Causes of anorexia
The trigger of a harmful eating behavior is usually the psyche of the person. This is shaped by the environment and the experiences of the person concerned, but genes also play an important role. A particularly high risk is therefore posed by people with a close relative who already suffers from anorexia.
Exactly which genes are important in this context is still unclear and a genetic disposition alone does not make a person anorexic, otherwise many more people in a family would fall ill. Only when other factors are added, such as psychosocial problems or high pressure from the beauty ideals of our society, does the risk of eating disorders increase, especially among girls and young women. These can develop into real anorexia if the problems persist, the person’s self-esteem is low and the initial positive changes of a food restriction begin. In the beginning, the nutrient deficiency leads to a downright drug-like reaction in the brain, which explains the term anorexia “addiction”. If the risk factors mentioned above trigger an eating disorder, the biological processes in the body and brain intensify the eating disorder and anorexia becomes self-sustaining.
How is it diagnosed?
The diagnosis of anorexia can usually be made by taking the patient’s medical history and specific questionnaires. Disorder-specific instruments: Eating Disorder Inventory (EDI, Garner et al. , 1983) The EDI comprises 8 scales containing typical psychological characteristics of anorexia and bulimia patients: The newer version EDI-2 was supplemented by the scales asceticism, impulse regulation and social insecurity.
Eating Behavior Questionnaire (FEV, Pudel & Westenhöfer, 1989) FEV records three basic psycholgical characteristics of anorexia and bulimia. Dimensions of eating behavior: The underlying concept is “restrained eating” (Herman & Polivy, 1975), which can be a prerequisite for impaired eating behavior. Structured Interview for Anorectic and Bulimic Eating Disorders (SIAB, Fichter & Quadflieg, 1999) The SIAB consists of a self-assessment sheet for the patient (SIAB-S) and an interview section for the investigator (SIAB-EX).
It includes the diagnostic criteria of ICD-10 and DSM-IV and besides the typical anorectic and bulimic symptoms, other relevant symptom areas such as depression, anxiety and compulsions are also considered.
- Slimming striving
- Bulimia
- Bodyl. Dissatisfaction
- Ineffectiveness
- Perfectionism
- Interpersonal distrust
- Interoception and fear of growing up.
- Cognitive control of eating behavior (restrained eating), rigid vs. flexible control.
- Disturbability and instability of eating behavior when disinhibited by situational factors
- Feelings of hunger and their behavior correlates
Weight loss is a phenomenon that is very common in medicine.
From a psychiatric point of view, depression should definitely be excluded. Patients who suffer from the symptoms of schizophrenia can also occasionally show a pathologically changed eating behavior. Also very many physical illnesses can lead in their course to significant weight loss (tumor diseases, inflammatory changes of the gastrointestinal tract etc.).
In most cases, however, these diseases lack the fear of weight gain typical of anorexia. Most patients take measures to prevent weight gain at all costs. These include vomiting, misuse of laxatives, excessive physical activity, dehydrating agents (diuretics), enemas (enemas) and the use of medication. About half of all anorexic patients experience attacks of ravenous appetite in the course of the disease, which the patient tries to prevent with the above mentioned measures.
