[ zraj @ 07.11.2006. 15:06 ] @
Poremećaj u hranjenju najčešće nastaje kao posledica držanja restriktivnih dijeta i to kod osoba koje su emocionalno i psihički osetljive, odnosno onih koje rade na samouništenju sopstvenog zdravlja, praktikujući držanje nepravilnih dijeta, uzimanjem neproverenih dijetetskih preparata i određivanjem sopstvene idealne težine koja je najčešće ispod adekvatne. Zadatak nabavljača i proizvođača hrane, zdravstvenih centara i nutricionista je da upoznaju zdravstvene radnike i zakonodavne ljude o opasnostima koje donosi upotreba nepravilnih dijeta i dijetetskih preparata nepoznatog porekla, o standardnim načinima izračunavanja idealne telesne težine i pravilnim metodama gubljenja težine. Dijetetičari, takođe, imaju zadatak da obaveštavaju o riziku po zdravlje kada je u pitanju nepravilnost u ishrani. Poremećaj u ishrani je širok pojam koji obuhvata stanje od kompulsivnog prejedanja do anoreksije (Anorexia nervosa). Takav poremećaj je najčešće posledica nekog drugog problema, ali zahteva tretman nutricioniste. Mlađe osobe koje pate od nekog tipa poremećaja ishrane, najčešće privlače pažnju odraslih. Neki rani znakovi poremećaja u ishrani: § Uzimanje malih porcija ili odbijanje hrane. § Nagli gubici u težini bez nekog posebnog razloga. § Jak strah od dobijanja na težini. § Učestalo vežbanje. § Jedenje u tajnosti. § Napuštanje stola odmah posle jela i odlazak u kupatilo. § Velika kolebanja u težini. § Gubitak menstruacije § Zavisnost od laksativa, diuretika ili dijetetskih pilula (pilula za mršavljenje). Anorexia nervosa je poremećaj u kome dijeta i opsednutost vitkom linijom mogu dovesti do ekstremnog gubitka telesne težine, preko 20 % i konsekventno do smrti pri čemu je slika o sebi izmenjena. Bulimia nervosa je poremećaj koji se manifestuje čestim epizodama prejedanja (4000 cal i više za obrok) i to najmanje dva puta nedeljno u poslednja tri meseca, praćene provociranim povraćanjem ili uzimanjem sredstava za čišćenje uz intezivan osećaj krivice i stida. Binge eating je poremećaj nekontrolisanog uzimanja velikih količina hrane (preko 2500 cal za obrok) hrane, često u tajnosti, bez izazivanja povraćanja. Uzroci ovih poremećaja su multifaktorijalni: - genetski /smatra se da kod nekih osoba postoji nasledna predispozicija za nastanak ovih poremećaja. To mogu biti biohemijske abnormalnosti (nivo hormona i neurotransmitera). Kod osoba sa ovim poremećajem nađene su promene, ali se ne zna pouzdano da li su one uzrok ili poledica već nastalog poremećaja. - uticaj porodice Anoreksija: prezaštićeno ili zapostavljeno dete koje želi da ispolji svoja osećanja, strah od razvoda roditelja (skretanje pažnje na sebe), ne želi da odraste - potreba da i dalje bude zaštićen, osećaj beskorisnosti-vlasništvo roditelja, mogućnost da sami odlučuju bar o nečemu (o svom izgledu), česti psihijatrijski problemi u porodici (kod ove dece su tri puta češće anoreksije nego u normalnoj porodici). Bulimija: roditelji nisu zaštitnički usmereni, haotične porodice (alkoholizam, narkomani, seksualne abnormalnosti i psihički poremećaji), majka utiče na fizički izgled, tj. da li dete treba da oslabi ili se ugoji jer je nezadovoljna izgledom ćerke. - uticaj sredine, društva/želja da se bude privlačan u skladu sa savremenim modnim trendovima, isticanje ekstremne vitkosti kao modela, deklensirajući faktor-okidač (često počinju sa dijetom onoga dana kada im neko "i u prolazu" kaže nešto u vezi sa izgledom ili jelom). Poremećaj u ishrani-Anorexia nervosa, Bulimia i Binge eating-su psihijatrijske bolesti koje najčešće zahvataju ljude između 15 i 35 godine. Statistike pokazuju da preko dva miliona Amerikanaca boluje od ovih bolesti i na hiljade njih umire od istih. Veliki je i broj onih koji imaju drugu vrstu poremećaja, kao što je zavisnost od dijetetski pilula, laksativa, diuretika, držanja tzv. ''hir'' dijeta. Depresija, poniženje, osećaj odbačenosti prouzrokovane poremećajem u ishrane dovode do neslaganja u porodici, problemima u školi, rušenja sagrađene karijere i poremećaja u odnosima među ljudima. Bez određenih tretmana ljudima sa ovakvim poremećajima ne predstoji blistava budućnost. S druge strane stoji terapija udružena sa lekovima gde pacijent biva izlečen i sposoban da prikupi snagu za dalji normalan i zdrav život. Razumevanje srži problema koji dovode do poremećaja, rano primećivanje znakova i simptoma bolesti su putevi prevencije ovih oboljenja. Kao što su i uzroci ovih oboljenja kompleksni tako je i lečenje složeno: 1. Psihoterapija; 2. Porodična terapija; 3. Psihoporodična dijetoterapija; 4. Promena ponašanja; 5. Lekovi; Lečenje se može sprovoditi ambulantno (pojedinačno ili grupno) ili u bolnici. Cilj lečenja je da se postigne psihički oporavak, adekvatno reaguje na glad i sitost i ispoljavanje emocija. U lečenju treba da učestvuje psihijatar, dijetetičar i medicinska sestra. Ishod lečenja: kod muškaraca nisu zabeleženi smrtni slučajevi. 1-3 % pacijentkinja umire jer ne reaguje na terapiju, posle 4-12 godina 50 % pacijentkinja se oporavi s tim što neki od oporavljenih pređu u bulimiju. Karakteristike poremećaja ANOREXIA nervosa BULIMIA nervosa BINGE eating (kompulzivno jedenje) Ponašanje u vezi sa hranjenjem § Unos nekoliko stotina kalorija dnevno, nekad i manje od 100 cal/dan § Brojanje kalorija § Ne prepoznavanje znakova gladi § Učestvovanje u pripremi hrane i stalno pričanje o hrani § Preskakanje obroka § Izražena fizička aktivnost § Prejedanje više od dva puta nedeljno (4000 cal za obrok) u poslednja tri meseca § Osećaj da ne može da kontroliše količinu hrane § Preskakanje obroka § Često pričanje o hrani § Osećaj krivice posle jela § Povraćanje posle jela § Prejedanje preko dva puta nedeljno (2500 cal za obrok) u poslednjih šest meseci § Ne može voljno da prekine unos hrane § Ne povraćaju i ne uzimaju purgative § Izražena fizička aktivnost Izgled i ciljevi § Ne doživljava sebe kao mršavu osobu ("iskrivljena slika u ogledalu") § Strah od dobijanja kilograma § Vitkost joj je cilj § Telesna težina iznosi 85% idealne telesne težine § Ne shvataju da imaju problem sa jelom § Strah od dobijanja kilograma § Telesna težina je obično normalna ili 10% preko idealne telesne težine § Cilj je vitkost § Shvataju da imaju problem sa jelom § Često su na dijetama jer smatraju da im socijalni i profesionalni uspeh zavise od izgleda § Shvataju da imaju pogrešan model hranjenja Zdravstveni status § Amenoreja tri meseca ili više § Bol u trbuhu, punoća, muka § Opstipacija § Poremećaj spavanja § Ne podnošenje hladnoće (modre i hladne ruke i stopala) § Lanugo (sitne dlačice po telu) § Vrtoglavica § Pad pulsa i krvnog pritiska § Dehidratacija § Poremećaj funkcije srca i bubrega § Nutritivni deficit (vitamini, minerali) § Česte frakture § Smrt § Bol u trbuhu § Opstipacija § Fluktuacija telesne težine § Iregularan menstrualni ciklus § Karijesi (usled kiselog zeludačnog sadržaja pri povraćanju) § Gusobolja § Elektrolitni poremećaji § Slabost mišića § Iregularni srčani otkucaji § Rektalno krvarenje § Depresija § Smrt zbog elektrolitnog disbalansa ili rupture želuca § Fluktuacija telesne težine Psihicki status § Poremećen psiho-seksualni razvoj § Depresija § Perfekcionista § Negativni stav prema sebi (osećaj beskorisnosti, kao da je vlasništvo roditelja, ne mogućnost da upravlja sobom) § Skoro prekinuto prijateljstvo § Teško se nosi sa životnim teškoćama § Rano započeta seksualna aktivnost § Perfekcionista § Negativna identifikacija § Skoro prekinuto prijateljstvo § Teško se nosi sa životnim teškoćama § Frusracije § Osećaj da ne može da se kontroliše prilikom jela (prestaje usled bola u stomaku ili ako neko naiđe jer obično jedu sami u tajnosti) § Pod stresom je § Depresija Uticaj sredine § Roditelji prezaposleni ili stalno bdiju (prezaštićenost) § Porodična istorija gojaznosti ili poremećaja hranjenja § Veliki zahtevi od deteta § Haotični, nesređeni odnosi u porodici (razvod,alkoholizam) § Ako je u porodici vitkost-fittnes opsesija, uticaj majke na ćerku § Veliki zahtevi od deteta Nastanak (početak) bolesti § Tinejdžersko doba (češće kod devojaka) § Obično između 17 i 20 godina, mada može i u periodu od 40-50 godina § Obično posle ne medicinskih (jo-jo dijeta) dijeta Neposredni uzroci (okidači) § Ako im neko "u prolazu" kaže da mnogo jedu ili da su gojazne § Ako im neko "u prolazu" kaže da mnogo jedu ili da su gojazne Bulimia nervosa Introduction People with bulimia nervosa often live in a secret world of shame and self-disgust. With its episodes of overeating and furtive trips to the bathroom to vomit, bulimia involves behavior that's embarrassing and socially unacceptable. Bulimia is a type of eating disorder in which people are preoccupied with their weight and shape, often judging themselves severely and harshly for perceived flaws. People with bulimia experience episodes of bingeing and purging. During these episodes, they typically eat a large amount of food in a short period of time and then try to rid themselves of the extra calories in inappropriate ways, such as self-induced vomiting or excessive exercise. In between these binge-purge episodes, people with bulimia actually eat very little or often skip meals altogether. In Western, industrialized countries, about 1 percent to 3 percent of women experience bulimia during their life. The rate of bulimia in men is about one-tenth of that in women. Bulimia is a serious, potentially life-threatening condition. Because it's so intimately entwined with self-image — it's not just about food — bulimia can be difficult to overcome. But treatment can help people with bulimia feel better about themselves and adopt healthier eating patterns. Signs and symptoms People with bulimia regularly engage in episodes of binge eating followed by attempts to prevent weight gain. A binge is considered eating a larger amount of food than most people would eat under similar situations. For instance, someone with bulimia may eat an entire cake, rather than a slice or two. And he or she may continue eating until painfully full. Snacking throughout the day isn't considered a binge. However, sometimes people with bulimia will feel a need to purge after eating only a small or normal-size meal or portion. Binges often occur in private. People may be home alone where they raid the cupboards for food, for instance. Or they may make the rounds of numerous fast-food restaurants, eating meals at each one. Once the binge episode ends, the purging begins. That may mean heading to the bathroom to vomit or hitting the treadmill for hours of exercise. Someone may also take numerous laxatives or fast. Some people use their fingers or a toothbrush to induce vomiting by gagging. As the illness progresses, some people become so adept at self-induced vomiting that they can do it at will. Technically, bulimia is categorized in two ways: Purging. People regularly engage in self-induced vomiting or the misuse of laxatives, diuretics and enemas to compensate for binges. Nonpurging. People use other methods to rid themselves of calories and prevent weight gain, such as over-exercising or fasting. The attempt to rid one's self of extra calories is usually referred to as purging, no matter what the method actually is. Indeed, the lines between the two types of bulimia often blur or overlap. And in either case, signs and symptoms are similar. Physical indications Physical signs and symptoms of bulimia include: Abnormal bowel functioning Damaged teeth and gums Swollen salivary glands in the cheeks Sores in the throat and mouth Bloating Dehydration Fatigue Dry skin Irregular heartbeat Sores, scars or calluses on the knuckles or hands Menstrual irregularities or loss of menstruation (amenorrhea) People with bulimia tend to be at normal weight or overweight. Emotional and behavioral indications Emotional and behavioral characteristics associated with bulimia may include: Constant dieting Recurrent episodes of binge eating Feeling that you can't control your eating behavior Eating until the point of discomfort or pain Eating much more food in a binge episode than in a normal meal or snack Following a binge with efforts to prevent weight gain, such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise Unhealthy focus on your body shape and weight Having a distorted, excessively negative body image Going to the bathroom after eating or during meals Hoarding food Depression or anxiety Causes As with other mental disorders, there's no single cause of bulimia. The condition often begins in late adolescence or early adulthood — transitional periods that are often accompanied by growing peer pressure, dieting and emotional upheaval. Bulimia is more common in college students than in adolescents. Bulimia probably arises from an interplay of biological, psychological, familial, genetic, environmental and social factors: Biological. Some people may be genetically vulnerable to developing bulimia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. Studies of twins also support that idea. However, it's not clear specifically how genetics plays a role, and the overall evidence of a genetic component may be weak. In addition, there's some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake. Psychological. People with bulimia may have psychological and emotional characteristics that contribute to the disease. They may have low self-worth, for instance. They may have trouble controlling impulsive behaviors, managing their moods or expressing anger. The families of people with bulimia may tend to have more open conflicts, along with more criticism and unpredictability. Sociocultural. Modern Western culture often cultivates and reinforces a desire for thinness. The media are splashed with images of waif-like models and actors. Success and worth are often equated with being thin. Peer pressure may fuel this desire to be thin, particularly among young girls. Risk factors Certain situations and events are associated with an increased risk of developing bulimia. These include: Dieting. People who lose weight are often reinforced by positive comments from others and from their changing appearance. Children who diet are more likely than those who don't to develop an eating disorder such as bulimia. In addition, people with bulimia may excessively restrict their eating. That dieting can trigger a binge episode, leading to purging and then more dieting — and consequently a vicious cycle. Puberty. Some adolescents have trouble coping with the changes their bodies go through during puberty. They also may face increased peer pressure and may have a heightened sensitivity to criticism or even casual comments about weight or body shape. All of these can set the stage for bulimia and other eating disorders. Transitions. Whether it's heading off for college, moving, landing a new job or a relationship breakup, change can bring emotional distress. One way to cope, especially in situations that may be out of someone's control, is to latch on to something that they can control, such as their eating. Sports, work and artistic activities. Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders such as bulimia. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may contribute to eating disorders by suggesting young athletes lose weight. Media and society. The media, such as television and fashion magazines, frequently feature a parade of skinny beauties. But whether the media merely reflect social values or actually drive them is debatable. In any case, exposure to these images may lead girls and young women — and their male counterparts — to believe that thinness equates to success and popularity. When to seek medical advice The lives of people with bulimia are often centered around the condition. Binge-purge episodes may be planned in advance, for instance. Other times, episodes may be triggered by stress, dieting, feelings about weight or body shape, and eating what simply starts as a normal meal with friends. In any case, bulimia is running the show. Binge-purge episodes usually end in shame and self-disgust, with vows of not doing it again. But bulimia is difficult to overcome without professional medical treatment. People with bulimia may find themselves fantasizing about food and with cravings that seem too powerful to resist. People with bulimia may also have numerous physical problems, such as tooth decay, irregular heart rates, depression and fatigue. Bulimia is a serious medical condition that can threaten your life. You may have other conditions along with bulimia, such as anxiety or depression. All of these can rob you of the ability to enjoy life to its fullest. If you're experiencing any of these problems, or if you think you may have an eating disorder, you'd benefit from a medical evaluation. Screening and diagnosis When doctors suspect someone has bulimia, they typically perform a battery of tests and exams. These can help pinpoint a diagnosis and assess any related complications. These exams and tests generally include: Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining the abdomen. Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check electrolytes and protein, as well as liver, kidney and thyroid function. A urinalysis also may be done. Psychological evaluation. A doctor or mental health professional can assess thoughts, feelings and eating habits. Psychological self-assessments and questionnaires also are often used. Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. Testing may also be done to determine how much energy your body uses, which can help in planning nutritional requirements. These evaluations help doctors determine if someone meets the criteria for bulimia. These criteria are spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. DSM diagnostic criteria for bulimia are: Recurrent episodes of binge eating, including eating an abnormally large amount of food and feeling a sense of lack of control over eating. Recurrent behavior to compensate for the bingeing, such as self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, or excessive exercise. The behaviors occur at least twice a week for at least three months. Self-evaluations overly influenced by body shape and weight. The behaviors don't occur during periods of anorexia. Some people may not meet all of these criteria but still have an eating disorder and need professional help to overcome or manage it. Complications Bulimia has a host of serious and even life-threatening complications. The type of complications someone experiences often is related to their choice of purging method. Complications include: Cardiovascular problems. Electrolyte abnormalities or use of syrup of ipecac to induce vomiting can lead to heart muscle disorders and irregular heart rhythms. These can be life-threatening. Fainting and low blood pressure also are problems. Tooth and gum problems. Stomach acid can wash over teeth and gums during vomiting. Repeated vomiting can cause a significant and permanent loss of dental enamel. Teeth may become ragged and chipped, and dental cavities may increase. Throat and mouth problems. Frequent or regular vomiting can cause sores in your mouth or throat. You may notice bleeding if you force yourself to vomit. Low potassium levels. The purging process tends to dehydrate your body and lower the level of potassium in your blood. This can cause weakness and irregular heart rhythms. Digestive problems. Purging by vomiting or use of laxatives may irritate the walls of your esophagus and rectum. In severe cases, your esophagus can rupture, leading to life-threatening bleeding. Repeated purging may also cause constipation. Laxative abuse can lead to dependence. Gastrointestinal bleeding also may occur. Abuse of medications and drugs. The variety of over-the-counter drugs you may use during purge cycles may cause a drug problem. Some substances used include laxatives, diuretics, appetite suppressants and ipecac, a drug that induces vomiting. People with bulimia have higher rates of alcohol and substance abuse. Treatment People with bulimia often need several types of treatment. If their life is in immediate danger, they may need treatment in a hospital emergency department for such issues as dehydration, electrolyte imbalances or severe psychiatric problems. Treatment is generally done using a team approach that includes medical providers, mental health professionals and dietitians, all with experience in eating disorders. Here's a look at what's commonly involved in treating bulimia: Medical care. Because bulimia can cause a range of health complications, people with the condition may need treatment for their specific complications. They may also need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. A family doctor or primary care doctor may be the one who coordinates care with the other health care professionals involved. Sometimes, though, it's the mental health professional who coordinates care. Psychotherapy. A type of talk therapy called cognitive behavior therapy is most commonly used for bulimia and has shown the most benefit in treating the condition. Therapy can include individual or family therapy. Individual therapy can help you deal with the behavior and thoughts that contribute to bulimia. Family therapy can help resolve family conflicts or muster support from concerned family members. Group therapy and informal support groups typically aren't recommended since they may simply become a dangerous way for people with bulimia to share "how-to" tips on maintaining their condition. Nutritional therapy. Dietitians and other health care providers can offer information about a healthy diet and help design an eating plan to achieve a healthy weight and healthy-eating habits. Medications. Antidepressant medications may help some people with bulimia. The only antidepressant specifically FDA approved to treat bulimia is fluoxetine (Prozac), a type of antidepressant. However, doctors can still prescribe other antidepressants, and the medications may reduce the frequency of bingeing and purging. Antidepressants or psychiatric medications can also help treat accompanying mental disorders, such as depression or anxiety. Combining medications with cognitive behavior therapy seems to be the most effective course of treatment. Hospitalization. Severe problems resulting from an eating disorder may require treatment in the hospital. But bulimia can often be treated outside of the hospital. When needed, hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating-disorder programs may offer more intensive treatment over longer periods of time. With proper treatment, most people with bulimia recover. For some, though, the condition becomes a lifelong battle. Periods of bingeing and purging may come and go through the years, depending on life circumstances. In times of high stress, for instance, you may find yourself returning to familiar, if unhealthy, habits. If that happens, "booster" sessions with your health care providers can help you weather the crisis. Prevention In young children and adolescents, pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. In addition, parents can cultivate and reinforce a healthy body image in their children by reassuring them that they're of a normal or healthy size and that it's OK for body shapes to vary. People shouldn't tease children or make jokes about children who are slightly overweight or have a large body frame, and shouldn't give them negative nicknames. Routine screening of the general public for symptoms of bulimia isn't currently recommended in U.S. guidelines. However, some advocates suggest that it may be appropriate to screen college students, since that's when bulimia often begins. If you notice a family member or friend with low self-esteem, severe dieting, disordered eating behaviors and dissatisfaction with appearance, consider talking to them about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options. Self-care When you have an eating disorder, taking care of your health needs often isn't a priority. But proper self-care can help you feel better during and after treatment and help maintain your overall health. Try to make these steps a part of your routine. But don't beat yourself up if you aren't able to do so every day: Stick to your treatment. Don't skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable. Talk to your doctor about appropriate vitamin and mineral supplements. If you aren't eating well, chances are your body isn't getting all of the nutrients it needs. Don't isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits. Talk to your health care providers about what kind of exercise, if any, is appropriate for you, especially if you exercise excessively as a way to burn off post-binge calories. Coping skills You may find it difficult to cope with bulimia when you're hit with mixed messages by the media, culture, and perhaps your own friends or peers. You may even have heard people joke that they ought to go throw up after overeating — as if it were that simple. So how do you cope with a disease that can be deadly when you may be getting messages that being thin is a sign of success? Resist the urge to diet or skip meals. Dieting actually triggers binge eating and makes it difficult to cope with stress. Remind yourself what a healthy weight is for your body, especially at times when you see images that may trigger your desire to binge and purge. Don't visit Web sites that advocate or glorify eating disorders. These sites can encourage you to maintain dangerous habits and can trigger relapses. Identify situations that are likely to trigger thoughts or behavior that may contribute to your bulimia so that you can develop a plan of action to deal with them. Look for positive role models who can help boost your self-esteem, even if they're not easy to find. Remind yourself that the ultrathin models or actresses showcased in popular magazines often don't represent healthy bodies. If you're hiding your bulimia from loved ones, try to find a trusted confidante you can talk to about what's going on. Together, you may be able to come up with some treatment options. -------------------------------------------------------------------------------- By Mayo Clinic Staff Mar 13, 2006 © 1998-2006 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. DS00607 |