TheAnorexia maganizo ndi gawo lamavuto pakudya kapena matenda (ADD) monga bulimia ndi kudya kwambiri.

Munthu amene amadwala anorexia amatsogolera nkhondo yoopsa komanso yoopsa yolimbana ndi kunenepa kulikonse. Amakhala ndi mantha amantha ambiri omwe angafanizidwe ndi phobias enieni pokhudzana ndi zovuta zakudya, monga kunenepa kapena kunenepa kwambiri. Zotsatira zake ndizouma khosi komanso nthawi zambiri zoletsa zakudya.

Kuwongolera komwe anthu omwe ali ndi anorexia amadya ndikochulukirapo komanso kwamuyaya. Chilakolako nthawi zambiri chimasungidwa koma munthu amalimbana ndi kusowa ndi chikhumbo cha chakudya. Pamafunika kuchepa thupi pang’onopang’ono komwe kumatha kufika mpaka kuuma (kuonda kwambiri).

Pamtima pazikhalidwe za anorexiki, pali mantha owonera kunenepa kwambiri, omwe amakakamira munthuyo kupewa zinthu kapena zizolowezi zomwe zingayambitse kunenepa: kudya zakudya zosazolowereka, kudya osachita zolimbitsa thupi, ndi zina zotero. munthu amachepa pang'onopang'ono koma chisangalalo chomwe amamva sichichedwa ndipo amayesanso kuonda.

Lingaliro lomwe ali nalo la thupi lake ndi lopotozedwa, tikulankhula za izi alirezatalischi. Khalidwe losayenera ili lingayambitse zovuta zamankhwala (kusapeza bwino, mantha, amenorrhea, ndi zina zambiri) ndipo zithandizira kuti munthu akhale yekhayekha.

Anorexia kapena Anorexia nervosa?

Mawu akuti anorexia amagwiritsidwa ntchito molakwika kutanthauza anorexia nervosa, koma anorexia nervosa ndichachipatala mwawokha. Anorexia ndi chizindikiro chomwe chimapezeka m'matenda ambiri (gastroenteritis, khansa, ndi zina zambiri) zomwe zimafanana ndi kusowa kwa njala. Mu anorexia nervosa, chilakolako chimasungidwa koma munthu amakana kudya. 

Zimayambitsa

Anorexia nervosa ndi matenda omwe amadya kwambiri. Zomwe zimayambitsa matendawa ndizovuta ndipo nthawi zambiri zimalumikizana.

Ochita kafukufuku amavomereza kunena kuti zinthu zambiri ndizomwe zimayambitsa anorexia kuphatikiza majini, neuroendocrine, zamaganizidwe, mabanja komanso chikhalidwe. 

Ngakhale kuti palibe jini lomwe ladziwika bwino, kafukufuku akuwonetsa a chiopsezo cha banja. Ngati m'banjamo m'modzi mwa akazi ake ali ndi vuto la anorexia, pamakhala chiopsezo chowirikiza kanayi¹¹ kuti mayi wina m'banja lino amafikiridwa ndi vutoli kuposa banja "labwino".

Kafukufuku wina wopangidwa pamapasa ofanana (monozygotic) akuwonetsa kuti ngati m'modzi wa amapasa ali ndi vuto la anorexia, pali mwayi wa 56% kuti mapasa ake adzakhudzidwanso. Izi zikuwonjezeka mpaka 5% ngati ali mapasa osiyana (dizygotes)¹. 

Zinthu za endocrine monga kuchepa kwama mahomoni zikuwoneka kuti zikusewera matendawa. Kutsikira kwa mahomoni (LH-RH) komwe kumakhudzidwa ndikuwongolera ntchito yamchiberekero kukuwonetsedwa. Komabe, kuchepa uku kumawonedwa ngati pali kuchepa thupi ndipo mulingo wa LH-RH umabwerera mwakale ndikulemera. Vutoli limawoneka ngati chifukwa cha anorexia osati choyambitsa. 

Au mulingo wamitsempha, maphunziro ambiri amatulutsa kusokonekera kwa serotonergic. Serotonin ndichinthu chomwe chimatsimikizira kudutsa kwa uthenga wamanjenje pakati pa ma neuron (pamlingo wa ma synapses). Zimakhudzidwa makamaka pakulimbikitsa malo okhutira (dera laubongo lomwe limayendetsa njala). Pazifukwa zambiri zosadziwika, pali kuchepa kwa ntchito ya serotonin mwa anthu omwe ali ndi anorexia.².

pa mulingo wamaganizidwe, maphunziro ambiri apanga kulumikizana pakati pa kuwoneka kwa anorexia nervosa ndi kudzidalira koyipa (kumverera kopanda ntchito komanso kusakwanitsa kuchita ntchito) komanso kufunikira kofuna kuchita zinthu mosalakwitsa.

Zolingalira ndi kafukufuku wosanthula zimapeza zokhazikika pamakhalidwe ndi malingaliro omwe anthu omwe ali ndi anorexia amakumana nawo. Anorexia nthawi zambiri imakhudza achinyamata omwe amapewa zovuta zomwe zimakhala zoopsa kwambiri ndipo amadalira kwambiri kuweruza kwa ena. Zolemba zama psychoanalytic nthawi zambiri zimayambitsa kukana kwa thupi ngati chinthu chogonana. Atsikana atsikanawa mosakondera akanakonda akanakhalabe asungwana ndipo akanakhala ndi vuto lodzidziwitsa okha ndikudziyimira pawokha. Zovuta zomwe zimadza chifukwa chodya zimavulaza thupi lomwe "limabwerera m'mbuyo" (kusakhalitsa kusamba, kuchepa kwa thupi ndi kuwonda, ndi zina zambiri).

Pomaliza, kafukufuku wokhudzana ndi umunthu wa anthu omwe akhudzidwa ndi matenda a anorexia, apeza mitundu ina yaumunthu yomwe imakhudzidwa kwambiri ndi matendawa monga: kupewa umunthu (zoletsa chikhalidwe, kudzimva kuti sukwanitsa kugwira ntchitoyi, kusakhudzidwa ndi malingaliro olakwika. 'Ena… ), umunthu wodalira (kuyenera kutetezedwa kwambiri, kuopa kupatukana,…) ndi umunthu wambiri (ungwiro, kulamulira, kusasunthika, kusamalira tsatanetsatane, malingaliro osamala,…). 

Au msinkhu wazidziwitso, Kafukufuku akuwonetsa malingaliro olakwika omwe amadzetsa zikhulupiriro zabodza zomwe nthawi zambiri zimapezeka mu anorexics ndi bulimics monga "kuonda ndikutsimikizira chimwemwe" kapena "phindu lililonse lamafuta ndiloyipa".

Pomaliza, anorexia ndi matenda omwe amakhudza anthu okhala m'maiko otukuka kwambiri. Zinthu zachikhalidwe chifukwa chake zimakhala zofunikira pakukula kwa anorexia. Makhalidwe ochezera omwe anyamata achichepere okhala ndi matupi oonda kwambiri komanso okonda kugonana amakopa kwambiri achinyamata athu kuti adziwe kuti ndi ndani. Kupembedza kocheperako kumapezeka paliponse munyuzipepala, zomwe "zimatigulitsa" mosalekeza kuchuluka kwa zakudya zozizwitsa ndipo nthawi zambiri zimalimbikitsa kuwongolera kulemera kwa chikuto cha magazini nthawi isanakwane, nthawi yamatchuthi komanso tchuthi cha chilimwe.

Matenda ogwirizana

Pali zovuta zama psychopathological zomwe zimakhudzana ndi anorexia nervosa. Komabe, ndizovuta kudziwa ngati ndiko kuyamba kwa anorexia komwe kungayambitse mavutowa kapena ngati kupezeka kwa mavutowa kumapangitsa kuti munthu akhale anorexic.

Malinga ndi kafukufuku wina^{3, 4,5}, zovuta zazikulu zamaganizidwe zokhudzana ndi anorexia ndi izi:

• Matenda osokoneza bongo (OCD) omwe amakhudza 15 mpaka 31% ya anorexics
• chikhalidwe phobia 
• kukhumudwa komwe kungakhudze 60 mpaka 96% ya anorexics panthawi ina yamatenda 

Nthawi yosala kudya kwambiri komanso machitidwe olipira (kuyeretsa, kugwiritsa ntchito mankhwala otsegulitsa m'mimba, ndi zina zambiri) kumabweretsa zovuta zomwe zimatha kuyambitsa mavuto a impso, mtima, m'mimba komanso mano.

Kukula

Pofotokozedwa koyamba ndi kafukufuku wamilandu mu 1689 wolemba Richard Morton, sizinapitirire zaka za m'ma 50 kuti afotokozere mwatsatanetsatane za anorexia nervosa chifukwa chofunikira cha Hilde Bruch pankhaniyi. 

Kuyambira pamenepo, matendawa akuchulukirachulukira. Malinga ndi kafukufuku waposachedwa, 

kuchuluka kwa anorexia padziko lonse mwa akazi akuyerekezedwa ndi 0,3%, ndi kufa kwakukulu (pakati pa 5,1 ndi 13%). Zingakhudze akazi nthawi 10 kuposa amuna^{6, 7,8}.

matenda

Kuyesa kwa psychopathological

Kuti mupeze matenda a anorexia nervosa, zinthu zosiyanasiyana ziyenera kuwonedwa pamakhalidwe a munthuyo.

Ku North America, chida chodziwika bwino chowunikira ndi Kusanthula ndi Buku Lophatikiza la Mavuto a Mitsempha (DSM-IV) lofalitsidwa ndi American Psychiatric Association. Ku Europe ndi kwina konse padziko lapansi, akatswiri azaumoyo amagwiritsa ntchito Gulu Lapadziko Lonse La Matenda (ICD-10).

Mwachidule, kuti tithetse vuto la anorexic, ndikofunikira kuwunika kupezeka kwa njira zingapo, chachikulu ndicho a kukana kukhala ndi thupi labwinobwino. Nthawi zambiri, munthu wodwala anorexic amakana kukhala pa 85% ya kulemera kwake koyenera (komwe kumachokera kutalika ndi mafupa). Palinso mantha owopsa kapena oopa kunenepa omwe amakhudzana ndi vuto lalikulu la chithunzi cha thupi (masomphenya olakwika okhudzana ndi kulemera, kukula ndi mawonekedwe amthupi). Pomaliza, machitidwe osiyanasiyana okhudzana ndi chakudya amakhala mwa anthu omwe ali ndi anorexia monga bisani chakudya kapena ngakhale pezani ena kuti adye. Chakudya chilichonse chimatsatiridwa ndikudzimva kuti ndi wolakwa yemwe amalowa mwa munthu yemwe ali ndi anorexic ndikumupangitsa kuti atenge khalidwe lobwezera (masewera olimbitsa thupi, kutenga zotsukira…).

Kuunika kwadzidzidzi

Kuphatikiza pa kuwunika kwa psychopathological, kuyezetsa thupi kwathunthu ndikofunikira kuti mupeze matenda a anorexia nervosa ndikuwunika momwe kuperewera kwa zakudya m'thupi komanso zotsatira zakusowa kwa chakudya mthupi la munthuyo.

Kwa ana ochepera zaka 8, adotolo adzafufuza mayankho omwe angatanthauze kusowa chakudya. Kuchepetsa kukula kwa msinkhu, kuchepa kapena kugwa kwa BMI, kupezeka kwa mseru komanso kupweteka kwam'mimba kosafotokozedwa kudzafunidwa.  

Poyang'anizana ndi wachinyamata yemwe atha kupereka anorexia nervosa, katswiri adzafuna kuchedwa kutha msinkhu, amenorrhea, kulimbitsa thupi komanso / kapena kusazindikira mwanzeru.

Kwa achikulire, zidziwitso zingapo zitha kuwongolera dokotala kuti adziwe matenda a anorexia nervosa. Zina mwazofala kwambiri, adotolo azikhala tcheru poyang'ana kuonda (kuposa 15%), kukana kunenepa ngakhale ali ndi thupi lochepa (BMI), mayi yemwe ali ndi amenorrhea yachiwiri, bambo yemwe ali ndi kuchepa kwakukulu libido ndi kuwonongeka kwa erectile, kutaya thupi komanso / kapena kusazindikira komanso kusabereka.

Makhalidwe omwe amakhazikitsidwa ndi munthu yemwe cholinga chake ndikuchepetsa kudya amakhala ndi zovuta zocheperako paumoyo. Dokotala adzafufuza zamankhwala komanso zamankhwala (kuyesa magazi, ndi zina zambiri) posaka mavuto:

• mavuto amtima monga kusokonezeka kwa mungoli wamtima
• mano, kuphatikizapo kukokoloka kwa enamel
• Matenda am'mimba monga matenda am'matumbo
• fupa, kuphatikizapo kuchepa kwa mafupa a mchere
• impso
• khungu

Mayeso owunika a EAT-26

Mayeso a EAT-26 amatha kuwunika anthu omwe angakhale ndi vuto lakudya. Ili ndi funso lazinthu 26 zomwe wodwalayo amadzaza yekha ndikuzipereka kwa katswiri yemwe amafufuza. Mafunsowa atithandizira kukayikira kupezeka komanso kuchuluka kwa zakudya, machitidwe olipira komanso kuwongolera komwe munthu amachita pakudya.

Source: Kwa mtundu waku France woyesa mayeso a EAT-26, Leichner et al. 1994⁹

Mavuto

Zovuta zazikulu za anorexia ndizovuta kapena zochepa zovuta za thupi zomwe zimayambitsa kuchepa thupi.

Kwa ana omwe ali ndi anorexia, kuonda kwambiri kumatha kukula.

Zovuta zazikulu za anorexia ndizovuta zakucheperako zolimbitsa thupi zomwe zimayambitsidwa ndimakhalidwe oletsa kudya komanso kuyeretsa operekera ndalama.

Kuletsa zakudya kumatha kubweretsa kuwonongeka kwa minofu, kuchepa magazi m'thupi, hypotension, kuchepa kwa mtima, komanso kuchepa kwa calcium komwe kumatha kubweretsa kufooka kwa mafupa. Kuphatikiza apo, anthu ambiri omwe ali ndi anorexia amakhala ndi amenorrhea (kusowa kwa nthawi) koma izi sizimadziwika, zobisika ndi nthawi zopangira zomwe zimapangidwa ndikumwa piritsi la kulera.

Kusanza mobwerezabwereza kumatha kuyambitsa matenda osiyanasiyana monga: kukokoloka kwa enamel wa mano, kutupa kwa kholingo, kutupa kwa tiziwalo timene timatulutsa malovu komanso kutsika kwa potaziyamu komwe kumatha kubweretsa kusokonezeka kwaphokoso kapena kulephera kwamtima. .

Kumwa mankhwala otsegulitsa m'mimba kumayambitsanso mavuto ambiri omwe munthu amatha kuwona m'matumbo atony (kusowa kwa kagayidwe kazakudya) kumayambitsa kudzimbidwa, kuchepa kwa madzi m'thupi, edema ngakhale kutsika kwa msinkhu wa sodium womwe ungayambitse impso.

Pomaliza, vuto lalikulu kwambiri komanso loopsa kwambiri la anorexia nervosa limakhalabe imfa chifukwa cha zovuta kapena kudzipha, zomwe zimakhudza kwambiri anthu omwe ali ndi matenda a anorexia. Anorexia wakale amadziwika ndipo amayendetsedwa koyambirira, kumakhala bwino kudandaula. Kusamaliridwa, zizindikirazo zimasowa nthawi zambiri pazaka 5 mpaka 6 kuyambira pomwe zidayamba.