughts, destructive ways to lose weight, help you get rid of food addiction and regain self-confidence, happiness and pleasure in life.

How to get rid of an eating disorder, where to start?

First of all, you need to find the strength in yourself to recognize the existence of a problem. This can be tricky, especially if you are still convinced (somewhere deep in your soul) that losing weight through bulimia or anorexia is the key to success, happiness, and self-confidence. Even if you “intellectually” understand that this is not the case at all, it may be difficult for you to get rid of old habits.

The good news is that if you are serious about change and willing to ask for help, you will succeed. But at the same time, it is important to understand that for a full recovery it is not enough just to “forget” about unhealthy eating behavior. You will have to "get to know" the girl behind these bad habits, thoughts of losing weight and striving for the "perfect picture" again.

Ultimate recovery is possible only if you learn:

• Listen to your feelings.
• Feel your body.
• Accept yourself.
• Love yourself.

You may feel that you are unable to cope with this task. But remember - you are not alone. Qualified specialists are always ready to help you, you just have to take the first step!

Step one: Get help

It may be scary and terribly embarrassing for you to approach strangers about such a matter, but if you really want to get rid of your addiction, you must overcome your fear. The main thing is to find someone who can really support you and listen without judgment and criticism against you. This could be a close friend or family member, or someone you trust. You may be much more comfortable discussing this problem with a therapist or psychologist.

How to confess to the interlocutor about your illness?

There are no clear rules on how to tell the interlocutor about your illness. But pay attention to the time and place - ideally, no one should rush and interrupt you.

How to start a conversation. Perhaps this is the most difficult. You can simply say, “I have something very important to confess to you. It is very difficult for me to talk about this, so I will be very grateful if you will let me talk and listen to me carefully.” After that, you can talk about how your disease arose, how it all began; about your experiences, feelings, new habits, and how your eating disorder has changed your life.

Be patient. Your girlfriend or family member will probably react very emotionally to your confession. They may be shocked, amazed, embarrassed, frustrated, and even annoyed. It is possible that they will not even know how to properly respond to your confession. Let them digest what they hear. Try to describe in as much detail as possible the characteristics of your particular eating disorder.

Explain how specifically your interlocutor can support you. For example, tell him that he can check in with you from time to time about how you are feeling, ask if you have seen a specialist for help, help you create a healthy eating plan, etc.

There are many different treatment options available to patients today, but it is important to find the approach or course of treatment that works best for you.

• Find a Specialist in Eating Disorders
• The chosen specialist must have a higher education in the specialization "psychotherapy" or "medicine", as well as a higher education in the field of psychology and sufficient experience in the treatment of eating disorders
• You should not contact gastroenterologists, psychiatrists, neurologists, nutritionists at the first stage of treatment for an eating disorder. All of these specialists should be contacted already at the stage of an eating disorder. Our Clinic employs all the necessary specialists for the successful completion of the recovery phase.

Step 2: Make a long-term treatment plan

Once you address your health concerns, your personal "treatment team" can create a long-term plan for treating your eating disorder. It may consist of:

Individual or group psychotherapy. Working with an eating disorder specialist is essential in order to “uncover” any underlying issues that have led to the eating disorder. A specialist will help you restore your self-esteem, as well as teach you how to properly respond to stress and emotional experiences. Each specialist has his own methods of treatment, so it is important to discuss with him in advance what results you expect from the course of treatment.

Family therapy. Family therapy can help you and your family members understand how an eating disorder affects your relationship and how problems in the family can trigger the disorder and prevent it from being cured. You will re-learn how to communicate with each other, respect and support each other...

inpatient treatment. In rare cases, you may need hospitalization and inpatient treatment. In most cases, hospital treatment is required for severe anorexia and severe bulimia. You will be under the supervision of specialists 24 hours a day, which will significantly increase your chances of recovery. As soon as the doctors make sure that your condition is stable, you can continue treatment at home.

Step 3: Learn "self-help" strategies

When entrusting the solution of a problem to specialists, do not forget that your personal contribution to treatment is no less important. The sooner you figure out what exactly led to the development of your eating disorder, and the faster you learn "healthy" ways to solve this problem, the faster you will get better.

How to build a healthy relationship with food

While food itself isn't a problem, building a healthy relationship with it is essential to your recovery. It can be very difficult for many patients to control their behavior when it comes to food - often they first severely limit their diet, and then abruptly break down and begin to uncontrollably absorb everything that comes to hand. Your task is to find the optimal balance.

Forget about rigid dietary rules. Severe food restrictions and constant control of everything you eat during the day can trigger the development of an eating disorder. That's why it's so important to replace them with healthy eating habits. For example, if you constantly limit yourself to sweets, try to soften this “rule” at least a little. You can occasionally allow yourself to eat ice cream or a cookie.

Stop dieting. The more you limit yourself to food, the more likely it is that you will constantly think about it and even become obsessed with it. So instead of focusing on what you "shouldn't" eat, focus on nutritious foods that will give you energy and vitality. Think of food as fuel for your body. Your body knows perfectly well when it needs to replenish its energy reserves. Listen to him. Eat only when you are really hungry, stop eating as soon as you feel full.

Stick to a regular meal schedule. Perhaps you are used to skipping certain meals or not eating anything for a long time. But remember that when you do not eat anything for a long time, all your thoughts become only about food. To avoid this, be sure to eat something every 3-4 hours. Plan your main meals and snacks in advance and don't skip them!

Learn to listen to your body. If you have an eating disorder, chances are you have learned to ignore the hunger and satiety signals your body sends. You may not even recognize them anymore. Your task is to learn how to respond to these natural signals again so that you can plan your meals according to your physiological needs.

Learn to accept and love yourself just the way you are.

When you base your self-worth solely on looks, you forget about your other qualities, accomplishments, and abilities that make you attractive. Think about your friends and family members. Do they love you for the way you look? Chances are, your looks are at the bottom of their list of things they like about you, and you probably rate them on roughly the same scale of values. So why is your appearance so important to you?

Paying too much attention to how you look, you "slide" into low self-esteem and lose confidence in your own abilities. But you can learn to perceive yourself in a positive, "harmonious" way:

Make a list of your positive qualities. Think of everything you like about yourself. Clever? Kind? Creative? Faithful? Cheerful? What do people around you consider your good qualities? List your talents, skills, and accomplishments. Also think about negative qualities that YOU DON'T HAVE.

Focus on what you like about your body. Instead of looking for flaws when you look in the mirror, appreciate what you like about your appearance. If “imperfections” distract you, remind yourself that no one is perfect. Even supermodels get retouched in their photos.

Stop thinking about yourself in a negative way. As soon as you notice that you start thinking negatively again, harshly criticizing yourself, judging, feeling guilty, stop. Ask yourself, do you have any real basis for such judgments? How can you refute them? Remember, your belief in something else is no guarantee of the truth.

Dress for yourself, not for others. You should be comfortable in the clothes you wear. Choose clothes that emphasize your personality and make you feel comfortable and confident.

Get rid of fashion magazines. Even knowing that all the photos in these magazines are completely photoshopped, they can still make you feel insecure and inferior. It is better to stay away from them until you are sure that they do not undermine your self-esteem.

Pamper your body. Instead of treating your body like an enemy, look at it as something valuable. Treat yourself to a massage, manicure, facial, candlelit bath, or scented lotion or perfume of your choice.

Lead an active lifestyle. Movement is essential for your mental and physical well-being. It is best if these are outdoor workouts.

Eating Disorder Prevention Tips

Treating eating disorders is a long process. It is very important to maintain the achieved results in order to avoid recurrence of the disease.

How to prevent the return of an eating disorder?

Gather a "support group" around you. Surround yourself with people who support you and want to see you healthy and happy. Avoid people who sap your energy, encourage erratic eating behavior, or make you feel bad. Refuse to communicate with girlfriends who always comment on your changes in weight. All these comments are not made out of good intentions, but out of envy.

Fill your life with something positive. Make time for things that bring you joy and satisfaction. Try something you've always wanted to do, learn something new, pick up a hobby. The more useful your life becomes, the less you will think about food and weight loss.

The enemy must be known by sight. Decide under what conditions the likelihood of a relapse is highest - during the holidays, during the exam session, or during the “swimsuit season”? Identify the most dangerous factors and develop an "action plan". For example, you may visit your eating disorder specialist more frequently during these times, or ask for additional moral support from your family and friends.

Avoid sites on the Internet that promote an unhealthy attitude towards your body. Avoid information resources that advertise and encourage anorexia and bulimia. Behind these sites are people who are trying to justify their unhealthy attitude to the body and nutrition. The "support" they offer is dangerous and will only hinder your recovery.

Be sure to follow your individual treatment plan. Don't skip visits to an eating disorder specialist or other parts of your treatment, even if you see improvement. Strictly follow all the recommendations developed by your "treatment team".

Any eating disorder can lead to the development of serious health problems. As a rule, it is based on psychological factors. Therefore, it is necessary to get rid of them together with specialists.

Problem types

Experts know that an eating disorder can manifest itself in many different ways. Tactics of treatment in each case should be selected individually. It will depend on the established diagnosis and the condition of the patient.

The most popular types of disorders are:

It is not always possible to recognize people who suffer from any of these disorders. For example, with bulimia nervosa, weight may be within the normal range or slightly below the lower limit. At the same time, people themselves do not realize that they have an eating disorder. Treatment, in their opinion, they do not need. Dangerous is any condition in which a person tries to draw up nutritional rules for himself and strictly adheres to them. For example, a complete refusal to eat after 4 p.m., a strict restriction or a complete rejection of the use of fats, including vegetable origin, should alert.

What to look for: dangerous symptoms

It is not always possible to understand that a person has an eating disorder. The symptoms of this disease must be known. To identify if there are problems, a small test will help. You just need to answer the following questions:

• Do you have a fear that you will gain weight?
• Do you find yourself thinking about food too often?
• Do you refuse food when you feel hungry?
• Do you count calories?
• Do you cut food into small pieces?
• Do you periodically have bouts of uncontrolled eating?
• Are you often told about your thinness?
• Do you have an obsessive desire to lose weight?
• Do you induce vomiting after eating?
• You appear
• Do you refuse to eat fast carbohydrates (baked goods, chocolate)?
• Are there only dietary dishes on your menu?
• Do people around you try to tell you that you could eat more?

If you answered “yes” more than 5 times to these questions, then it is advisable for you to consult with a specialist. He will be able to determine the type of disease and choose the most appropriate treatment tactics.

Characteristics of anorexia

Refusal to eat appears in people as a result of mental disorders. Any severe self-restraint, an unusual choice of products are characteristic of anorexia. At the same time, patients have a constant fear that they will recover. Patients with anorexia may be 15% less than the established lower limit of normal. They have a constant fear of obesity. They believe that the weight should be below normal.

In addition, people suffering from this disease are characterized by the following:

• the appearance of amenorrhea in women (absence of menstruation);
• violation of the functioning of the body;
• loss of sexual desire.

This eating disorder is often accompanied by:

• taking diuretics and laxatives;
• exclusion from the diet of high-calorie foods;
• provoking vomiting;
• taking medications designed to reduce appetite;
• long and exhausting workouts at home and in the gym in order to lose weight.

To establish the final diagnosis, the doctor must fully examine the patient. This allows you to exclude other problems that manifest themselves in almost the same way. Only then can treatment be prescribed.

Characteristic signs of bulimia

But it's not just anorexia that can develop in people with eating habits. Specialists can diagnose a neurogenic disease such as bulimia. In this condition, patients periodically cease to control how much they eat. They have bouts of gluttony. As soon as the overeating is over, patients experience severe discomfort. There is pain in the stomach, nausea, often episodes of overeating end in vomiting. Feelings of guilt for such behavior, self-dislike, and even depression cause this eating disorder. Treatment alone is unlikely to succeed.

Patients try to eliminate the consequences of such overeating by inducing vomiting, gastric lavage, or taking laxatives. It is possible to suspect the development of this problem if a person is haunted by thoughts about food, he has frequent episodes of overeating, periodically he feels an irresistible craving for food. Often episodes of bulimia alternate with anorexia. If left untreated, this disease can lead to rapid weight loss, but the balance in the body is disturbed. As a result, severe complications occur, and in some cases, death is possible.

Binge Eating Symptoms

Understanding how to get rid of an eating disorder, many forget that such problems are not limited to bulimia and anorexia. Doctors also face such a disease as compulsive overeating. It is similar in its manifestations to bulimia. But the difference is that people suffering from it do not have regular discharges. Such patients do not take laxatives or diuretics, do not induce vomiting.

With this disease, bouts of gluttony and periods of self-restraint in food can alternate. Although in most cases between episodes of overeating, people constantly eat a little something. This is what causes significant weight gain. This may occur only intermittently for some and be short-lived. For example, this is how certain people react to stress, as if eating problems. With the help of food, people suffering from compulsive overeating look for an opportunity to get pleasure and give themselves new pleasant sensations.

Reasons for the development of deviations

In case of any malnutrition, the participation of specialists is indispensable. But help will only be effective if the causes of eating disorders can be identified and addressed.

Most often, the development of the disease is provoked by the following factors:

• high standards for oneself and perfectionism;
• the presence of traumatic experiences;
• stress experienced due to ridicule in childhood and adolescence about;
• mental trauma resulting from sexual abuse at an early age;
• excessive concern for the figure and appearance in the family;
• genetic predisposition to various eating disorders.

Each of these reasons can lead to the fact that self-perception will be violated. A person, regardless of his appearance, will be ashamed of himself. You can identify people with such problems by the fact that they are not satisfied with themselves, they cannot even talk about their bodies. They attribute all the failures in life to the fact that they have an unsatisfactory appearance.

Problems in teenagers

Very often, eating disorders begin in adolescence. Significant hormonal changes occur in the child's body, his appearance becomes different. At the same time, the psychological situation in the team also changes - at this time it is important for children to look the way they are accepted, not to go beyond the established standards.

Most teenagers are preoccupied with their appearance, and against this background, they may develop various psychological problems. If the family did not devote sufficient time to the development of an objective, adequate self-esteem in the child, did not instill a healthy attitude towards food, then there is a risk that he will develop an eating disorder. In children and adolescents, this disease often develops against a background of low self-esteem. At the same time, they manage to hide everything from their parents for quite a long time.

These problems develop, as a rule, at the age of 11-13 years - during puberty. Such teenagers concentrate all attention on their appearance. For them, this is the only means that allows them to gain self-confidence. Many parents play it safe, fearing that their child has developed an eating disorder. In adolescents, it can be difficult to determine the line between normal preoccupation with appearance and a pathological condition in which it is time to sound the alarm. Parents need to start worrying if they see that the child:

• tries not to attend events where there will be feasts;
• spends a lot of time on physical activity in order to burn calories;
• too dissatisfied with his appearance;
• uses laxatives and diuretics;
• obsessed with weight control;
• overly scrupulously monitors the calorie content of foods and portion sizes.

But many parents think that an eating disorder in children cannot be. At the same time, they continue to consider their teenagers at the age of 13-15 as babies, turning a blind eye to the disease that has arisen.

Possible Consequences of Eating Disorders

The problems that these symptoms can lead to should not be underestimated. After all, they not only adversely affect health, but can also cause death. Bulimia, like anorexia, causes kidney failure and heart disease. With frequent vomiting, which leads to a lack of nutrients, such problems can develop:

• damage to the kidneys and stomach;
• feeling of constant pain in the abdomen;
• the development of caries (it begins due to the constant exposure to gastric juice);
• lack of potassium (leads to heart problems and can cause death);
• amenorrhea;
• the appearance of the cheeks of the "hamster" (due to pathological enlargement of the salivary glands).

With anorexia, the body goes into a so-called starvation mode. This may be indicated by the following signs:

• hair loss, breaking nails;
• anemia;
• amenorrhea in women;
• decrease in heart rate, respiration, blood pressure;
• constant dizziness;
• the appearance of a hair gun all over the body;
• the development of osteoporosis - a disease characterized by increased bone fragility;
• an increase in the size of the joints.

The sooner the disease is diagnosed, the sooner it will be possible to get rid of it. In severe cases, even hospitalization is necessary.

Psychological help

Many people with overt eating disorders believe they don't have any problems. But without medical help, it is impossible to correct the situation. After all, it is impossible to independently figure out how to conduct psychotherapy for eating disorders. If the patient resists and refuses treatment, the help of a psychiatrist may be needed. With an integrated approach, a person can be helped to get rid of problems. After all, with severe violations, psychotherapy alone will not be enough. In this case, drug treatment is also prescribed.

Psychotherapy should be aimed at the work of a person on his own image. He must begin to adequately evaluate and accept his body. It is also necessary to correct the attitude towards food. But it is important to work out the reasons that led to such a violation. Specialists who work with people suffering from eating disorders say that their patients are overly sensitive and prone to frequent negative emotions such as anxiety, depression, anger, sadness.

For them, any restriction in food or overeating, excessive physical activity is a way to temporarily alleviate their condition. They need to learn to manage their emotions and feelings, without this they will not be able to overcome an eating disorder. How to treat this disease, you need to deal with a specialist. But the main task of therapy is the formation of a correct lifestyle for the patient.

Worse work to get rid of the problem is for those who have difficult relationships in the family or constant stress in the workplace. Therefore, psychotherapists must also work on relationships with others. The sooner a person realizes that he has a problem, the easier it will be to get rid of it.

Recovery period

The most difficult task for patients is the development of self-love. They need to learn to perceive themselves as a person. Only with adequate self-esteem can physical condition be restored. Therefore, nutritionists and psychologists (and in some cases psychiatrists) should work on such patients at the same time.

Professionals should help overcome an eating disorder. Treatment may include:

• drawing up a nutrition plan;
• inclusion in the life of adequate physical activity;
• taking antidepressants (only necessary if there are certain indications);
• work on self-perception and relationships with others;
• treatment of mental disorders such as anxiety.

It is important that the patient has support during the treatment period. Indeed, often people break down, take breaks in treatment, promise to return to the planned action plan after a certain time. Some even consider themselves cured, although their eating behavior does not change much.

- a group of psychogenic behavioral syndromes characterized by deviations in the intake and processing of food. This group includes anorexia nervosa, bulimia nervosa, overeating and some other disorders. Symptoms are varied, including refusal to eat, overeating, provoked and involuntary vomiting, use of laxatives, and denial of the subjective significance of the weight problem. The diagnosis is based on the results of a conversation with a psychiatrist and psychological testing data. Treatment is based on individual and group psychotherapy, the use of medications.

General information

In the International Classification of Diseases, eating disorders are classified under a separate heading "Eating Disorders". A common characteristic of the group is the contradiction between the physiological need for food and the desires of the patient. The peak incidence occurs in adolescence and young age. A stable gender predisposition is determined, girls and women make up 85-95% of patients with anorexia and bulimia, 65% of those with psychological overeating. According to recent studies, psychogenic eating disorders are more likely to develop in people from wealthy families with a high level of education and income, among residents of economically developed countries.

Causes of eating disorders

In the occurrence of disorders of this type, a significant role is played by the psychological and physiological characteristics, the social relations of the patient. Specific causes are determined by a specialist in the diagnostic process. As a rule, several factors are identified that predispose to the disease, and one or two that served as triggers. Among the possible conditions for the development of psychogenic eating disorders are:

• Psychological features. Disorders are formed on the basis of emotional instability, feelings of guilt, low self-esteem, suggestibility, dependence on the opinions of others. At risk are adolescents experiencing an age crisis.
• Microsocial conditions of life. An important role in the formation of violations is played by the family's eating habits - lack of a diet, addiction to sweet foods, as well as upbringing methods - overprotection, authoritarianism, the use of food as a tool for punishment or encouragement. In adolescence and young age, the comments of parents, peers, spouses regarding appearance become significant.
• Stress. Psychogenic increase or decrease in appetite, mechanical gluttony without a feeling of hunger arise as ways to compensate for emotional stress. Gradually, a change in food intake and its result become independent sources of stress.
• public values. Eating disorders directly form the imposed "ideals" of beauty - harmony, thinness, fragility. Indirectly, violations are formed as a result of increased requirements for success, ability to work, and stress resistance.
• hereditary predisposition. The features of the physiological processes that form the basis of a perverted, reduced or increased appetite, the development of fullness are genetically transmitted. These include hormonal imbalance, impaired transmission of neurotransmitters.
• Mental Illnesses. Psychogenic syndromes are often detected in schizophrenia, bipolar affective disorder, depression, psychopathy. Such cases are distinguished by pronounced clinical signs, resistance to therapy.

Pathogenesis

Pathological changes in eating disorders occur at two levels - mental and physiological. Initially, a conflict is formed between the basic need to eat and actual human desires that arise as a result of social relations, adaptation to stress, self-esteem, etc. Desire forms an obsessive, overvalued idea that determines motives and behavior. With anorexia, the thought of losing weight dominates, with bulimia nervosa - the fear of gaining weight, with psychogenic overeating - the desire to relax, avoid stress. In more rare cases, ideas are of a peculiar nature. For example, the patient is afraid to eat a certain type of food, considering it dangerous. Following mental changes, the process of processing and assimilation of food is disturbed, a deficiency of nutrients, vitamins, and microelements develops.

Classification

Eating disorders are very diverse. The most common and clinically distinct types are considered in the ICD-10 as separate nosological units. Less studied features - nervous orthorexia, drunkorexia, selective nutrition - continue to be investigated and are not considered as a pathology by all specialists. In accordance with the international classifier of diseases, there are:

• Anorexia nervosa. It is characterized by the dominant idea of ​​weight loss, severe restrictions on the volume and caloric content of food, and exhaustion. Accompanied by the risk of death.
• bulimia nervosa. It is manifested by bouts of gluttony, followed by a sense of guilt and forcible disposal of what has been eaten. Weight remains stable or slowly increases.
• Psychogenic overeating. Gluttony occurs in response to a stressful situation, is fixed in behavior as a way to get rid of affective tension. Leads to weight gain.
• Psychogenic vomiting. Seizures develop against a background of strong emotions. Accompany somatoform diseases, hypochondriacal and dissociative disorders, pregnancy.
• Eating inedible inorganic origin. This group includes the eating by adults of chalk, clay, leaves of inedible plants. Violations lead to serious somatic diseases.
• Psychogenic loss of appetite. Craving for food decreases with prolonged depression, intense experiences that accompany psychotrauma. The severity and duration of the disorder directly correlates with emotional disturbances.

Symptoms of Eating Disorders

Symptoms of psychogenic anorexia are emaciation, persistent desire for thinness, unwillingness to maintain normal weight, distortion of body image, obsessive fear of weight gain. Patients adhere to excessively strict diets with the maximum possible restriction of calorie content and food volumes, eat food 1-2 times a day. If the rules of the “diet” are violated, they feel guilty, provoke vomiting, and use laxatives. The signs of dysmorphophobia are determined - a distorted idea of ​​​​one's own body. Patients consider themselves fat with really normal or insufficient weight. They are characterized by a depressed, depressed state, isolation, social distance, excessive preoccupation with nutrition and physical activity.

In bulimia, periodic episodes of eating large amounts of food are observed. Bouts of uncontrolled binge eating are followed by purging, a type of behavior aimed at ridding the body of the food eaten. Patients induce vomiting, take laxatives, give enemas, endure a period of strict dieting, and torture the body with physical exercises. Dominated by fear of weight gain, dissatisfaction with appearance, guilt. Episodes of bulimia often occur in secret from other people. The binge and purge cycle is repeated several times a week.

Psychological overeating is manifested by gluttony, which develops with emotional stress, stress. Patients do not realize the onset of satiety, continue to eat until the onset of uncomfortable sensations - a feeling of heaviness, fullness of the stomach, nausea. When eating food, they understand that the control of actions is lost, but they cannot restore it. The feeling of shame and guilt becomes a source of additional stress and again provokes gluttony. With psychogenic vomiting, seizures occur due to a stressful external situation and internal experiences. The eruption of the contents of the stomach occurs involuntarily. Psychogenic loss of appetite is characterized by an indifferent attitude to food. Patients indiscriminately skip meals, eat reluctantly, quickly saturate.

Complications

In disorders characterized by restriction in food intake, there is a risk of developing pathologies of the gastrointestinal tract, diseases associated with a deficiency of vitamins, minerals, and nutritional compounds. Patients become thinner bones, develop osteopenia, osteoporosis, B12-deficiency and iron deficiency anemia, hypotension, lethargy, muscle weakness, brittle nails, hair loss, dry skin. In severe cases of anorexia, the work of almost all organs and systems is disrupted, and there is a risk of death. Complications of psychogenic vomiting and bulimia are chronic inflammation and sore throat, destruction of tooth enamel, irritation and upset of the intestines, kidney problems, dehydration.

Diagnostics

The primary diagnostic examination is often carried out 1-3 years after the onset of the disorder, when the patient consults a doctor due to the appearance of somatic symptoms - disorders of the gastrointestinal tract, a significant change in weight, weakness. Diagnosis is carried out by a psychiatrist, clinical psychologist, somatic specialists. Specific research methods include:

• Conversation. The psychiatrist finds out the anamnesis, symptoms of the disease. He asks about the peculiarities of nutrition, the patient's attitude to his own appearance, existing stressful and psychotraumatic situations. The interview may be conducted in the presence of a close relative, as the patients themselves tend to deny the presence of the disorder and underlying psychological problems.
• personality questionnaires. The study is aimed at identifying character traits, emotional states, social problems that contribute to the development of eating disorders. Unstable self-esteem, dependence on the opinions of others, a tendency to self-accusation, a state of stress, psychological maladaptation are determined. SMIL, the Eysenck questionnaire, the Dembo-Rubinstein method, the Eating Behavior Rating Scale are used.
• Projective methods. Drawing and interpretation tests are conducted in addition to the questionnaires. They allow to reveal the tendencies denied, hidden by the patient - fear of gaining weight, rejection of one's own body, the need for a positive assessment of others, impulsiveness, lack of self-control. The test of color choices is applied, the drawing "Self-portrait", Thematic Apperceptive Test (TAT).

For the purpose of differential diagnosis - distinguishing between psychogenic disorders and somatic diseases - consultations of a gastroenterologist, cognitive-behavioral therapy, psychoanalysis, group trainings are prescribed. Work is underway to realize the existing distorted ideas about oneself, correct self-esteem, change behavior, master the skills of coping with a stressful situation.

Forecast and prevention

The prognosis is determined by the type of disorder, the timeliness of therapy. A favorable outcome is most likely in the absence of other mental illnesses (schizophrenia, depression, psychopathy), the preservation of the patient's critical abilities, and motivation for recovery. Prevention includes a commitment to proper nutrition from early childhood, the formation in children and adolescents of the value of health, body acceptance, the development of skills to withstand stressful situations, relieve emotional tension (playing sports, creativity, correctly defending one's own opinion, productive conflict resolution).

Look out for warning signs. You must be honest with yourself if you find such symptoms. Remember, eating disorders can have life-threatening complications. Don't underestimate the seriousness of an eating disorder. Also, don't think you can handle it on your own without someone's help. Don't overestimate your strengths. Key warning signs to look out for include:

• You are underweight (less than 85% of the normal range for your age and height)
• You are in poor health. You notice that you often bruise, you are emaciated, you have a pale or sallow complexion, dull and dry hair.
• You feel dizzy, you feel cold more often than others (the result of poor circulation), you feel dry eyes, you have a swollen tongue, your gums bleed, and fluid is retained in the body.
• If you are a woman, your period is three months or more late.
• Bulimia is characterized by additional symptoms, such as scratches on one or more fingers, nausea, diarrhea, constipation, swollen joints, and so on.

Pay attention to changes in behavior. In addition to physical symptoms, eating disorders are also associated with emotional and behavioral changes. These include:

• If someone tells you that you are underweight, you will be skeptical about such a statement and will do everything possible to convince the person otherwise; you don't like talking about being underweight.
• You wear loose, baggy clothing to hide sudden or significant weight loss.
• You ask for forgiveness for not being able to be present at meals, or find ways to eat very little, hide food, or induce vomiting after meals.
• You are fixated on a diet. All conversations come down to the topic of dieting. You try your best to eat as little as possible.
• You are haunted by the fear of becoming fat; you are aggressively opposed to your figure and weight.
• You expose your body to exhausting and severe physical stress.
• You avoid socializing with other people and try not to go out.

An eating disorder (eating disorder) is a psychogenic behavioral syndrome associated with eating disorders.

a) the long-established binge-purge cycle is harder to change;

b) recovery is slower when the "overeating-purging" cycle replaces the patient with another, more "normal" activity - for example, socializing with friends, outdoor activities, etc .;

c) the change is fraught with additional difficulties when the patient suffers from severe depression or other emotional distress.

Atypical bulimia nervosa is also distinguished when one or more of the key signs for bulimia nervosa are absent, but otherwise the clinical picture is typical. Most often this applies to people who are normal or even overweight, but with typical periods of overeating, accompanied by vomiting or taking laxatives.

Binge eating, resulting in excess weight, and a reaction to distress, may follow bereavement, accidents, surgery, and emotional distress, especially in persons predisposed to corpulence.