Anorexia nervosa is a mental illness in the field of eating disorders. In the World Health Organization (WHO) diagnostic catalog, it is listed under the code F50.0 Anorexia Nervosa.
A reliable diagnosis is usually made by a specialist in psychosomatic medicine, a neurologist/psychiatrist or a licensed psychotherapist.
The following examinations are necessary for this:
- Detailed interview (medical history),
- Determination of the body mass index (BMI),
- Blood pressure, pulse and temperature measurement,
- Check for edema,
- blood count,
- examination of heart, liver and kidney function.
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The main symptom of anorexia is a strictly controlled and reduced food intake. At the same time, those affected try to burn as many calories as possible - usually by exercising excessively.
Patients disguise this refusal to eat with, for example, a lack of appetite ("I'm not hungry.") or they find excuses to avoid eating together ("I've already eaten at home.").
In order to suppress an elementary need such as hunger, those affected need an enormous amount of discipline. As the disease progresses, patients no longer perceive the feeling of hunger.
Starvation and weight loss lead to physical symptoms such as
- Low blood pressure,
- water retention,
- osteoporosis (reduced bone density),
- dry skin,
- digestive problems,
- disturbances in the electrolyte balance and
- changes in the brain (reversible atrophy).
Chronic courses are dangerous, as the risk of life-threatening conditions such as heart failure increases.
Anorexia also manifests itself in psychological symptoms. It often leads to
- social withdrawal,
- depressive moods,
- inner restlessness and
- compulsions.
Psychotherapy is the first choice in the treatment of anorexia nervosa. In mild cases, outpatient therapy is sufficient. However, hospitalization is often advisable. In the case of life-threatening underweight, emergency care (force-feeding) may be necessary.
The main goals of therapy are
- Normalization of weight,
- (Re-)learning healthy eating behavior,
- resolving conflicts and
- dealing with one's own body image.
In individual sessions or group sessions, those affected learn, for example, strategies to break compulsive patterns and resolve conflicts.
Nutritional advice, for example in cooking groups, helps those affected to get back to a normal approach to food. It is also important to have an understanding environment that is familiar with the particularities of anorexia and offers patients the necessary support. Comments such as "Why don't you just eat more?" are inappropriate and are perceived as hurtful by those affected.
As the disease usually breaks out during puberty or in young adulthood, the family of those affected plays an important role.
At this point, it is important to remember that puberty and adolescence place enormous demands on everyone involved. Parents and young people have to come to terms with the process of detachment. It is important to find new ways of living together in the future. Old wounds open up, insecurity spreads and misunderstandings are the order of the day. A difficult phase for both sides.
If the family is included in the therapy against this background, then this step should in no way be seen as an assignment of blame, but rather as a component of a comprehensive treatment concept.
Digital technology in therapy
The non-profit company Jourvie offers apps for the early detection of eating disorders and as a digital therapy companion. Jourvie is the name of the app for sufferers, which includes an eating log with archive function, motivational exercises and helps users to deal with difficult situations. The Elamie app provides relatives with important information on the topic of early detection.
The company cooperates with the health insurance company AOK, the Therapienetz Essstörungen e. V. and ANAD e. V. (care center for eating disorders in Munich), among others.
Contrary to the popular belief that anorexia is a lifelong fate, a group of researchers from Boston reports encouraging results. The results of a long-term study from 2016 show that the majority of sufferers recovered from the illness in adulthood.
This knowledge gives realistic cause for hope - especially for chronic anorectic patients. They were previously considered incurable.
