Anorexia nervosa: diagnosis and treatment
The diagnosis of anorexia nervosa is often made by a doctor under the pressure of relatives (parents, legal representatives ). Concerned relatives usually come into conflict with the disabled person, who denies the disease, which can lead to crisis situations and a tense atmosphere in the family.
Nevertheless, it is very important to make a diagnosis as soon as possible. In adult patients, partner support plays an important role. Treatment must be comprehensive.
Diagnosis of anorexia nervosa
If an eating disorder is suspected, the doctor will focus on a careful medical history , perform a thorough physical examination, and may also request some other tests:
- History and physical examination. The doctor determines the body weight and height and determines the BMI value from them (for adults), or compares them with growth charts (for children and adolescents) [1, 2]. In addition, they try to learn as much as possible about the patient’s eating habits, social environment and mental state. For this purpose, he takes a careful medical history: he can ask questions not only about eating habits, vomiting , constipation , irregular menstruation , physical activity , medication use , alcohol and drug consumption , but also about possible self-harming behavior, suicide attempts, etc.
- Other health problems. The doctor also needs to find out any other diseases or health complications , such as malabsorption syndrome , esophagitis , celiac disease , Crohn’s disease , osteomalacia , constipation, hypertrophic osteoarthropathy, hormonal disorders (e.g. hyperthyroidism ), metabolic disorders (e.g. diabetes mellitus ), cancer diseases and psychiatric diseases, or possible drug use.
- Laboratory examination . The diagnosis also includesthe determination of various laboratory values, such as blood count , erythrocyte sedimentation , kidney function tests( creatinine and urea ), lipid metabolism ( triacylglycerols and cholesterol ), electrolytes , glycemia , amylase , transaminase, liver tests, urine tests, total protein and albumin . Furthermore , the doctor will focus on possible anemia and may have the level of certain hormones determined in the laboratory (such as growth hormone or thyroid hormones ), or and some other substances.
The doctor can also indicate an ultrasound examination of the abdomen and, if necessary, other examinations, such as EKG , gastroscopy and/or CT .
Treatment of anorexia nervosa
The treatment of anorexia nervosa consists not only in the treatment of physical problems: psychotherapy is also an important part of it . Ideally, treating doctors (of different specialties) and psychotherapist(s) work closely together. The earlier the treatment is started (i.e. the shorter the time between the onset of the disease and the start of the treatment), the better the patient’s prognosis .
Outpatient treatment, day care or hospitalization
Treatment can take place on an outpatient basis, in the form of a day hospital or even during hospitalization. The doctor decides on the most suitable form of treatment: he takes into account not only the physical condition, but also social and psychological factors. Psychotherapeutic treatment can take place individually or in groups. Not only the patient, but also his/her relatives are informed about the disease itself and its treatment. Especially at the beginning of treatment, but also later throughout its course, it is often very important to maintain the motivation of the affected person for treatment.
During treatment, body weight and eating habits should return to normal, while emphasis is also placed on managing mental problems. Nutritional counseling and help with managing daily activities are also included in the treatment . Especially for adolescents, psychological support is sometimes necessary in order to be able to accept the physical and mental changes associated with adolescence.
In addition to all this, possible associated diseases and complications need to be treated.
Treatment control and relapse prevention
During the course of treatment, regular examinations are carried out, the purpose of which is to check the progress of the treatment and to detect possible complications; such examinations may include, for example, measuring body weight or taking blood to determine certain laboratory values. In addition, it is necessary to prepare the patient for the period after the treatment is finished. The doctor can thus talk with the patient and his/her relatives about the future return to “normal life” and what to do in the event of a relapse.
Treatment usually lasts several months, sometimes even years. In the course of the treatment, it may be interrupted (even several times). Under certain circumstances, it is also possible to consider temporarily moving the affected person from the home environment to housing within the framework of a therapeutic group that specializes in the treatment of eating disorders.
Family environment
An important role in the treatment is played by the family of the affected person, or someone else close to him/her. For the success of the treatment, the contribution of the parents is often decisive in all stages of the diagnostic and treatment process: from the recognition of symptoms to the diagnosis to intensive cooperation with the therapeutic team.
Not only for children, but also for teenagers, important decisions and tasks rest on the shoulders of their parents or legal representatives . They often have to first convince the affected person to undergo treatment at all, and at the same time, if possible, not interfere too strongly with his/her autonomy (especially in the case of juveniles). At the same time, relatives usually find it difficult to come to terms with the fact that they can help relatively little. Many relatives bear the burden of not being able to constantly check on their child, although they are interested in the course of treatment and would like to participate in it. During treatment, conflict situations may arise in the family, which are sometimes better resolved with professional help, e.g. with the use of psychotherapy, family therapy or couple therapy. For more information on this topic, see the article Eating disorders: what can relatives do?
Medicinal treatment
If, at the same time, the sufferer is diagnosed with an eating disorder, for example, depression , the doctor may prescribe certain medications ( psychopharmaceuticals or antidepressants ). In anorexia nervosa, it is sometimes necessary to supplement the missing nutrients .
Forced treatment
In the ideal case, the treatment is carried out with the consent of the affected person, with whom the doctor discusses and agrees on the goals of the treatment , and the patient subsequently tries to eat a healthy, balanced diet . Sometimes, however, it is necessary to introduce “harder” measures to ensure a sufficient supply of food. This can be achieved, for example, by means of liquid nutrition , sometimes also by means of a nasogastric tube (a tube inserted through the nose through the esophagus into the stomach ). Under certain circumstances (in very rare cases) forced treatment is considered, especially when the patient is in a life-threatening condition.
Who can I contact?
Adults should first contact their GP , while children and adolescents should first contact their GP . If necessary, the general practitioner will provide further examination and treatment. Doctors of various specializations, possibly even psychotherapists, participate in the treatment itself.
