Normally when talking about anorexia it is thought that only girls suffer from it, but there are also boys who can suffer from it. Anorexia can affect either sex in adolescence. For this reason, special care must be taken at this stage where the changes that children present can be too drastic and lead to suspect that something is not going well. If you start to suspect that your son or daughter is starting to engage in strange behaviors and could be anorexic or anorexic, don't focus on scolding or punishing them as this will only exacerbate the problem. It is essential that if this happens you start by having a calm talk about the possible existence of a problem that worries you and that you want to help him.
You may also be interested in: Clinical manifestations of anorexia nervosaThe goal of treatment is nutritional recovery, identification and resolution of psychosocial triggers of appetite disorder, and restoration to a healthy eating pattern. The intervention process in anorexia nervosa (R. Calvo Sagardoy, 1983): The opposite intervention process with three general stages:
- Establishment of patient collaboration: It would try to identify the issues that are problematic for the patient (eg constipation, gastric fullness) and, on the other hand, that admit a controlled weight increase (systematic weighings under control conditions, with increases over the baseline). In this phase, the capacity of the patient to carry out the treatment is assessed, with admission being necessary if the minimum conditions for the increase are not met or there is a considerable life risk.
- Normalization of food and weight: Basically it would try to establish with the family and the patient (outpatient treatment) or with the medical, nursing staff and others (if the treatment is hospital) an operant conditioning program based on differential reinforcement: extinction of weight loss behaviors, vomiting, use of laxatives, etc. and reinforcement of proper ways of eating, increased food intake and weight gain. In the case of hospitalization, a behavioral contract is established as a condition for discharge due to a minimum weight gain.
- Work on the pre-disposing factors of personal vulnerability. Several aspects would be worked on:
- Rigid rules or assumptions about physical appearance, weight and personal self-worth, and the derived cognitive distortions: The thought-affect-behavior relationship, self-registration and the modification of automatic thoughts and self-testing are applied to the patient. the dysfunctional assumptions.
- Phobia of gaining weight and fear of lack of control: Cognitive techniques are complemented with exposure-desensitization procedures to different anxiety hierarchies (increased weight, thick physical appearance, etc.).
- Bulimic crisis: Self-control strategies are used (self-registration of controlled eating episodes, antecedents and consequences, and problem solving) and progressive exposure to "dangerous foods with prevention of compulsive intake response (eg initial presentation in slides and later live) Management of automatic thoughts associated with bulimic crises.
- Social interaction and assertive inhibition: cognitions based on inhibition and assertive fears are explored; Cognitive alternatives are generated and if this is the case, alternative assertive behaviors are modeled, rehearsed and practiced.
- Deficits in self - perception of the body scheme, distortions of body image and threats related to genital-sexual sensations: It begins with relaxation training that produces a distention of body tension and an increase in the body felt as a source of pleasant sensations, Afterwards, the detection of emotions and automatic thoughts linked to certain bodily sensations and with alternatives to these dysfunctional cognitions, alternatives that are reinforced and self-reinforced, continues.
- Family interaction: It is based on teaching family members the principles of differential reinforcement (extinction of dysfunctional behaviors and reinforcement of adaptive behaviors); Aspects related to family anxiety (eg fear of the girl's independence) are also addressed through cognitive restructuring and in the case of marital conflict, couples therapy is indicated for the parents.
- Support for the therapeutic team: When working in the hospital or outpatient setting with a team of therapists, co-therapists, it is necessary to maintain group cohesion in the face of the intervention and manage their anxieties and fears (eg when the risk of death is greater weight gain does not occur at the desired rate) by listening to their concerns-problems, establishing clear and continuous means of information, cognitive restructuring and problem solving.
Prognosis: Half of the patients with anorexia nervosa recover completely, 30% do so partially, and 20% show no improvement in their symptoms. Early mortality reaches 5% and is mainly due to cardiac complications and suicide.
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