EATING DISORDERS

ANOREXIA NERVOSA

Anorexia is the medical name for the disorder of 'not eating'. Due to an intense fear of gaining weight, people experience excessive restrictions on food intake and severe weight loss. Not only physical but also mental health is significantly affected by this disease. The weight loss process, which started with dieting, gets out of control and no matter how thin one loses, one continues to see oneself as overweight due to the deterioration in one's body image. The calories of the foods he eats are constantly calculated, and he cannot get away from thoughts of diet and weight. In fact, people with anorexia are at normal weight or underweight. But they do not see this and do not believe it when told. They often do not accept that this is a problem and deny that they have such a problem. They are afraid of gaining weight and do not agree to stay at a normal weight. They focus their whole lives on weight and weight loss. They are obsessively obsessed with diet and weight. They have reduced the amount of food they eat, do exercise in the form of overload, and use foreign substances such as vomiting, bowel stimulants and slimming pills of unknown content in order not to gain weight.

Although it has been defined as an eating disorder for a century, its history is quite remarkable. The hedonism and asceticism seen in ancient eastern cultures and the early periods of Christianity led people to starve themselves. And in almost every religion, not eating or restricted eating has been one of the main elements of the gratitude and reward mechanisms between the creator and his servant. It has long been accepted that beliefs and cultural behaviors have a significant impact on eating disorders. It is thought that the thin and tall body type, especially idealized in western society, has a significant impact on the development of anorexia. In another view, feminist and cult By combining local approaches, the 'two world hypothesis' was put forward (Katzman and Lee). Accordingly, food refusal refers to the individual's coping mechanism with the difficulties of the transition period he is in. The person refuses to eat as an effort to perfect his physical self in his lifestyle, social and political views, or as an attempt to break away from his country and adapt to the country, socio-economic situation or culture in his new world.

Eating disorders, depression, alcohol and substance abuse in his family. Those who have abused, those who have biologically premature menstruation and are slightly overweight, those who need to keep their body under constant control as a profession (athletes, models, etc.), those who are under intense psychological stress (divorce or separation process, mourning, etc.), those who have a constantly anxious personality. Those who have it 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 expressing emotions, difficulty coping with stress, the need to constantly please those around them, expectation of being perfect, inability to separate from the family, high family goals and psychiatric diseases such as depression, aggressive or age-inappropriate behavior patterns, social withdrawal and obsession disorders ( It is often accompanied by psychological changes such as obsessive-compulsive disorder. Due to excessive weight loss and nutritional disorders, menstrual irregularities, digestive system disorders such as diarrhea, and relatively mild physical symptoms such as deterioration in skin, hair and nails may even be life-threatening in the advanced stages.

The expected diagnosis is based on age and height. Being under body weight (not accepting a higher weight), extreme fear of gaining weight and lack of menstruation are the main symptoms. Deterioration in body perception, people's weakness It ranges from not accepting their body size to believing that some parts of their body 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, and exercising excessively to maintain weight loss or prevent weight gain.

BULIMIA NERVOSA

Bulimia is a disease characterized by bouts of binge eating followed by behaviors that prevent weight gain, such as frequent vomiting or use of laxatives. Their most important difference from those with anorexia is that they can generally be normal weight or overweight. However, they are not very weak. Body weight is not a criterion for diagnosis. The fear of gaining weight through binge eating and purging behavior is enough.

Binge eating; It is the consumption of excessive amounts of food in a very short time. High-calorie foods that are easily digested are generally preferred. They are aware that it is not healthy and right, but they cannot prevent it. Binge eating attacks can occur every day or several times a month. And it takes approximately 1 hour. Loss of control during eating may begin spontaneously, or it may begin with patients planning a time and place that they can hide.

What initiates eating attacks is often not hunger, but an anxiety-provoking situation or depression. Patients get rid of this mood while eating, but then they experience a negative affect with the addition of guilt and regret. An eating attack does not begin with hunger, nor does it end with satiety. The meal ends due to food exhaustion, feeling of nausea, and abdominal discomfort. Feelings of guilt and discomfort bring with them the need for purification/liberation. The most commonly used purification method (85-90% of patients) is vomiting. K While vomiting is initially achieved with a provocative warning, in the future they may vomit voluntarily without the need for any mechanical or chemical stimulation. Approximately one-third also have laxative abuse.

PROCESS IN EATING DISORDERS

Full recovery is observed in 40% of anorexia patients, moderate recovery is observed in 30%, while 20% has a poor outcome. When the disease begins at an early age, the full recovery rate reaches 70% when it is diagnosed quickly and treatment is started. Bulimia nervosa progresses with frequent remissions and frequent relapses. Although long-term treatment success rates vary, they are better than those for 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 branches related to the problem. If there is significant weight loss (BMI ≤ 13), hospitalization should be considered.

Individual psychotherapies, in certain cases, family therapies and medication support (SSRI) are sometimes administered separately, sometimes together, depending on the patient's condition.

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