This article does not consider methods of pharmacological treatment of anorexia and bulimia. Also, the techniques and methods of psychiatric intervention are not discussed. The article draws attention to the methods of psychological work with people suffering from these diseases.
Causes of the disease
The real sources that provoked anorexia and bulimia are not known. Pathologies can lead to many things. Therefore, speaking of anorexia, doctors cite a number of risk factors against which the disease can develop.
Serious illnesses can lead to anorexia. Among them:
But the most common are anorexia nervosa and bulimia, which are based on mental disorders.
The disease can develop as a result of such factors:
dysfunctional family. This family is characterized by an unhealthy psychological climate. These can be people who are fixated solely on themselves, hiding emotions, prone to constant irritation. This category includes families in which there is an addiction: drug addiction, alcoholism. The child in this atmosphere feels unnecessary, superfluous.
Low self-esteem. Such people consider themselves fat (regardless of true weight), ugly, stupid, uninteresting. They are sure that the only chance to achieve anything in life is to become the owner of an ideal figure.
Negative atmosphere during meals. This reason stretches from deep childhood. The baby, who did not want to eat, was force-fed. Often this procedure caused a gag reflex in the crumbs. This factor provokes a negative attitude towards nutrition in adulthood.
Unmet need for love and acceptance. This is observed most often in chubby girls. They are not loved or accepted for who they are. Sitting on a diet, and dropping the first kilograms, the young ladies notice sympathy, interest in their address. This encourages them to lose weight with increased strength. After all, you want to be loved.
Perfectionism. Obsession, obsession with behavior can lead to serious consequences. High striving for perfection
Fight against certain obstacles. Some doctors argue that the development of anorexia is a way of self-affirmation. A person strives to overcome the obstacle that is appetite. Having successfully passed the test, he experiences pleasure and sees in this the real meaning of life.
Anorexia
Unlike bulimia, it is a deadly disorder. This is NPP, in which there is a conscious refusal of food in order to lose weight and a panic fear of gaining weight. More common in teenagers. Symptoms:
Weight below the norm by 15% or more
Unhealthy preoccupation with their weight, constant checking on the scales, diets
Very little or very low-calorie food intake, general decrease in appetite
Ignoring the feeling of hunger, and then - and its complete disappearance
Violation and cessation of menstruation, decreased libido
Hair loss, tooth decay, fainting, bluish skin color, abdominal pain, heart problems, decreased immunity and general deterioration in health
It differs from bulimia in lack of appetite, serious health complications up to death (with bulimia this is not so critical) and weight loss of up to 50% (with bulimia, weight often remains within the normal range).
Patients with anorexia have a number of characteristic features:
1. Change in the constitution of the body with pronounced thinness, which a person absolutely does not perceive.
2. Increased physical activity and complete denial of fatigue.
3. Feeling of helplessness, which paralyzes the thinking and behavior of a person.
Consequences of the disease
The disease is fraught with serious consequences:
1. The occurrence of leukopenia, as well as anemia, which is provoked by increased production of cholesterol and carotene in the body.
2. Bradycardia, cachexia, hypotension and problems with the gastrointestinal tract due to prolonged refusal to eat.
3. Erosion of tooth enamel due to constant vomiting.
4. Violation of the functions of sex hormones.
5. The occurrence of hypoestrogenism, as well as amenorrhea and osteoporosis.
6. Change and dysfunction of the thyroid gland.
7. A significant change in the potassium-sodium level in the body.
8. Violation of the heart due to a low amount of potassium in the plasma, which is fatal.
bulimia
Irresistible craving for overeating with subsequent cleansing of the body - artificial vomiting, enemas, laxatives or debilitating physical exertion. These can be raids on the refrigerator at night, or you can chew all day without ceasing.
So, bulimia differs from nervous overeating by the lack of taste in food - a person eats and it tastes bad, or even disgusting. When overeating, a person enjoys the taste of food. Weight in bulimia is usually normal, in contrast to overeating.
Diagnostic signs of bulimia:
It is worth noting that the classifications are currently being updated. Planned changes will include situations such as:
Features of bulimia:
attacks depend on stress, boredom, sadness, sadness and are a type of reaction
on various feelings and emotions;
overeating is planned and organized;
the patient has a negative attitude towards food;
people eat in isolation, are ashamed of the act of eating;
those suffering from bulimia are removed from society as they eat alone;
compensation with another form of behavior (exercise, vomiting, use of laxatives)
women overeat twice as often as men;
the variety and aesthetic appearance of the foodstuffs consumed at meals is of little importance.
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bulimia |
Anorexia |
|
Uncontrollable bouts of hunger, accompanied by overeating and subsequent forced emptying of the stomach |
Persistent refusal to eat |
|
Affected people remain in normal physical shape |
Leads to a loss of about 50% of body weight |
|
Does not cause critical harm to health |
Leads to complete exhaustion of the body |
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Inherent in weak-willed, weak-willed people |
Occurs in individuals with low self-esteem, strong self-hypnosis and steel will |
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Fairly easy to treat |
Has a high mortality |
WHAT DO ANOREXIA AND BULIMIA HAVE IN COMMON?
Common to patients with both anorexia and bulimia is that they have a distorted view of their own body. Anorexics always see themselves as too fat, they always feel that they are not thin enough, not beautiful enough.
As a rule, diseases develop according to the following scheme: self-doubt - an obsession with the need to lose weight - extremes in achieving the goal - health problems - a hospital. Despite the fact that the fear of gaining weight is associated with actions that are unsafe for health, the victims of anorexia and bulimia refuse to admit the obvious. As the disease progresses, they no longer adequately perceive their own body: unnatural thinness seems beautiful to them, and this is what prevents them from seeking help.
WHAT IS THE DIFFERENCE BETWEEN ANOREXIA AND BULIMIA
Anorexia and bulimia are psychosomatic disorders associated with eating disorders.
Anorexia is a syndrome in which a person completely loses his appetite, which leads to severe, sometimes irreversible consequences. People with anorexia at first force themselves to ignore the feeling of hunger, then their appetite disappears. Victims of anorexia also resort to vomiting, although they take food in scanty quantities.
Bulimia is uncontrollable binge eating followed by forcible disposal of what has been eaten, most often with the help of vomiting or a laxative. Bulimics are not always obese or underweight. Binge eating attacks are psychologically based and most often follow a mental or emotional overexcitation. Patients absorb food in very large quantities, quickly and often without chewing (swallowing in pieces). This is followed by feelings of guilt and fear of obesity.
Treatment for Anorexia and Bulimia:
Psychotherapy of anorexia
First of all, the patient is isolated from loved ones and hospitalized. Treatment is carried out in several stages:
1. Diagnostic - lasts from two to four weeks. The main goal is to eliminate a sharp weight deficit.
2. Therapeutic - lasts much longer and involves the treatment of the disease itself. Psychiatrists, as a rule, prescribe a special course of antipsychotics in large doses along with insulin.
In some situations, a non-drug method of therapy is used, which involves:
Psychiatrists are of the opinion that the most effective methods of treatment are:
There are more gentle methods, which include:
We list the psychotherapeutic approaches in the treatment of anorexia.
Cognitive analytic therapy.
Based on the theory that a person's mental condition, such as anorexia, is the cause of unhealthy behavior patterns, as well as thoughts that were most often laid down and developed in childhood.
During therapy, various events of the childhood period are considered that could influence the emergence of unhealthy behavior patterns and the necessary actions are determined that will help restore healthy effective forms of behavior and thinking.
cognitive behavioral therapy
Based on the theory that our thoughts about the current situation influence our actions, and vice versa, our actions influence our thoughts and feelings. In anorexia, the patient's condition is largely due to inadequate and unrealistic thoughts about food and diet. The therapist will help to adopt healthier and more realistic thoughts that will lead to positive behavior.
Interpersonal Therapy
Based on the theory that relationships with other people have a powerful positive effect on mental health. Anorexia can be associated with low self-esteem, anxiety, self-doubt, which limits communication with other people.
During therapy, the consequences of negative relationships are discussed, and what needs to be done so that they can be named.
Focus psychodynamic therapy.
Based on the theory that the development of mental illness may be due to unresolved conflicts that occurred in the past, most often in childhood or early young age.
During therapy, the patient understands how early childhood experiences may have affected his condition. The aim of the work is to find more successful ways to deal with stressful situations, negative thoughts and emotions.
Family Approach
Working with the whole family is aimed at understanding the eating disorder and also includes discussion of the impact of this disorder on all family members. Therapy helps to understand the patient's condition and how the family can help the patient.
Ericksonian therapy and hypnosis.
Back in the 1900s, Pierre Janet first used hypnotherapy to treat anorexia. Many recent studies also confirm the effectiveness of this type of therapy in developing self-confidence, increasing self-esteem, reducing stress and depressive disorders. (Newsweek, Pediatric Nursing, and University of Maryland Medical Center). Hypnotherapy not only increases confidence and self-esteem, but also promotes the development of healthy eating habits, acceptance of one's image, and the ability to cope with difficulties in everyday life.
Bulimia treatment.
Bulimia is treated by a psychotherapist or psychiatrist. He decides whether it is necessary to go to the hospital or can be treated at home.
The best results in the fight against bulimia nervosa are obtained by an integrated approach when psychotherapy and drug treatments are combined. In this case, it is possible to return a person to mental and physical health for several months.
Psychotherapy for bulimia.
The treatment plan is made individually for each patient. In most cases, it is necessary to undergo 10-20 psychotherapy sessions 1-2 times a week. In severe cases, you will need to meet with a psychotherapist several times a week for 6-9 months.
Psychoanalysis of bulimia. The psychoanalyst identifies the reasons that caused the change in eating behavior and helps to understand them. These may be conflicts that occurred in early childhood or contradictions between unconscious attraction and conscious beliefs. The psychologist analyzes dreams, fantasies and associations. Based on this material, he reveals the mechanisms of the disease and gives advice on how to resist attacks.
Cognitive Behavioral Therapy in the treatment of bulimia is considered one of the most effective methods. This method helps to change thoughts, behavior and attitudes towards bulimia and everything that happens around. A person in the classroom learns to recognize the approach of an attack and resist obsessive thoughts about food. This method is great for anxious and suspicious people for whom bulimia brings constant mental suffering.
Interpersonal psychotherapy. This method of treatment is suitable for those people whose bulimia is associated with depression. It is based on the identification of hidden problems in communicating with other people. The psychologist will teach you how to get out of conflict situations correctly.
Family Therapy bulimia helps to improve family relationships, eliminate conflicts and establish proper communication. For a person suffering from bulimia, the help of loved ones is very important, and any carelessly thrown word can cause a new bout of overeating.
Group therapy for bulimia. A specially trained psychotherapist creates a group of people suffering from eating disorders. People share their medical history and experience of dealing with it. This gives a person the opportunity to increase self-esteem and realize that he is not alone and others also overcome similar difficulties. Group therapy is especially effective in the final phase to prevent recurring episodes of overeating.
Monitoring food intake. The doctor adjusts the menu so that the person receives all the necessary nutrients. In small quantities, they introduce those products that the patient previously considered forbidden for himself. This is necessary in order to form the right attitude towards food.
It is recommended to keep a diary. There it is necessary to record the amount of food eaten and indicate whether there was a desire to sit down again or if there was an urge to vomit. At the same time, it is advised to increase physical activity and play sports, which help to have fun and get rid of depression.
Remote Internet treatment of anorexia and bulimia.
Working with a psychologist or psychotherapist in overcoming the consequences of anorexia and bulimia can also take place online via skype or e-mail. In this case, you can use the methods of cognitive and behavioral therapy, and analytical methods of therapy also work well. It all depends on the professionalism of the psychologist, psychotherapist.
Anorexia is a disease that is accompanied by malnutrition and excessive weight loss. Anorexia is diagnosed when a person weighs 15% less than their normal weight. Anorexia is a dangerous disorder that can even end in death due to exhaustion of the body.
The term anorexia literally means "loss of appetite", although people with this disorder are often hungry, but for one reason or another, refuse to eat.
Anorexics feel a paranoid fear of weight gain and even consider themselves too fat, although they are usually underweight.
Unfortunately, this ailment is very difficult to treat if the patient does not turn to a specialist, but tries to solve the problem on his own. The percentage of success in this scenario is small, and there may be even more associated complications.
Problems caused by anorexia:
Therefore, anorexia is a condition that requires treatment. In most cases, this process is seriously hampered, because patients, as a rule, do not recognize that they need help.
A psychologist or psychotherapist will identify internal emotional problems in a person with anorexia. A comprehensive treatment plan is carried out, which is adapted to meet the individual needs of each person. In many cases, the patient needs to go to the hospital in order to undergo complex treatment: psychological support, psychotherapy and medication, as well as help from a nutritionist to restore nutrition.
Treatment goals include:
The most commonly used treatments for anorexia are:
Because the problem of anorexia is mostly psychological, psychotherapy is the first and most important treatment. The success of psychotherapy takes time and money, but it gives the patient the best chance for recovery.
Anorexics deny they have a problem and need help even if their body weight is dangerously low. Part of the challenge in treating anorexia is to help the person recognize that there is a problem, secondly, to understand what the problem really is, and thirdly, to want to be treated.
Psychotherapy for anorexia is aimed at improving the emotional state of the patient and cognitive problems.
This is a kind of individual counseling that focuses on changing mindsets.
Cognitive Behavioral Therapy focuses on identifying and changing dysfunctional thought patterns, attitudes, and beliefs that may cause a desire to improve lifestyle and diet, and overall attitudes towards food.
Nutritional Counseling – therapy provided by a counselor for an eating disorder. The strategy aims to teach patients with anorexia a healthy approach to eating and weight to help them return to normal eating habits.
Another form of psychotherapy is family therapy, which is usually carried out in the presence of a person who suffers from anorexia and his family members. This therapy helps people suffering from anorexia to realize their role in the family.
According to research, cognitive behavioral therapy can reduce the risk of relapse after weight gain. Likewise, family therapy is an important support.
Anorexics can benefit from group therapy where they can find support in other people who share the same experiences and problems.
Support groups are a great way to get emotional support. There are also support group sites where you can find many inspiring messages from people who have overcome this insidious disease and returned to normal life.
There are no specific drugs for the treatment of psychogenic disorders. Initially, drugs are prescribed to treat emerging health problems.
Drugs for treatment:
In some cases, zinc supplements are prescribed to help improve the overall health of anorexia sufferers. Other benefits of zinc that may be helpful for anorexia include repairing skin, hair, and nails, strengthening bones, and relieving stress, anxiety, and depressive symptoms.
Most anorexics suffer from depression and are often prescribed antidepressants to support their treatment. According to statistics, symptoms of depression are more common in anorexia and bulimia than in people who do not suffer from an eating disorder. Some antidepressants may be used to help control the anxiety and depression associated with eating disorders.
Studies have found that antidepressants are more effective when a person begins to regain their weight. Some antidepressants may also help improve sleep and stimulate appetite.
In addition, some of them have the side effect of weight gain, so the choice of the appropriate drug must be approached very carefully.
Chlorpromazine is most commonly prescribed for severe obsessive-compulsive disorder, anxiety, and nervous tension. Chlorpromazine is an antipsychotic that affects dopamine levels. An effective remedy for stimulating hunger and weight gain.
People with anorexia have low body weight and lack of menstruation, which puts them in a state similar to early menopause. For this reason, they are at risk of fractures resulting in thinning of the bones (osteoporosis).
Taking estrogen can help restore bone mineralization, strengthen them and prevent them from future fractures.
Before prescribing drugs, the risks must be carefully weighed - many drugs have potential side effects that can be dangerous as a result of serious health problems and very low body weight.
Weight gain in people with anorexia is vital. It is advisable not to rush, because, just as a sharp drop in weight is not useful, an excessively rapid weight gain is contraindicated.
A reasonable weight gain is in the range of 200 to 400 grams per week, or 800 to 1600 grams per month.
In people with anorexia, the food intake per day should increase very slowly and gradually, by several meals throughout the day (every 2 to 3 hours) and in very small portions.
In severe cases (less than 20% of normal body weight), treatment in a clinic under the supervision of specialists may be necessary, especially when it comes to malnutrition and other serious complications such as heart disease, major depression and the risk of suicide.
During these hospitalizations, people with anorexia are encouraged to eat regularly. Sometimes (when the patient refuses to eat) it may be necessary to undergo enteral nutrition (through a tube).
Treatment in the clinic can last depending on the state of health with anorexia and the degree of damage to internal organs and systems.
Specialized clinics focus on the treatment of various types of eating disorders, including anorexia. Usually, they have a wide range of specialists - psychologists, doctors, nutritionists and fitness experts.
Rehabilitation usually requires long-term therapy, as well as strong motivation on the part of the patient. Support from family and friends is essential.
If you notice that a relative or friend is suffering from anorexia, seek help immediately. These kinds of disorders become more dangerous as time goes by, more and more difficult to treat, and death or permanent deterioration in health becomes more and more inevitable.
The first experience of using behavioral therapy was based on the theoretical provisions of I.P. Pavlov ( classical conditioning) and Skinner (Skinner B. F.), ( operant conditioning).
As new generations of physicians have adopted behavioral techniques, it has become clear that a number of patient problems are much more complex than previously reported. Conditioning did not adequately explain the complex process of socialization and learning. Interest in self-control and self-regulation within the framework of behavioral psychotherapy has brought " environmental determinism”(human life is determined primarily by its external environment) to reciprocal determinism (personality is not a passive product of the environment, but an active participant in its development).
Publication of the article " Psychotherapy as a learning process” in 1961 by Bandura A. and his subsequent work was an event for psychotherapists looking for more integrative approaches. Bandura presented in them theoretical generalizations of the mechanisms of operant and classical learning and at the same time emphasized the importance of cognitive processes in the regulation of behavior.
The conditioning model of human behavior has given way to a theory based on cognitive processes. This trend was evident in the reinterpretation of Wolpe's systematic desensitization (Wolpe J.) as an anti-conditioning technique in terms of such cognitive processes as expectation, coping strategy and imagination, which led to such specific areas of therapy as covert modeling (Cautela J., 1971 ), training skills and abilities. Currently, there are at least 10 areas of psychotherapy that emphasize cognitive learning and emphasize the importance of one or another cognitive component.
Cognitive Behavioral Psychotherapy ( behavior modeling) is one of the leading areas of psychotherapy in the United States, Germany and a number of other countries, is included in the standard for training psychiatrists.
Behavior Modeling- a method that is easily applied in an outpatient setting, it is problem-oriented, it is more often called training, which attracts clients who would not like to be called "patients". It stimulates self-solving problems, which is very important for patients with borderline disorders, which are often based on infantilism. In addition, many cognitive-behavioral psychotherapy techniques provide constructive coping strategies to help patients acquire social adaptation skills.
Cognitive-behavioral psychotherapy refers to short-term methods of psychotherapy. It integrates cognitive, behavioral and emotional strategies for personality change; emphasizes the impact of cognition and behavior on the emotional sphere and the functioning of the body in a broad social context. The term "cognitive" is used because violations of emotions and behavior often depend on errors in the cognitive process, deficits in thinking. The "cognitions" include beliefs, attitudes, information about the individual and the environment, forecasting and evaluating future events. Patients may misinterpret the stresses of life, judge themselves too harshly, come to wrong conclusions, and have negative self-images. A cognitive-behavioral psychotherapist, working with a patient, applies and uses logical techniques and behavioral techniques to solve problems through the joint efforts of the psychotherapist and the patient.
Cognitive-behavioral psychotherapy has found wide application in the treatment of neurotic and psychosomatic disorders, addictive and aggressive behavior, anorexia nervosa.
Anxiety can be a normal and adaptive response to many situations. The ability to recognize threatening events and avoid them is a necessary component of behavior. Some fears disappear without any intervention, but long-term phobias can be assessed as a pathological response. Anxiety and depressive disorders are often associated with a pseudo-perception of the surrounding world and the requirements of the environment, as well as rigid attitudes towards oneself. Depressed patients rate themselves as less capable than healthy individuals due to such cognitive errors as "selective sampling", "overgeneralization", "all or nothing principle", minimization of positive events.
Behavioral psychotherapy serves as a means of choice for obsessive-phobic disorders and, if necessary, is supplemented by pharmacotherapy with tranquilizers, antidepressants, and beta-blockers.
The following behavioral treatment goals are achieved in patients with obsessive-phobic disorders: complete elimination or reduction of obsessive symptoms (thoughts, fears, actions); its translation into socially acceptable forms; elimination of individual factors (feeling of low value, lack of confidence), as well as violations of horizontal or vertical contacts, the need for control by a significant microsocial environment; elimination of secondary manifestations of the disease, such as social isolation, school maladaptation.
Cognitive Behavioral Psychotherapy with anorexia nervosa pursues the following short- and long-term therapeutic goals. Short term goals: restoration of premorbid body weight as a necessary condition for psychotherapeutic work, as well as the restoration of normal eating behavior. Long term goals: the creation of positive attitudes or the development of alternative interests (other than dieting), updating the behavioral repertoire, gradually replacing anorexic behavior; treatment of a phobia or fear of losing weight control, body schema disorders, consisting in the ability and need to recognize one's own body; elimination of uncertainty and helplessness in contacts, in relation to gender identity, as well as problems of separation from the parental home and the adoption of the role of an adult. These are the key tasks of psychotherapy, which lead not only to changes in weight (symptom-centered level), but also to the resolution of psychological problems (person-centered level). The following algorithm of psychotherapeutic measures is widespread: cognitively-oriented behavioral psychotherapy at first in an individual form. It consists of self-control techniques, goal scaling, assertive behavior training, problem solving training, signing weight loss contracts, progressive Jacobson muscle relaxation. Then the patient is included in group psychotherapy. Intensive supportive psychotherapy is practiced. In parallel with this, systemic family psychotherapy is carried out.
Addictive behavior can be evaluated in terms of positive (positive reinforcement) and negative consequences (negative reinforcement). When conducting psychotherapy, the distribution of both types of reinforcements is determined in assessing the mental status of the patient. Positive reinforcement includes the pleasure of taking a psychoactive substance, the pleasant impressions associated with it, the absence of unpleasant withdrawal symptoms in the initial period of substance use, the maintenance of social contacts with peers through drugs, and sometimes the conditional pleasantness of the patient role. The negative consequences of addictive behavior are a more common reason for seeking treatment from a specialist. This is the appearance of physical complaints, deterioration of cognitive functions. To include such a patient in the treatment program, it is necessary to find a "replacement behavior" without the use of psychoactive substances or other types of deviant behavior. The scope of psychotherapeutic interventions depends on the development of social skills, the severity of cognitive distortions and cognitive deficits.
The goals of cognitive-behavioral psychotherapy are presented as follows:
Behavioral and problem analysis is considered the most important diagnostic procedure in behavioral psychotherapy. Information should reflect the following points: specific signs of the situation (facilitating, aggravating conditions for the target behavior); expectations, attitudes, rules; behavioral manifestations (motor, emotions, cognition, physiological variables, frequency, deficit, excess, control); temporary consequences (short-term, long-term) with different quality (positive, negative) and with different localization (internal, external). Information gathering is aided by observation of behavior in natural situations and experimental analogies (eg, role play), as well as verbal reporting of situations and their consequences.
Purpose of behavioral analysis- functional and structural-topographic description of behavior. Behavioral analysis helps to plan therapy and its course, and also takes into account the impact on behavior of the microsocial environment. When conducting problem and behavioral analysis, there are several schemes. The first and most developed is as follows:
1) describe detailed and behavior-dependent situational features. Street, house, school - these are too global descriptions. A finer differentiation is needed;
2) reflect behavioral and life-related expectations, attitudes, definitions, plans and norms; all cognitive aspects of behavior in the present, past and future. They are often hidden, so at the first session it is difficult to detect them even for an experienced psychotherapist;
3) identify biological factors that manifest through symptoms or deviant behavior;
4) observe motor (verbal and non-verbal), emotional, cognitive (thoughts, pictures, dreams) and physiological behavioral signs. The global designation (for example, fear, claustrophobia) is of little use for subsequent psychotherapy. A qualitative and quantitative description of the features is required;
5) evaluate the quantitative and qualitative consequences of behavior.
Another option for functional behavioral analysis is the compilation of a multimodal profile (Lazarus (Lazarus A. A.)) - a specifically organized version of a system analysis carried out in 7 areas - BASIC-ID (in the first English letters: bechavior, affect, sensation, imagination, cognition, interpersonal relation, drugs - behavior, affect, sensations, ideas, cognitions, interpersonal relations, drugs and biological factors). In practice, this is necessary for planning options for psychotherapy and for training novice psychotherapists in the methods of cognitive-behavioral psychotherapy. The use of a multimodal profile allows you to better enter into the patient's problem, correlates with the multiaxial diagnosis of mental disorders, and makes it possible to simultaneously outline options for psychotherapeutic work (see Lazarus Multimodal Psychotherapy).
In dealing with a typical problem, it is necessary to ask the patient a series of questions to clarify the difficulties: Does the patient correctly evaluate events? Are the patient's expectations realistic? Is the patient's point of view based on false conclusions? Is the patient's behavior appropriate in this situation? Is there really a problem? Was the patient able to find all possible solutions? Thus, questions allow the psychotherapist to build a cognitive-behavioral concept, which is why the patient experiences difficulties in one area or another. During the interview, ultimately, the task of the psychotherapist is to select one or two key thoughts, attitudes, behaviors for psychotherapeutic intervention. The first sessions are usually aimed at joining the patient, identifying the problem, overcoming helplessness, choosing a priority direction, discovering the connection between irrational belief and emotion, clarifying errors in thinking, identifying areas of possible change, including the patient in a cognitive-behavioral approach.
The task of the cognitive-behavioral psychotherapist- to make the patient an active participant in the process at all its stages. One of the fundamental tasks of cognitive-behavioral psychotherapy is the establishment of partnerships between the patient and the therapist. This collaboration takes the form of a therapeutic contract in which the therapist and the patient agree to work together to eliminate the symptoms or behavior of the latter. This joint activity has at least 3 goals:
Since CBT is a short-term approach, this limited time must be used carefully. The central problem psychotherapeutic training» - determination of the patient's motivation. To strengthen the motivation for treatment, the following principles are taken into account: the joint definition of the goals and objectives of psychotherapy. It is important to work only on those decisions and commitments that are verbalized through "I want" and not "I would like"; drawing up a positive action plan, its achievability for each patient, careful planning of stages; manifestation by the psychotherapist of interest in the personality of the patient and his problem, reinforcement and support of the slightest success; the “agenda” of each lesson, the analysis of achievements and failures at each stage of psychotherapy contributes to strengthening motivation and responsibility for one’s result. When signing a psychotherapeutic contract, it is recommended to write down the plan or repeat it using positive reinforcement techniques, communicating that it is a good plan that will promote the fulfillment of desires and recovery.
At the beginning of each session, during an interview, a joint decision is made on which list of issues will be addressed. The formation of responsibility for one’s result is facilitated by the “agenda”, thanks to which it is possible to consistently work out psychotherapeutic “ targets". The "Agenda" usually begins with a short review of the patient's experience since the last session. It includes psychotherapist feedback on homework assignments. The patient is then encouraged to comment on what issues they would like to work on in the session. Sometimes the therapist himself suggests topics that he considers appropriate to include in the "agenda". At the end of the lesson, the most important conclusions of the psychotherapeutic session are summarized (sometimes in writing), and the emotional state of the patient is analyzed. Together with him, the nature of independent homework is determined, the task of which is to consolidate the knowledge or skills gained in the lesson.
Behavioral techniques are focused on specific situations and actions. In contrast to rigorous cognitive techniques, behavioral procedures focus on how to act or how to deal with a situation rather than how to perceive it. Cognitive-behavioral techniques are based on changing inadequate stereotypes of thinking, ideas with which a person reacts to external events, often accompanied by anxiety, aggression or depression. One of the fundamental goals of every behavioral technique is to change dysfunctional thinking. For example, if at the beginning of therapy the patient reports that he is not happy with anything, and after conducting behavioral exercises he changes this attitude to a positive one, then the task is completed. Behavioral changes often occur as a result of cognitive changes.
The most famous are the following behavioral and cognitive techniques: reciprocal inhibition; flood technique; implosion; paradoxical intention; evoked anger technique; stop tap method; the use of imagination, hidden modeling, self-instruction training, relaxation methods at the same time; assertiveness training; methods of self-control; introspection; scaling reception; study of threatening consequences (decatastrophization); Advantages and disadvantages; interrogation of testimonies; study of the choice (alternatives) of thoughts and actions; paradoxes, etc.
Modern cognitive-behavioral psychotherapy, emphasizing the importance of the principles of classical and operant learning, is not limited to them. In recent years, it has also absorbed the provisions of the theory of information processing, communication, and even large systems, as a result of which the methods and techniques of this trend in psychotherapy are being modified and integrated.
In the article we talk about anorexia nervosa. You will learn why this disease occurs and why it is dangerous. You will understand how to properly treat pathology, and why anorexia patients need special care and psychological support.
Neurological - a neuropsychological disorder characterized by complete or partial refusal of food, which is associated with an obsessive desire to lose weight. In the international classification of diseases ICD-10, anorexia nervosa is marked under the number F50.
Mental anorexia affects mainly adolescents and young girls.. For the sake of a slender figure, they exhaust themselves with diets, exercises, induce vomiting, take laxatives. Over time, the desire to lose weight becomes obsessive, and patients no longer adequately perceive their appearance.
Anorexia nervosa requires immediate treatment
Mental disorder is preceded by such factors:
Psychogenic anorexia is a consequence of inadequate perception of one's appearance and low self-esteem. Obsessive ideas about the imperfection of one's own body, the overvalued idea of losing weight lead to a change in the food instinct and the instinct of self-preservation. As a result, metabolic processes slow down, internal organs atrophy.
The main cause of anorexia nervosa is in the field of psychosomatics, so the treatment is carried out under the supervision of a psychiatrist.
There are 3 stages of anorexia nervosa, each with its own symptoms:
Anorexia as a mental illness begins with an inadequate perception of one's own appearance. It seems to a person that he is too full, while the body weight is within the normal range or only slightly exceeds it. The patient's ideas about beauty change - he admires thin people, considering them successful and beautiful.
In order to lose weight, the patient changes the diet, excluding from it all foods that can lead to fullness, actively goes in for sports. Over time, food refusals become more frequent. To reduce the feeling of hunger, a person starts smoking, drinks a lot of coffee, takes medication to reduce appetite.
A constant feeling of hunger leads to irritability, tension, dissatisfaction with oneself grows, and a sharp change in mood is noted. Patients seek solitude, thoughts about the imperfection of their body become obsessive.
When body weight decreases by a third or more, the process of losing weight slows down, fatigue appears, feeling cold, dizziness, fainting, and dehydration develops. The skin becomes pale, dry, in women, menstruation becomes scarce or disappears altogether. The body stops digesting food, food causes heartburn, stomach pain, vomiting.
Anorexic does not consider himself sick. However, without medical intervention and the help of a psychiatrist, it is very difficult to cope with the disease.
An important part of the treatment of anorexia is a balanced diet and changes in eating behavior
Anorexia as a psychological disorder requires a professional approach to treatment. If the patient develops cachexia, hospitalization will be required, as the body already refuses to eat food in the usual way.
Treatment at home is possible only at the initial stage, when the patient has sufficient nutrition and attention from relatives and friends. Let's figure out how to get rid of anorexia nervosa in severe cases, when weight loss exceeds 30%.
Depending on the symptoms, the treatment of anorexia nervosa at the first stage consists in stopping weight loss, restoring carbohydrate, water-salt, fat and protein metabolism. For this purpose, the following are assigned:
Drug therapy for cachexia lasts 2 months. Comprehensive treatment promotes rapid weight gain.
With anorexia on nervous grounds, for a complete recovery, the patient needs to completely change his lifestyle. A person can do this only with the psychological support of loved ones and the help of a psychologist and nutritionist.
The patient is told about the importance of good nutrition. Classes are complemented by the preparation of the correct menu. The patient independently plans his diet for 3-4 months under the supervision of a doctor.
Changing lifestyle means choosing an exciting sport. The patient realizes that physical exercises should not be exhausting, they should bring pleasure and be beneficial to health. Sports activities can be replaced by outdoor walks.
Because the body refuses to eat in severe cases of anorexia, nutrients can be given intravenously in a hospital setting. With a stable improvement in the patient's condition, the patient is offered food in small portions 6-7 times a day, gradually increasing the number of calories. It is important to ensure that anorexics do not cause vomiting artificially.
Nutrition is supplemented with nutritional supplements - vitamins of group B, C, fatty acids Omega-3 and Omega-6. They are given intravenously or taken orally.
As for dietary supplements, doctors are against their use, since in most cases they are ineffective. Before treating the nervous system at home with nutritional supplements, consult your doctor.
Cognitive-behavioral therapy for anorexia nervosa is aimed at getting rid of feelings of inferiority, correcting ideas about beauty and health and is carried out using 3 main approaches:
Cognitive Behavioral Therapy (CBT) helps to address psychological issues and develop healthy eating habits at the same time.
The most tangible effect of family therapy gives in the treatment of children and adolescents. For them, the care of parents and relatives is very important. A good example for kids will be the healthy eating habits of dad and mom, an active lifestyle, a passion for interesting sports.
No less important is the support of the husband for those women who have recovered after pregnancy or for other reasons and now feel inferior and unloved, trying to lose weight.
Care and love from loved ones and friends is an important part of recovery. Family members need to understand how serious anorexia is and what causes it.
One of the methods of family therapy is the Maudsley method. It was developed in London specifically for the treatment of adolescents between the ages of 13 and 17. The method evaluates the family and parents as active participants in the patient's recovery process and in some cases helps to prevent hospitalization.
The essence of the method lies in the fact that parents take responsibility for controlling the planning of the menu and the consumption of the prescribed dishes by the patient. If necessary, hospitalization of the teenager arranges daily meetings with family members, doctors conduct family consultations.
Hypnosis can be useful as part of complex therapy for anorexia. It helps the patient cope with depression, increase self-esteem, form eating habits.
In the absence of hospitalization and due attention to the patient from family members, the consequences of anorexia nervosa are severe:
In 20% of cases, anorexia ends in death, while half are suicides.
Statistics show that the prognosis for anorexia is favorable in 50-75% of cases. Treatment is long and takes from several months to several years. But even after a course of therapy in a hospital, the risk of relapse remains, and those who have recovered continue to strive to lose weight.
Prevention of the disease consists in the formation of healthy eating habits and the correct perception of one's own body by a child from an early age. Be sure to warn family members about the dangers of anorexia.
In the case of those who have recovered, it is important to avoid relapses, for which follow these rules of conduct:
For more information about anorexia nervosa, see the video:
Among the various treatments for anorexia, psychotherapy is the main one. Of course, it is possible to eliminate the negative consequences of the disease with the help of various drugs and procedures and, thanks to the diet, restore the patient's weight. However, if the patient does not change his attitude to the process of nutrition, to himself, his own weight and figure, then there will be no positive result. After stopping the course of treatment, the disease will return with a high probability.
Mainly used in the treatment of anorexia cognitive behavioral therapy, which is aimed at the patient's awareness of his current condition and the definition of the most significant goals, among which should be recovery. In anorexia, such therapy is designed to change the patient's eating behavior.
Initially cognitive behavioral therapy for anorexia was aimed only at restoring the conditioned reflex in the patient's mind: to eat when hungry. Typically, such psychotherapy was carried out in a hospital setting. During treatment, the patient gained weight, but after discharge from the hospital, a relapse occurred, and the patient began to lose weight again.
Much more effective is cognitive-behavioral therapy, aimed at correcting the patient's misconceptions about their own weight, body and figure. The return of a normal and healthy assessment of appearance and body weight leads to the fact that the patient no longer needs to lose weight. He objectively evaluates his weight, figure, appearance, accepts himself as he is. During therapy, obsessive ideas about losing weight and the fear of fullness disappear. The patient begins to eat and gradually gains weight, and then with the help of other methods of treatment, the consequences of anorexia are eliminated. All this happens, of course, under the constant supervision of a doctor.
Psychotherapy also allows you to get rid of the “avoidance” syndrome, when the patient deliberately avoids situations that he considers dangerous. There is a self-isolation of a person, which does not contribute to recovery at all. Psychotherapy should be aimed not only at eliminating the symptoms of anorexia, but also at returning the patient to a full life: to their interests, hobbies, hobbies.
An essential component of psychotherapeutic measures for anorexia is family psychotherapy. It is especially important in the treatment of anorexia in adolescents. Family psychotherapy is aimed at correcting stereotypes in relationships between family members. Often the cause of the development of the disease in a teenager is the behavior of parents: they are constantly dissatisfied with their child, they try to impose their opinion on him, they do not respect his interests. The teenager begins to look at himself negatively, which leads to the development of anorexia. Family therapy teaches family members to respect each other's opinions, helps to improve the atmosphere in the family. The therapist will explain to the parents how to behave with the child during rehabilitation. Family psychotherapy can be carried out both with the participation of the whole family, and in couples (child and father, child and mother, only parents).
Among other psychotherapeutic methods for the treatment of anorexia, body oriented therapy and mirror baths. A patient with anorexia, together with a psychotherapist, is in a special room among the mirrors, where he studies his naked body, fixes his feelings, both emotional and bodily. This is followed by a discussion of the information received with a psychotherapist. This therapy helps the patient to cope with the negative attitude towards their own body.
It is worth distinguishing psychotherapy from nutritional counseling. Unfortunately, only knowledge about proper nutrition will not help get rid of anorexia, since the problem lies much deeper than just eating disorders. Nutrition counseling can be a good addition to psychotherapy.
Despite the fact that psychotherapy is the main treatment for anorexia, it still cannot be carried out outside the general complex of therapeutic measures. The most effective result gives: psychotherapy, instrumental and drug treatment.
In the clinic "Mental Health" psychotherapy for anorexia is usually carried out in sessions, since several sessions of psychotherapy are not enough for a complete recovery. At the same time, it is very important that the patient work on himself on his own, so the psychotherapist can give homework to patients. We provide psychotherapy for anorexia both on an outpatient basis and in our country hospital.
