Anorexia is the medical term for ‘not eating’. With the intense fear of gaining weight, extreme restrictions in the amount of food and severe weight loss are seen in people. Not only the body, but also the mental health is significantly affected by this disease. The weight loss process, which starts with a diet, gets out of control and no matter how much she loses weight, she continues to see herself as overweight due to the deterioration in body image. The calories of the foods he eats constantly are calculated, and he cannot get away from diet and weight thoughts. In fact, people with anorexia are normal weight or underweight. But they don’t see it and don’t believe it when told. Often they do not accept that this is a problem and they deny that they have such a problem. They are afraid of gaining weight and refuse to stay at a normal weight. They focus their entire lives on weight and weight loss. He has an obsession with diet and weight. They have reduced the amount of food very much, they exercise as a load, they use foreign substances such as vomiting, bowel trainer drugs and unknown weight loss pills in order not to gain weight.
- Although it has been defined as an eating disorder for centuries, its history is quite remarkable. Hedonism and asceticism in ancient eastern cultures and early Christianity led people to starve. And in almost every religion, not eating or restricted eating has been one of the main elements of gratitude and reward mechanisms between the creator and the servant. The idea that beliefs and cultural behaviors have a significant impact on eating disorders has long been accepted. It is thought that the idealized thin and long body type, especially in the western society, has an important effect on the development of anorexia. In another view, the ‘two worlds hypothesis’ was put forward by combining feminist and cultural approaches (Katzman and Lee). Accordingly, refusal to eat refers to the mechanism of coping with the difficulties of the transition period in which the individual is. The person refuses to eat as an effort to perfect his physical self in his way of life, social and political views, or as an effort to adapt to the country, socio-economic situation or culture in his new world by breaking away from his country.
Those who have an eating disorder, depression, alcohol and substance abuse in their family, those who have early menstruation biologically and are slightly overweight, those who have to keep their body under constant professional control (athletes, models…), those who are under intense mental stress (divorce or separation process, bereavement, etc.), those with a persistently anxious personality, and of course perfectionists are more prone to anorexia (eating disorders). Although generalization is not always valid, in people with anorexia; low self-confidence, difficulty in expressing feelings, difficulty in coping with stress, the need to constantly please those around, the expectation of being perfect, inability to leave the family, high goals of the family and psychiatric diseases such as depression, aggressive or age-inappropriate behavior pattern, social withdrawal and obsession disorders ( Psychological changes such as obsessive compulsive disorder are often accompanied. Due to excessive weight loss and nutritional disorders, even life-threatening symptoms can be seen in the advanced stage with relatively mild physical symptoms such as menstrual irregularity, digestive system disorders such as diarrhea, deterioration in skin, hair and nails.
Being under the expected body weight for age and height (not accepting a higher weight), excessive fear of gaining weight, and lack of menstruation are the main symptoms in diagnosis. The deterioration in body image ranges from not accepting that people are weak to believing that some parts of their bodies are large/wide. Denial of the seriousness of the disease is an important finding in most patients, and they may develop behaviors such as eating too slowly, eating too little, exercising excessively to maintain weight loss or prevent weight gain.
Bulimia is a disease characterized by binge-eating episodes followed by behaviors that prevent weight gain, such as vomiting or laxative use. The most important difference from anorexias is that they can be normal weight or overweight. However, they are not very weak. Body weight is not a criterion for diagnosis. The fear of gaining weight with binge eating and purging behavior is sufficient.
binge eating; It is the consumption of excessive amounts of food in a very short time. Mostly, easily digestible high-calorie foods are preferred. They are aware that it is not healthy and correct, but they cannot prevent it. The binge eating attack can happen every day or a few times a month. And it takes about 1 hour. Loss of control during eating can start spontaneously, or it can start with the planning of time and space that patients can hide.
It is not hunger but an anxiety-provoking situation or depression that initiates eating attacks. Patients get rid of this mood while they eat, but then they have a negative affect on which guilt and regret are added. Eating attack does not start with hunger, nor does it end with satiety. The meal ends because of the exhaustion of the meal, the feeling of nausea, and discomfort in the abdomen. Feelings of guilt and discomfort bring along the need for purification. The most common cleansing method (85-90% of patients) is vomiting. While vomiting is initially provided with a provocative stimulus, they may vomit voluntarily without the need for any mechanical or chemical stimulus in the future. About one-third also have laxative abuse.
PROCESS IN EATING DISORDERS
40% of patients with anorexia have complete recovery, 30% have moderate recovery, while 20% have a poor outcome. When the disease begins at an early age, the rate of complete recovery reaches 70% when quickly diagnosed and treated. Bulimia nervosa goes away with frequent recovery and frequent disease recurrences. Although long-term treatment success rates vary, it is better than anorexia. Excessive preoccupation with body weight and shape and a history of childhood obesity are associated with poor outcome.
Long-standing eating disorders are accompanied by blood and biochemical disorders, vitamin deficiencies, decrease in bone mineral density, and hormonal abnormalities. For this reason, all eating disorders should be examined in detail, and joint treatment should be carried out with the branches related to the problem. If there is significant weight loss (BMI ≤ 13), hospitalization should be considered.
Individual psychotherapies, family therapies and drug support (SSRI) in certain cases are sometimes treated separately, sometimes together, depending on the patient’s condition.