eating disorder
Introduction
Introduction to eating disorders Eating Disorder (ED) is a group of syndromes characterized by abnormal eating behavior. This group of diseases mainly includes anorexia nervosa (AN) and bulimia nervosa (BN), which are mental disorders. The main feature of neuropathic anorexia is that patients deliberately cause underweight by various methods such as dieting, and refuse to maintain the lowest standard weight. The main features of bulimia nervosa are repeated overeating and inappropriate offset after binge eating. Behaviors such as vomiting, diuresis or laxatives, dieting or excessive exercise. The abnormal behavior of eating disorders is not secondary to any other physical and mental illnesses, and the fear of and trying to counteract the 'fat' effect of food is often the most obvious psychological pathology in most patients. For patients with a body mass index below 15, hospitalization is usually recommended to ensure improved nutrition and weight gain and to promote therapeutic efficacy. basic knowledge The proportion of illness: 0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: arrhythmia, bloating, constipation, abdominal pain, leukopenia, depression, electrolyte imbalance, hypokalemia, hypomagnesemia, pancreatitis
Cause
Causes of eating disorders
1. Individual factors: including biological factors and personality factors. Biological factors refer to a certain genetic predisposition in patients with eating disorders (more people in the family with eating disorders and other mental disorders than in the normal population) and functional abnormalities in some brain regions; personality factors are common in patients with eating disorders Typical personality characteristics - the pursuit of self-control, the pursuit of perfection and uniqueness; love fantasy, do not want to grow up. In adolescence, it is easy to show strong conflicts of autonomy and dependence, causing problems in eating.
2. Family factors: Family factors may play an important role in the occurrence, development, maintenance and rehabilitation of eating disorders. The common 'family eating disorder' model has (1) the emotional entanglement of family members, unable to distinguish each other - 'love your love, hurt your pain'; (2) parents overprotect the child; (3) Parental conflicts, children involved in it, burdened with excessive burdens; (4) family mode is rigid, unable to adapt to the child's development - always treat the grown up child in a way that treats the baby. Some scholars have suggested that patients with eating behavior represent the resistance of parental over-control and over-protection to the pathogenesis of eating disorder; or the use of dieting as a means to achieve parental anti-control as a way to resolve conflicts within the family. . Some scholars believe that the patient's dependence is strong, and the relationship with the mother is too close and dependent, and self-control eating is a symbol of independence.
3. Social and cultural factors: In modern social and cultural concepts, women's slim figure is the representative of self-confidence, self-discipline and success. Therefore, women who develop adolescence can easily target their weight loss when pursuing psychological power and independence. The media vigorously promotes the effect of weight loss, advocating the ultimate body for everyone, and makes it easier for girls who pursue perfection and fantasy to fall into it.
Prevention
Eating disorder prevention
It involves the scope of primary, secondary and tertiary prevention.
Primary prevention includes active health educationknowledge knowledge, healthy aesthetic orientation, positive self-affirmation, positive interpersonal relationships, and control of advertising and sales of diet pills.
Secondary prevention includes knowledge of widespread eating disorders and enhances the ability of primary care institutions to identify and refer to eating disorders.
Tertiary prevention includes the ability to identify specialist hospitals for diagnosis and treatment of eating disorders.
Complication
Eating disorder complications Complications arrhythmia bloating constipation abdominal pain leukopenia depression electrolyte disorder hypokalemia hypomagnesemia pancreatitis
Medical complications of anorexia nervosa:
(1), cachexia: extreme weight loss, subcutaneous fat is significantly reduced, muscles disappear, low metabolic state (low T3 syndrome), cold, difficult to maintain normal body temperature.
(2), heart: myocardial weakness, heart becomes small, arrhythmia, atrial, ventricular premature contraction, bundle branch block, outdoor heart overspeed, can suddenly die.
(3), digestive tract symptoms: delayed gastric emptying, abdominal distension, constipation, abdominal pain.
(4), reproductive system: menopause, low.
(5), skin: the body can be covered with baby-like slender fluff.
(6), blood system: leukopenia.
(7), spiritual aspects: depression.
(8) Complications associated with vomiting and laxatives.
(9), metabolism: electrolyte imbalance, especially hypokalemia, hypochlorine alkalosis, hypomagnesemia.
(10), gastrointestinal tract: may be associated with pancreatitis, pancreatic enlargement with increased serum amylase, esophagus and stomach rot, intestinal function.
(11), oral cavity: teeth are eroded by gastric acid due to repeated vomiting, especially the anterior teeth.
(12), neurological aspects: fatigue, weakness, mild organic brain syndrome.
Symptom
Eating disorders symptoms common symptoms overeating gluttony anorexia nervosa
Because the earliest visible problems are often malnutrition, digestive tract and endocrine symptoms such as weight loss, constipation, vomiting, amenorrhea, and intentional concealment of patients with psychological experience. These patients initially visited the general hospital for gastroenterology, endocrinology, and gynecology. , Chinese medicine, etc., a large number of laboratory tests and symptomatic treatment, thus delaying the diagnosis and treatment of the disease. In addition, because of the early, middle and late stages of these diseases, it is easy to combine depression and obsessive-compulsive symptoms. In psychiatry, it is often diagnosed and treated simply by 'depression' or 'obsessive-compulsive disorder', while ignoring the most fundamental psychological pathology. . Therefore, eating disorders with psychosomatic nature require more attention and understanding in both general hospitals and psychiatric hospitals to improve the efficacy and prognosis of such diseases.
a, subjective gluttony: patients with anorexia nervosa often set a strict eating plan for themselves, when they (he) eat more than the plan, they will complain of "gluttony", this symptom is called "subjective gluttony."
b. Fear of fat: The fear of obesity in patients with eating disorders is significantly different from the fear of obesity in normal people. The weight limit set by them is lower than the minimum weight of normal weight.
Examine
Eating disorder check
The diagnosis of anorexia has an effective visual aid condition - the patient has significant visible weight loss, the body mass index drops below 17.5, or does not reach the desired body growth criteria during puberty development, with developmental delay or cessation.
In addition, such weight loss or weight loss is deliberately caused by the patient himself, including means of refusing to eat "food that causes weight gain", and at least one of the following: 1 self-induced vomiting; 2 catharsis; 3 excessive exercise; 4 appetite Inhibitors or diuretics, etc. Many patients have specific psychopathic body image distortionsa persistently overvalued concept that is unusually afraid of getting fat, and the patient sets a too low weight limit for himself, which is much lower than his pre-existing condition. The physician considers it to be a moderate or healthy weight.
At the same time, endocrine disorders occurred, and women showed amenorrhea (menopause has at least 3 consecutive menstrual cycles); males showed loss of sexual interest or sexual dysfunction. Before puberty, puberty development slows or stagnates (growth stops, girls' breasts do not develop and primary amenorrhea, boy genitalia is naive), with the recovery of the disease, puberty can be normal, but menarche is delayed. When the above symptoms exist for 3 months or longer, the diagnosis of anorexia should be considered.
Diagnosis
Diagnostic identification of eating disorders
Anorexia nervosa
1, disease diagnosis:
The diagnosis of anorexia has an effective visual aid condition - the patient has significant visible weight loss, the body mass index drops below 17.5, or does not reach the desired body growth criteria during puberty development, with developmental delay or cessation. In addition, such weight loss or weight loss is deliberately caused by the patient himself, including means of refusing to eat "food that causes weight gain", and at least one of the following: 1 self-induced vomiting; 2 catharsis; 3 excessive exercise; 4 appetite Inhibitors or diuretics, etc. Many patients have specific psychopathic body image distortionsa persistently overvalued concept that is unusually afraid of getting fat, and the patient sets a too low weight limit for himself, which is much lower than his pre-existing condition. The physician considers it to be a moderate or healthy weight. At the same time, endocrine disorders occurred, and women showed amenorrhea (menopause has at least 3 consecutive menstrual cycles); males showed loss of sexual interest or sexual dysfunction. Before puberty, puberty development slows or stagnates (growth stops, girls' breasts do not develop and primary amenorrhea, boy genitalia is naive), with the recovery of the disease, puberty can be normal, but menarche is delayed. When the above symptoms exist for 3 months or longer, the diagnosis of anorexia should be considered.
Description: 1, the calculation method of body mass index: the number of kilograms of body weight / square meter of height; 2, need to rule out weight loss caused by physical diseases (such as brain tumors, intestinal diseases such as Crohn's disease or malabsorption syndrome, etc.). 3. Atypical anorexia nervosa can be diagnosed when one or more of the above characteristic conditions are absent, such as body weight and amenorrhea, and a typical clinical phase is present.
2, differential diagnosis
In addition to weight loss due to physical illness, it is also necessary to identify the following psychiatric diseases.
1. Antifeedant, inducement and weight loss under the control of illusion of schizophrenia;
2. Loss of appetite and weight loss due to depression;
3. Gastrointestinal discomfort, difficulty eating and weight loss due to somatization disorders;
4. Malnutrition caused by obsessive-compulsive disorder caused by food type restriction, prolonged time, and reduced eating.
Neuropathic bulimia
The appearance of bulimia patients often has no special features, and the body weight is usually within the normal range. Its diagnostic feature is that the patient continues to have uncontrollable cravings for food and the urge to eat, showing unrestrained eclipse and eating a lot of food in a short time. At the same time, patients use at least one of the following methods to counteract the 'fat' effect of food: 1 self-induced vomiting; 2 abuse of laxatives; 3 intermittent fasting; 4 use of appetite suppressants, thyroxine preparations or diuretics. If you are a diabetic, you may ignore your insulin treatment. Most people with bulimia also have a morbid fear of getting fat, and they set a strict weight limit for themselves. This threshold is usually lower than the weight that the pre-treatment doctor thinks is moderate or healthy. There is often a history of anorexia nervosa, which varies from a few months to several years, and some patients show a typical alternating anorexia and bulimia. The episode of binge eating is at least 2 times a week for 3 months.
Description: 1 Diagnosis of bulimia requires elimination of overeating caused by organic diseases of the nervous system, and binge eating secondary to mental disorders such as epilepsy and schizophrenia. 2 Sometimes the disease can be secondary to depression, leading to a diagnosis or a side-by-side diagnosis if necessary. 3 When there is a typical clinical phase of anorexia nervosa, priority is given to the diagnosis of anorexia nervosa. 4 In the absence of one or more of the above characteristic conditions, such as the morbid fear of getting fat, and in addition to having a typical clinical phase, can be diagnosed as atypical bulimia.
