Anorexia nervosa (Greek ἀνορεξία (anorexia), "loss of appetite") is one of eating disorders (ED), not to be confused with anorexia as a medical condition. It is mainly reflected a concern tyrannical appearance, leading to drastic food shortages. The causes are multiple and overdetermined. In any event, they are a psychopathology of body image. Fashion and phenomena of imitation between adolescents are often implicated, but they remain difficult to isolate the history of the subject who suffers from his home environment and precipitating life events.
The sociology proposes to take into account the share of social aspects, such as the fact that anorexia nervosa does not appear in the same proportions across all cultures and all eras. In some cultures, it is absent. Often, people who suffer from these disorders are mostly teenage girls, even if there are more and more boys.
The first case mentioned in history is that of Catherine Benincasa, Saint Catherine of Siena, who lived in the fourteenth century (1347-1380). Yet, already in the Middle Ages, periods of fasting and severe privations during in mystical religious communities. Another famous case is that of Elizabeth of Wittelsbach, known as Sissi, Empress of Austria-Hungary, who lived in the nineteenth century (1837-1898). In the twentieth century, it is also possible to quote the philosopher Simone Weil.
The first description of the disease is attributed to Richard Morton, who gave him the name of "nervous consumption" in the seventeenth century (1689). Charles Lasègue, French physician of the nineteenth century was one of the first to give a description of the psychopathological he called the "hysterical anorexia. Initially, experts believed in the disruption of the pituitary. It was not until the 1950s that come with the idea of a psychic origin of anorexia nervosa therefore accepting that - until proven otherwise - the physical problems associated are the consequence of stopping power.
From the 1980s, the eating disorder psychopathology have attracted attention of specialists, including their structural relationship with addiction.
In France, a bill is presented to fight against anorexia, in 2008.
Anorexia nervosa is a psychiatric disorder which was reflected in a significant weight loss, but it is tied to a specific dietary restrictions voluntarily, sometimes involuntarily, even if the causes of these self-inflicted deprivation remain unconscious for sufferers. In anorexia nervosa, the patient fight against hunger, while in anorexia, it has lost appetite.
The diagnostic criteria for anorexia nervosa are usually used:
* Refusal to maintain body weight at or above a minimally normal weight for age and height (eg weight loss leading to maintenance of body weight less than 85% of that expected or failure to gain weight during the growing season leading to a weight of less than 85% of that expected);
* Intense fear of gaining weight or becoming fat, while weight is below normal;
* Altered sense of weight or shape one's own body (body image), undue influence of weight or body shape for narcissism or self-esteem, or denial of the seriousness of the current low.
Anorexia is one of the most deadly diseases of the psyche. The mortality rate at 10 years is 5%, roughly 20% in the longer term, since the health of those who survive remains irreversibly undermined.
Anorexia affects less than 0.5% of young women in the pure form anorectic. The bulimic syndrome affects 1% of young women and 0.1% of young men. This disease mainly concerns young girls 12-20 years but may appear as young as 9 or 10 years. The boys are less affected (9 out of 10 anorexics are female) but the evolution of morality tends to make them more likely to become ill.
We can distinguish two types of form of anorexia nervosa (besides the fact that he has admitted there are as many ways to be anorexic as people with the disorder):
* Restrictive type: during the current episode of anorexia nervosa, small intensely about her diet and did not regularly presented to binge or resorted to self-induced vomiting or taking laxatives (ie -d. laxatives, diuretics, enemas).
* Type with binge eating / vomiting or taking laxatives: during the current episode of anorexia nervosa, small intensely about her diet and has regularly presented binge eating and / or used self-induced vomiting or taking purgatives (laxatives, diuretics, enemas).
They remain unknown. There are likely genetic factors, suspected on family structures and twins.
Cases of anorexia nervosa are increasing in the Western world. This is true in all European countries, the United States and Canada, Japan, in white populations in South Africa and in the better-off South America. They are found mostly in white populations and are rare in African Americans and Africans. There are only very few cases of anorexia nervosa outside the Western sphere, as shown by different studies among Alaskan Eskimo populations, or in India.
Some explain this separation by the fact that Western society is more focused on individualism, which develops the competition. Black populations in Africa and the Americas would be less affected by anorexia because they have a spirit and a more communal way of life less focused on the individual competition.
But there is also risk activities that increase the risk of TCA, including anorexia nervosa. Such is the case of ballet dancers, who are required an absence of curves, small hips and a flat chest. According to various European and American studies, 15-30% of future ballerinas exhibit behavior identical to that of food anorexic or bulimic to mentally control their weight. Other studies on students supermodels, or the professional jockeys, show the same behavior.
We also note that anorexia is more common in middle and upper classes.
In psychopathology, we consider anorexia as an addictive behavior. The link to the primary orality and / or secondary education are obvious and can be understood as an avatar of the Oedipus complex or its precursors. The conduct of food refusal can also be seen as avoidance of a process of intellectualization of primary identification and / or secondary. It is a symptom of poor integration of the unconscious body image in relation to secondary sexual characteristics, curves of female puberty, etc.. for young women. The disorder often occurs in family contexts individuals (low marks on the difference between generations, etc..). The internal object relationship with mother is marked by a refusal or inability to identify with an adult woman sexually. The defense mechanisms by rationalization, intellectualization and asceticism are frequently at the forefront. But there is another current from the United States and Canada that combines the area of anorexia phobia, while Bulimia fall under dependency. (Graduate Institute of Mental Health Douglas clinical eating disorders, Montreal, Qc, Canada)
"Being thin" is a pretext, support the need to master a world that seems extremely harmful (the judgments of others is distorted both in intensity and direction).
People in the medical profession in contact with people with anorexia have noted a strong feeling of guilt and obsessive routine. In the brain anorexic information "I am guilty" is linked to a morality that rejects everything that is "unfair" it implies that being guilty, they must be punished. And when you are punished, they should not feel happy. The greatest pleasure available in human nature is the primary need from food, feed the anorexic becomes "unacceptable".
The guilt may come from a series of causes and effects misunderstood (Divorce, thoughts of others, sexual practice no longer welcome, rejection in love ... / anything can be sources) If you understand the cause of discomfort the individual would be responsible for the "problem". The anorexic often mixes two pieces of information: "to be present at an event" and "be responsible for the event."
Must be established or confirmed by experts and reflect the overall mental functioning, defense mechanisms, the type of anxiety (depression, psychosis) and the type of object relationship. Teenagers sometimes have an eating anorexic-looking but passengers are sometimes covered attitudes of identification with peers, to celebrities or other models. If the problem persists, it must be specialized consultations and ad hoc treatments. Be careful to distinguish what would report to addictive disorders, borderline or psychotic disorder with sometimes hidden delusions of poisoning. Clinically, the border between the two poles of organization psychopathological, psychotic and borderline is not always easy to distinguish.
Under the current criteria of DSM-IV  for anorexia nervosa, all the following conditions should be met:
a) refusal to maintain body weight above the normal minimum (less than 85% for age and size)
b) intense fear of gaining weight or becoming fat, despite underweight
c) alteration of the perception of weight or the shape of his own body (dysmorphic disorder)
d) undue influence of weight or body shape on self esteem, or denial of the seriousness of the current low
e) amenorrhea for at least three consecutive cycles in women menstruate (amenorrhea).
Physically, this disease leads to weight loss. Losing weight is directly related to food deprivation. It induces a so-called malnutrition.
The food deprivation quickly leads many deficiencies in minerals, vitamins and other essentials. These, and weight loss will lead to disruption or damage to the body: muscle loss, drop in blood pressure, faintness, fainting, hair loss, anxiety, insomnia, fatigue, feeling cold permanent memory loss, amenorrhea (cessation of menses), calcium deficiency, osteoporosis, major relationship problems (loss of friends, family conflicts). The physical disorders may ultimately threaten the life of the person. Mortality is estimated at just under 6% per decade in the disease.
The anxiety and the need to lose weight will be responsible for a physical hyperactivity.
Formerly, treatment was mainly based on the isolation of the family environment. However, lack of scientific evidence of his interest, it is no longer practiced. Hospitalization, when necessary, is to assist in weight regain. To do this, (the) patient is ideally accompanied (e) by a team comprising a doctor, a dietician and a (e) psychotherapist. The management must afford a psychotherapeutic work just make sense of symptoms and solutions. The fear of becoming fat may then be absorbed or disappear. A specialized treatment is usually necessary. It must be multi-disciplinary medical, psychotherapeutic and / or educational and nutritional. The main difficulty is the refusal of treatment, for fear of gaining weight and becoming obese. We need to help / patient (e) to realize that he suffers from a disease that is treatable.
The treatment is to initiate dialogue with the youth / e by working towards a re-feeding and weight regain. A general practitioner is holding parallel, monitoring of weight and health. In severe cases, hospitalization is necessary: it often enables the girl to enter into other relationships and develop a sense that is alien to exist by itself. Parents can also be supported in a family psychotherapy.
In all cases, a nutritional approach is essential. It is important to note that, in fact, no therapy can be undertaken before the patient was able to reach a certain weight, allowing it to fully understand the concepts presented. And this is what calls the new method Maudsley. Coming from a British hospital, this method seems to get favorable results, particularly among young anorexic clients whose age is between 11-14 years. It reduces mortality and ensure the treatment of malnutrition. What differentiates this method is the heavy involvement of parents in the treatment plan, which was unthinkable, it is thirty years, or, conversely, the patient was removed from his family.
By cons, in some extreme cases, severe means of recharge will be necessary (nasogastric). In other cases involve older teenagers and adults resistant to all forms of aid seriously putting at stake their health and their lives, it will be necessary to obtain a warrant from the Court to allow a psychiatric assessment to determine if there is a possibility to hospitalize a person against his will.
The treatments give positive results, both physically and psychologically more precisely when the patient is treated within a period of four years. It requires great patience to psychiatrists, psychotherapists, physicians and paediatricians who work to support. Relapse is the rule, but after months or years of common struggle, the teenager or adult she has become, may be opened to greater autonomy and less dependence on their eating behavior.
It is estimated that the cure is achieved in approximately 50% of cases, and one third of cases, patients remain more or less eating disorders, low weight and a very strong fear of becoming fat. Relapses are part of the treatment, if they are regarded merely as failures that led to discouragement and abandonment. They must be worked and developed in psychotherapy it can be integrated as a stage of treatment. It is also estimated that 20-25% of cases where anorexia nervosa persists. In any case, treatment should be considered in the medium to long term. It does not get rid of this type of problem by miraculous treatment. The eating disorders are testing the process of adolescence, thought, action, sexual differentiation, autonomy, etc.. They also call into question the balance and achievement of children.
There is no medication has shown any efficacy in this disease.
In addition to adolescents, anorexia can directly affect infants. Anorexia symptomatic newborns is a sign of functional disorder of reflex centers located in the brain, and if the child is premature, this disturbance is due to lesions cerebromeningeas at birth (cerebral hemorrhage, anoxia , for example). In this case, refusal of food is obviously important and tenacious, and, thus, differs from anorexia so-called "primitive", where the new-born hypotonic, do not take or refuse the breast and nipple.
Since its birth, the child is caught in a relationship with the mother who comes between the need and demand. The purpose of eating that meets the need is also subject to an application of love to the foster mother. The child needs to be nurtured and loved in the same time or the mother who loves him also asked to absorb the food she prepares for him. Since the desire of the child fits between the need and demand based on a lack. The infant may have to reject the food and food and confusing amou.
Runs organicists and biological hypotheses
Many assumptions are Organicist worked for decades, not all are outdated, like all other psychopathology, research in the area are ongoing and none of them is needed now as can be retained as final. We must be careful when you take that knowledge and disseminate it.
In 1994, was isolated a hormone secreted by fat tissue cells, adipocytes. This hormone, called leptin, would inform the brain about the fat reserves of the body. Leptin is the product of the expression of the gene obese (ob). The mutations ob induce a greater morbid obesity associated with diabetes bold. The secretion of leptin action would reduce food intake and promote weight loss. Plasma leptin levels are strongly correlated with fat mass measured by body mass index. The loss of weight due to food restriction is associated with decreased plasma levels of leptin. There would leptin receptor in the arcuate nucleus of the hypothalamus. Increased levels of circulating leptin is detected by neurons in the arcuate nucleus. It follows a set of complex responses, humoral, viscero-motor and behavioral inhibit food intake.
One means by which leptin decrease food intake would decrease appetitive value of food. The leptin would alter the state of the circuit meso-limbo-cortical involvement in reward mechanisms. Weight loss resulting from a chronic food restriction increase the rewarding effects of stimulation of the lateral hypothalamus and conversely, injection of leptin would decrease the effect of rewarding stimulation of the lateral hypothalamus in the rodent. This mechanism could be useful in analyzing the phenomenon of chronicity in anorexia nervosa.
Adipocytes do not secrete leptin only. Another peptide was recently identified, adiponectin, which occurs in the regulation of glucose and lipid metabolism. Blood levels of adiponectin are decreased in obesity and increased in normal weight bulimics. Epidemiological studies of twins show that there is a legacy part of an eating disorder.
* For monozygotic twins, Kendler et al. are:
- 56% concordance in anorexia - 23% concordance for bulimia
* And dizygotic twins:
- 5% in anorexia - 8.7% in bulimia.
There is therefore possibly a biological vulnerability partly hereditary, passing perhaps the gene encoding leptin or other neurotransmitters involved in regulating eating behavior.
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