What are the prevention, types and treatment of Anorexia nervosa?

Prevention

As it is a disorder that usually begins in adolescence, observation by the family is crucial to detect the minor habits that are a warning sign. Here are some protective factors :

Good eating habits: Many teenagers eat alone while watching TV or communicating with their friends via WhatsApp. The lack of fixed schedules and supervision by parents about what they eat increases the chances of developing an eating disorder. Therefore, eating as a family and at regular times helps prevent anorexia.

Communication with parents: Knowing the children’s concerns, tastes and circle of friends can help prevent this disorder and detect it early.

Social relations: the socialisation of adolescents constitutes a protective factor.

Types

Two subtypes can be distinguished in anorexia nervosa:

• Restrictive subtype: weight loss is achieved through diets or intense physical exercise, and the patient does not resort to binge eating or purging.

• Purging subtype: the patient resorts to purging ( laxatives, enemas, vomiting ) even if he has eaten a small amount of food.

Diagnosis

Anorexia nervosa is usually diagnosed based on severe weight loss and psychological symptoms. The typical profile is that of an adolescent who has lost at least 15% of her body weight, fears obesity, has stopped menstruating, denies being ill, and appears healthy.

Treatment

“The treatment is always multidisciplinary and consists of several parts”, highlights Noelia Olmo. It involves psychiatrists, psychologists, dietitians-nutritionists, endocrinologists, nurses, social workers…

The first step of treatment is to assess the patient’s general condition with blood tests and weight control, to assess whether there are significant alterations. Next, the psychotherapeutic intervention begins, which is based, according to the psychiatrist, “on creating a bond with these people “. As she explains, they are people “who have been broken on a vital level, and that is why we accompany them so that they can rebuild their new life project.” In this sense, she stresses that it is not just “psychoeducation and teaching how to eat better.” Hence, the treatment is long, even many years.

Health professionals address self-image rejection with patients and help them gain weight and return to good eating habits to reduce the risk of death from malnutrition. Also, working together with the family is very helpful.

Pharmacological treatment is not a key tool but may be necessary to treat symptoms of depression and anxiety, as well as other conditions that often accompany anorexia, such as obsessive-compulsive disorder, attention deficit hyperactivity disorder (ADHD), substance abuse, personality disorders…

Admission to a hospital centre is necessary when:

• Malnutrition is very serious, and there are alterations in vital signs. 
• Family relationships are unsustainable, and it is better to separate the patient from his environment.
• When mental disorders worsen.
• Outpatient treatment is effective when:
• It is detected early.
• There are no episodes of bulimia or vomiting, and there is a family commitment to cooperation.

The biological situation is restored with the recovery of body weight and proper eating habits, and menstruation returns. Psychological treatment seeks to restructure rational ideas, eliminate the erroneous perception of the body, improve self-esteem and develop social and communication skills between the patient and his environment. In addition, the family must take an active part in the treatment because sometimes the triggering factor of the disease is within them, and recovery inevitably takes place at home.

Anorexia and Covid-19

The coronavirus pandemic has led to an uptick in eating disorders, particularly anorexia nervosa. Olmo provides the figures from his hospital: in 2020, the number of new cases of children under 18 attended increased by 50% compared to 2019, and in October 2021, this figure had already reached an increase of 54% compared to 2020. Hospitalisations also increased by 50% in 2020 and somewhat less (40%) in 2021 (40%).

The reasons for this increase are several. First, the pandemic has contributed to exacerbating certain symptoms in the most obsessive personalities with a tendency to control or excessive self-care. On the other hand, confinement and restrictions have led many girls to focus more on their body image due to the absence of leisure activities and socialisation. 

Profile of those affected

The onset of anorexia is in early adolescence, around 12 years of age, although the most affected population is between 14 and 18. However, experts warn that they are beginning to see girls a little younger, around 9 or 10 years old. In 95 per cent of cases, anorexia mostly affects young women, although, in recent years, there has been an increase in adult women, men, and children. There are groups more likely to suffer from these disorders, as is the case of gymnasts, dancers or models.

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