Les troubles alimentaires: L’anorexie mentale

The pandemic we are currently experiencing will have led, as we all know, to an increase in anxiety, depression and anguish among people struggling with eating disorders. Requests for help from ANEB (Anorexie et Boulimie Québec) have more than doubled in the past year, reaching an increase of up to 131%.

The isolation, the loss of routine, the desire to keep control, and the time spent on social networks have had a definite impact on the changes in their habits and relapses, and on the obsession that accompanies these disorders. .

According to Dr. Mimi Israel, head of the Department of Psychiatry at the Douglas Institute and Associate Professor in the Department of Psychiatry at McGill University, eating disorders most commonly occurring in adolescence, parents need to be careful about the messages they receive. convey. Don't get obsessed with eating, don't put pressure on children by telling them about their weight or stigmatizing them about unhealthy eating habits. Self-esteem is everything. It’s not what we look like or how much we weigh, but who we really are, what matters. »

This is the first article in a series on eating disorders.

Definition of anorexia nervosa

Anorexia nervosa is a recognized eating disorder listed in theDiagnostic and statistical manual of mental disorders fifth edition (DSM-5) which defines and categorizes mental disorders. This disorder is characterized by the desire to be thin, fear of obesity, distorted body image and restriction of food intake, which leads to weight loss and low body weight.

Different types of anorexia nervosa

There are two types of anorexia nervosa: the restrictive type and the binge / eliminating behavior type.

In the first case, individuals limit their food intake and may have excessive physical activity. They do not exhibit binge eating or elimination behavior on a regular basis.

In the second case, in addition to reducing their food intake, individuals regularly have binge eating attacks, where they eat frantically, and then an elimination behavior, where they make themselves vomit or take various purgatives (e.g. laxatives, diuretics, enemas).

Etiology of anorexia nervosa

The causes of anorexia nervosa are unknown. One of the only recognized risk factors is being female. However, other factors could also favor the development of this disease, such as being on a diet or being excessively concerned about your weight. There could also be genetic predispositions and social factors. Indeed, many people affected by this disease come from the middle or upper class. Finally, the enhancement of thinness in Western society could also have a role to play in the development of this disease.

Symptoms of anorexia nervosa

Symptoms of anorexia nervosa can include bloating, abdominal pain, andconstipation. People with anorexia may also have a slow heart rate, low blood pressure, low body temperature, excess hair on the body and face, swelling and depression. In women, stopping menstruation is common. In individuals who suffer from anorexia binge eating / eliminating behavior and frequently induce vomiting, symptoms may also include erosion of the tooth enamel and inflammation of the esophagus. Anorexia nervosa can also cause hormonal changes, such as a decrease in sex hormones (estrogen and testosterone) and an increase in cortisol. These changes can lead to a decrease in bone density, which increases the risk ofosteoporosis. Significant weight loss can also affect the body's fluids and electrolytes, which can lead to dehydration and fainting. Finally, in severe cases of anorexia nervosa, all important organs in the body can be affected.

Diagnosis of anorexia nervosa

The diagnostic criteria for anorexia nervosa include:

  • Restriction of food intake leading to low body weight
  • Fear of gaining weight or obesity
  • Distortion of body image and / or denial of the severity of the disease

Treatment of anorexia nervosa

Treatment of anorexia nervosa generally requires the intervention of a multidisciplinary team including several health professionals, such as doctors, psychologists, psychiatrists and nutritionists. The initial goal of treatment is to restore weight. This phase of treatment may require hospitalization. During this phase, individuals also receive psychiatric and nutritional recommendations. Then, long-term treatment begins and mainly includes psychotherapy aimed at normalizing eating behavior and weight. This therapy lasts between one to two years after weight recovery. In adolescents, family therapy may also be part of the treatment. Regular follow-ups with various health professionals (doctors, psychologists, nutritionists, etc.) also take place throughout the treatment. Finally, drugs can also be prescribed.

Nutritional approach for anorexia nervosa

The primary goal of treatment for anorexia nervosa is to restore weight. Weight restoration is done through nutritional supplementation. Solid foods by mouth are ideal, but liquid supplements can also be used. In some severe cases, tube feeding may also be required. The speed of weight gain may vary depending on the severity of the weight loss. In very severe cases, more gradual weight gain may be required to prevent refeeding syndrome. This syndrome designates a set of complications that can occur with too rapid weight recovery in individuals who are very underweight. When restoring weight, it is also recommended to stop physical activity, as it can prevent weight gain. Finally,supplements calcium andvitamin D are often prescribed for people with reduced bone mass.

Once the weight is restored, long-term treatment aims to normalize eating behavior and weight. During this phase of treatment, individuals generally undergo behavior therapy and have regular follow-ups with a team of healthcare professionals including a nutritionist. The nutritionist can step in to make a dietary plan, provide dietary recommendations, and provide nutritional education to help normalize weight.

Nutritional education for anorexia nervosa

In the case of anorexia nervosa, the role of the nutritionist is particularly to provide education on normal eating. This teaching may include the following recommendations:

  • Plan three regular meals a day.
  • Consume normal portions.
  • Expand the food repertoire. People with anorexia nervosa often eat a small variety of foods.
  • Avoid slimming or diet foods.
  • Discourage adoption of vegetarianism or veganism, which can often be used to camouflage a restriction in food intake.
  • Avoid weighing yourself frequently. Limit weighings to those performed during follow-ups with health professionals.
  • Teach how to keep a food journal.
  • Educate and reassure individuals of gastrointestinal symptoms that may occur at the start of refeeding. These symptoms subside after a few weeks of refeeding.

 

References

  1. https://quebec.huffingtonpost.ca/entry/troubles-alimentaires-demandes-aide-aneb_qc_60185fdac5b63b0fb2836d08
  2. https://www.merckmanuals.com/fr-ca/accueil/troubles-mentaux/troubles-des-conduites-alimentaires/anorexia-mentale
  3. https://www.merckmanuals.com/fr-ca/professional/troubles-psychiatriques/troubles-du-comportement-alimentaire/anorexia-mentale
  4. https://www.merckmanuals.com/fr-ca/accueil/les-faits-en-bref-troubles-mentaux/troubles-des-conduites-alimentaires/anorexie-mentale
  5. https://www.unlockfood.ca/fr/Articles/Adolescence/Quand-la-nouriture-et-le-poids-corporel-privez-toute-la-place---coup-d%E2%80%99% C5% 93il-on-les-les-de-l% E2% 80% 99alimentation.aspx
  6. https://www.inserm.fr/information-en-sante/dossiers-information/anorexie-mentale
  7. Coughlin, Janelle W., et al.Modern Nutrition in Health and Disease, by A. Catharine Ross, Wolters Kluwer / Lippincott Williams & Wilkins, 2014, pp. 13241325..

Article written by:

Marie-Noël Marsan, Nutritionist

 

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