To eat or not to eat – thoughts revolve around nutrition all day, and yet people are hungry. It often starts with a diet, but the desire to control weight comes to life and becomes a mental illness: anorexia nervosa – better known as anorexia. It mainly affects young women, only one patient in twelve is male.
Those affected cannot understand the assurances of relatives and friends that they are too thin and certainly not fat, because they have a disturbed perception of their body, a so-called body image disorder. This means that they no longer see their real body, but another. Your perception is distorted and no longer corresponds to reality. People with anorexia usually see a fuller body, so they think they are fatter than they are. Your body does not get enough nutrients and suffers from deficiency symptoms.
Symptoms of anorexia: fatigue, heart problems, fluffy skin
The people concerned are often tired, cold, many have a slow heart rate, heart rhythm and concentration disorders or even osteoporosis. Menstruation often does not occur in women. Anorexia also changes the organism from the outside: hair loss, dry and itchy skin, fine down on the skin (lanugo hairs) and damage to the teeth due to frequent vomiting are the signs. Those affected often also suffer from other mental illnesses such as depression, obsessive-compulsive disorder or anxiety disorders.
Various causes: predisposition to social influence
There is no single cause for the development of anorexia. Different factors combine and can influence each other:
- biological and physical influences
- hereditary predisposition
- Disordered eating habits in infancy or onset of strict dieting
- personal development factors
- low self-esteem, emotional instability, or concerns about appearance, shape, and weight
- Social influences such as a predominant thin beauty ideal
However, these factors alone do not make you sick, but rather set the stage for illness. Anorexia triggers are usually deeper and more complex. These can be, for example, stressful experiences such as the loss of a loved one, separation from a partner or trauma, for example through violence. Almost all patients report being afraid of losing control. This is sometimes due to experiences of violence, often sexual, which they have lived through helplessly. There are always deep-seated triggers and factors that influence each other and need to be considered in therapy.
Anorexia Treatment: Working on the Cause
Those who suffer from this disease live with the bad conscience of not being able to control their hunger. For doctors and therapists, the eating disorder is one of the most difficult mental illnesses to treat, because sufferers often perceive anorexia as a kind of invisible friend. Depriving your body of the nourishment it needs gives you that much-desired sense of control. Therapy can only work when patients admit to themselves that their eating habits are not normal.
Treatment for anorexia takes place in specialized eating disorder clinics and includes three pillars:
- The first pillar includes the weight and eating habits of those affected. It’s about relieving acute symptoms, gaining weight and developing healthy eating habits. Many affected people no longer even know what a normal portion is.
- The second pillar is the psychotherapeutic treatment of the underlying problems.
- The third pillar is to prevent relapses. The possible factors triggering and maintaining the disease are taken into account and treated.
Psychotherapy can help those affected
Some control their eating disorder through outpatient psychotherapy, with a therapist who specializes in eating disorders. A family doctor should be closely involved. One shows that outpatient therapies can be effective five-year study. But it must be a particular psychotherapy: a cognitive-behavioral therapy or an in-depth psychological therapy.
In the case of hospital therapy, motivation is encouraged at the beginning. First, a therapy contract is concluded: with this, the patients commit to gaining a certain agreed amount of weight within a week. Point two of the contract: normalization of eating habits.
Therapy: individual and group work
Many appetite suppressants like to prepare food with love, but then peck at it. In therapy, they must also eat it. Weigh yourself twice a week. It is not uncommon for patients to drink a liter of water beforehand to put more weight on the scale and hide the fact that they have not always eaten everything.
There is an individual therapy session at least once a week: Specialized psychotherapists often work with cognitive behavioral therapy methods. Deep psychological methods are also used and aim to help patients find and understand their own causes of illness. Group discussions then focus more on general questions, such as why many people want to retain their anorexia.
Possible sequelae: osteoporosis, hormonal changes, heart failure
The theme of self-esteem is important in therapy: people with anorexia often have extremely high expectations of themselves and feel that they cannot live up to these expectations. So they constantly devalue themselves. Running away from self-imposed hunger is the only good thing – as long as you have control over yourself.
Those affected can also become physically very ill: heart damage with heart failure, hormonal changes, osteoporosis with broken ribs or vertebrae at a young age can be the consequences of anorexia. About a quarter of patients cannot be definitively cured, the disease becomes chronic. Overall, the risk of dying is ten times higher than that of healthy peers.
The disease usually begins with dieting during puberty
The disease often begins with dieting at the onset of puberty. However, the desire to be thin is not usually the driving force behind pathological starvation: patients often come from sheltered homes with a strong desire for harmony, in which anger and negative feelings are not allowed. Illness is an attempt at autonomy. In the case of adolescents, the parents are therefore usually involved in the therapy.