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Post  counselor on Mon Oct 15, 2012 11:04 am


Reduced power that can reach the complete refusal of food, the effects range from a marked weight loss in cachexia paintings. Predominantly affects the female sex, even if the 5-10 0ei patient is represented by males. The age of onset is more typical adolescent, with a bimodal distribution showing two peaks at 14.5 and 18 years, are described late-onset cases, more than 30 years and even postmenopausal. Social classes most affected seem to be the medium or high. The nuclear characteristics of the disorder are summarized in the presence of severe behavior leading to the self-imposed weight loss stemming from pathological fear of becoming fat, associated with alterations in endocrine ball. The central problem of a. so it is not so much an eating disorder, but rather a complex disorder that regards the vision of your body and use the perverse anorexic does your body emaciated, performed with apparent autonomy, but instead is used as a control environment surrounding. Among the various types of diagnostic criteria, the most recent and comprehensive is that of the DSM-IV-R consists of the following steps: 1) refusal to maintain body weight at or above a minimally normal weight for age and height, 2) intense fear of gaining weight and becoming obese, pathological fear wholly unjustified by the actual weight conditions, that does not diminish with the gradual decrease of weight, 3) body image disturbances with impaired perception of the size of your body that, at times, may have delusions characteristics and the patient claims to be normal or oily even in the most marked emaciation, 4) secondary amenorrhea for at least 3 consecutive months or the presence of menstrual cycles only with appropriate therapy. The DSM-IV-R also identifies two subgroups: a) the type restricter, where weight reduction is achieved by dieting, fasting and exercise, b) the type bulimia (binge eating / purging type ) which occur regularly binge eating and / or purging behavior such as self-induction of vomiting and use of laxatives, diuretics, enemas. The course may be variable: usually there is a single episode followed by a more or less complete remission, or it can manifest a recurrent course. Unfavorable prognostic factors include male gender, the presence of personality disorders, marked weight loss, a serious disorder of the body image, membership in the bulimic subtype, an association with obsessive-compulsive disorder or a personality disorder Schizotypal. Favorable factors are represented by a younger age and the presence of a good premorbid social and occupational adjustment. Mortality can vary from 5 0x1p-1537l 20, for the majority of cases due to electrolyte imbalance and, much more rarely, suicide. There are many etiological hypotheses. Psychoanalytic theories describe a classical regression to the oral phase (Freud), a defense against unconscious fantasies of fertilization (Abraham), an incomplete overcoming of the paranoid-schizoid (Klein). Some authors consider the a. a weight phobia, where the weight loss and fasting serve as avoidance behavior. More recently, the psychodynamic interpretation is oriented towards the study of interpersonal and family relationships anorexic. According to Sullivan, the harmonious development of interpersonal relationships in the child is determined by the fulfillment of two basic needs: the libidinal gratification and power. The fulfillment of these needs allows you to create the third basic need, the need for security. In the anorexic subject, the relationship with a caring mother, but unable to accept the need for autonomy and the need for power's daughter leads to a situation of division. The need for libidinal satisfaction expressed by food, is in fact fully gratified, while the need for power is constantly repressed and frustrated, realized as an obstacle to the feeling of security. During puberty, which typically emerges in the conflict autonomy / dependence on the family structure, resurfaces the split between oral satisfaction gratified and unmet need for power. The refusal of food, and then a. mental represent the negation of food satisfaction incompatible with the satisfaction of feeling of power. In this situation there is a devaluation of the parental figure and power, but at the same time, the ambivalence typical of puberty, it gives them a new power that has a major role in the maintenance of the condition: his daughter's illness authorize parents to worry and take care of her constantly. Feature is the pervasive sense of inadequacy and inability of these patients, for whom the innate need for power and self-assertion would be satisfied only by rigid control over their emaciated appearance.

Biological theories are based on the fact that often symptoms such as amenorrhea and alterations in the hypothalamic thermoregulatory are early and independent from the weight loss. The neuroendocrine alterations are represented by a reduced TSH response to TRH and LH to stimulation test, a reduction of the basal gonadotropins, a decrease of GH and T3, secondary in part to the loss of weight, in part to caloric restriction. Other changes seem to be completely independent from these factors, such as increased cortisol basal secretion of LH type prepubertal and an alleged reduction of norepinephrine in the CSF. As regards the aspect neurotransmitter, has been proposed an increase in dopaminergic activity (reduced need for food, loss of libido, delusional perception of one's body). In underweight anorexics there was a reduction in both serotonergic and noradrenergic. Regarding the latter has been hypothesized that the long-term reduction of CSF values ​​of norepinephrine may represent a biological marker of stroke. Often the initial symptoms of a. is unrecognized or underestimated, because it is taken into account only in front of a clear weight loss. In fact, you may notice abnormal behavior long before the weight loss. For such patients, hitherto quite normal and slightly overweight enough to begin a weight loss program, are beginning to gastric disorders often as a pretext to justify a reduced intake of food, sometimes with spontaneous vomiting and constipation. In most cases, seek to increase the energy consumption by hyperactivity generic. Sometimes appears initially a state of euphoria, increased extroversion, reinforced also by the environment, for which the patient feels more accepted and becomes more relaxed in interpersonal relationships and only then, when the excessive weight loss the patient will become subject to criticism, appears a tendency to social isolation. It mainly affects the absolute and irrational conviction of being fat (even with weight already below the average), with an urgent need for further weight loss. In this period also appears amenorrhea. The food allowed is carefully chosen, usually liquid or solid, low-calorie, nutrition becomes standardized and often ritualized in the mode of application. Sometimes the anorexic does not sit at the table, sometimes participates in the meal with a behavior that looks a lot like a ceremony. This attitude involves all family members and the excess persistence in pushing eating stimulates further resistance in the patient, thus creating a vicious circle, which often leads to the anorexic does not become aware of their problems but only to stigmatize the invasive behavior the family lived as the sole source of his discomfort. Weight loss thus becomes progressively visible and is maintained with different strategies: the refusal to eat the vomit procured until the excessive use of laxatives. Sometimes, anorexics may have attacks of bulimic type, which is often followed by vomiting procured and intense feelings of guilt. Feature is the extreme difference between the picture and the picture of deterioration somatic psychic patients, while greatly emaciated, are lively, active, and often play sports (to further reduce weight). Amenorrhea is the rule, however, it is important to remember that, unlike ipopituitarie syndromes, there is atrophy of the mammary gland and persist hair in the armpits and groin. Apart from an obvious decrease in the basal metabolic rate, usually there are no marked alterations of biological or endocrine systems. The a. psychogenic syndromes is certainly one of the more complex the treatment plan for the absolute lack of insight and rigid denial of illness. In this sense, patients stubbornly refuse any medical approach, with attitudes manipulative or show to work apparently. On the other hand, the severity of the disease and the high mortality, requiring action as early as possible. Treatment should be individualized and will include composite and measures internal medicine, medical care, psychopharmacological and psychotherapeutic interventions, so as to adapt to the severity of the condition, to the personality and cognitive set and relationship of each patient. The short-term treatment, after a careful assessment internist, aims immediate and timely correction of medical complications, such as the dehydration and electrolyte imbalances. In parallel, an approach is essential relational psychotherapy or cognitive footprint. A component of the treatment, always necessary, is to provide proper nutrition education, the application of techniques to improve social skills and to offer all the support necessary for an easier reintegration in the family.

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