Want to eat but dare not eat, do you really understand anorexia?

Author: Li Xueni, Chief Physician, Peking University Sixth Hospital

Deputy Director of the Eating Disorders Collaborative Group of the Psychosomatic Medicine Branch of the Chinese Medical Association

Reviewer: Tang Qin, Director of the Science Department of the Chinese Medical Association

Do you know about anorexia?

From the literal meaning, "anorexia" gives people the feeling of hating to eat and not wanting to eat. Is this really the case?

1. Does anorexia mean not wanting to eat?

Anorexia, also known as anorexia nervosa in medicine, we believe that both terms are accurate.

Because of the word "anorexia", people generally think that anorexia means not wanting to eat. So many patients say when they come to see a doctor that they don't have anorexia because they don't want to eat. They have a good appetite and are particularly interested in food. They want to eat everything they see.

So what is the problem? We have a saying that anorexia patients do not want to eat or cannot eat, but they dare not eat.

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If the patient tells us the truth, he will say, "I am very interested in food and want to eat it, but I am afraid of it. What am I afraid of? I am afraid of gaining weight and getting fat."

This fear is different from the ordinary girls' love of beauty and wanting to have a slim figure. His fear has reached a pathological level, that is, although his weight is already too low and has been medically diagnosed as malnutrition, he is still afraid of getting fat, and the corresponding behavior is to pursue weight loss.

One of our old professors once half-jokingly said that patients with anorexia do not need any diagnostic criteria. You can almost make a diagnosis just by looking at the patient, because he looks very thin, and even an ordinary person can feel that this person is overly thin.

In this case, he will still be obsessed with losing weight. We say that he is deliberately causing weight loss or preventing weight gain. This is the characteristic of anorexia.

2. How should anorexia be treated?

For anorexia, we emphasize comprehensive treatment, but it emphasizes multidisciplinary cooperation. Because it is not only a psychological problem, but also many other problems, so usually in our treatment team, we need psychiatrists, psychotherapists, internists, nutritionists and nurses, so the treatment starts from these aspects.

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First of all, a very important basis for anorexia is nutritional therapy. We will have nutritionists to help them evaluate their current nutritional status and nutritional needs, and then rebuild their nutritional levels. We also have a term called refeeding, which means letting them resume eating. There is a refeeding process. This is what nutritionists need to do. Nutritional therapy is the basis.

On this basis, we will help them to rebuild their nutrition through behavioral management and behavioral monitoring. Behavioral management in hospitals is usually assisted by nurses.

Then the internal medicine treatment will also keep up at any time, because malnutrition can cause damage to the cardiovascular system, digestive system, liver damage, kidney failure, etc. In the process of restoring nutrition, the internal medicine department must assess their physical condition at any time, understand the condition of each organ system, and treat the symptoms. Therefore, the internal medicine doctor also plays a very important role in the acute treatment process.

What remains is psychotherapy and psychiatric treatment.

We have professional psychological intervention for anorexia nervosa, which may include family intervention and individual cognitive behavioral intervention. These two methods may be the most important and most commonly used.

For psychiatric treatment, if the patient already has depression or has obvious depressive symptoms, we may give symptomatic antidepressant treatment. Of course, in addition to depression, he may also have other symptoms, such as anxiety and compulsion. Some patients may even have psychotic symptoms when the condition is serious, that is, hallucinations. If necessary, we will also combine psychiatric drug treatment accordingly.

In addition, anorexic patients want to lose weight on the one hand, but they also know that they are unhealthy and should recover on the other hand, so they usually feel very conflicted during treatment.

There is also a large number of people whose health is not seriously damaged. For example, they are just thin but not weak or to the point where they cannot climb the stairs. At this time, they often show obvious neglect of their health, claiming that they are fine and have no problems, and resist treatment.

Therefore, during treatment, we may encounter great resistance, such as the patient's non-cooperation, hostility, impulsiveness, etc. When necessary, we will also use psychiatric symptomatic treatment and some drugs to reduce impulsivity and hostility to reduce the difficulty of cooperation.

3. Is anorexia easy to treat? Can it be cured?

Anorexia has been identified and treated for more than 300 years. It is generally recognized that it is a relatively difficult disease to treat, partly because of patients' resistance to treatment and partly because there is no specific medicine.

For example, when a schizophrenia patient is controlled by hallucinations and delusions, he will resist treatment. However, after taking medication, his hallucinations and delusions can be quickly controlled, and he will know that he is sick and will cooperate with the treatment. However, anorexia is different. There is no drug that can directly reverse his distorted thoughts and perceptions of weight and body shape.

At the same time, although many anorexia patients are aware that they are sick, they also feel that the disease has brought them certain benefits, such as slimness, special care from their family members, etc. They themselves will be very conflicted about the treatment, so its treatment is indeed very difficult.

However, my personal feeling now is that the treatment of anorexia is not as difficult as we originally imagined. For example, after nutritional treatment is followed up, as the patient's physical health recovers, the morbid thoughts and feelings often naturally fade away. Coupled with the continuous psychological education and support provided by professionals, teaching them how to deal with the troubles caused by these thoughts and feelings, they can achieve a good life even though they still feel awkward and uncomfortable.

Of course, support from family and society is also very useful, so we also attach great importance to educating and supporting the patients' families, helping their family members learn how to support them in getting rid of the impact of the disease. In this way, the patients' conditions can mostly be improved.

Current statistics show that about 50% of patients are cured. In this way, compared with other psychiatric diseases, the prognosis is not too bad. We are still optimistic about the treatment. And we found that even if a patient has been ill for 20 or 30 years and has been in a state of chronic malnutrition, as long as he is determined to receive treatment, he may still get better.