Eating disorders
Eating behavior disturbances are rarely standalone disorders. More often, they accompany depression, catatonia, withdrawal syndrome, or paranoid delusions of poisoning.
- Anorexia nervosa (anorexia nervosa): deliberate refusal to eat in order to lose weight, accompanied by dysmorphomania-dysmorphophobia. Leads to cachexia, electrolyte imbalances, and hormonal disruptions. The cachectic stage requires immediate hospitalization.
- Bulimia: uncontrolled binge eating followed by feelings of guilt and compensatory behavior (inducing vomiting, laxative use).
- Pica: ingestion of non-nutritive substances. In adults, it indicates severe psychiatric pathology (schizophrenia, dementia); in children, it may be a manifestation of autism or a normal variant (at an early age).
Treatment of eating disorders depends on the underlying diagnosis and is most effective in an inpatient setting. It includes nutritional repletion and psychopharmacotherapy (antipsychotics, antidepressants).
Conscious distortion of illness severity
Patients may intentionally distort symptoms for secondary gain or out of fear.
- Malingering: feigning a non-existent illness to obtain social or material benefits. Unlike hysteria, the malingerer does not suffer from their condition.
- Aggravation: intentional exaggeration of the symptoms of a genuinely existing disease, also with the aim of obtaining benefits.
- Dissimulation: intentional concealment of illness due to fear of losing a job, destroying a family, or fear of treatment. Commonly seen in patients with infections, tuberculosis, and psychiatric disorders.
Involuntary exaggeration of illness severity (Hypernosognosia)
Hypernosognosia — inadequate overestimation of the severity of one's condition. Patients mistake normal physiological processes for pathology and disbelieve in recovery.
Manifestation variants:
- Hypochondria: groundless conviction of having a severe illness.
- Anxiety and panic: a feeling of impending doom. Medical terms and examinations only amplify the fear.
- Depression: passivity and hopelessness. Patients often conceal deterioration; the risk of suicide is high.
- Manipulation: demonstration of helplessness to attract attention.
- Nosophilia: an unhealthy obsession with the treatment process, although objectively the disease is not life-threatening.
Underestimation of illness severity
Reduced insight into one's condition arises as a psychological defense mechanism or due to organic brain damage (especially of the frontal lobes).
- Hyponosognosia: neglect of treatment. It may manifest as indifference (apathy toward therapy) or as "demonstration of busyness" (postponing treatment due to supposedly important matters).
- Anosognosia: complete denial of illness. Encountered in manias, delusions, dementia, and substance use disorders. In oncology, it acts as a psychological defense against the fear of death. If such a patient formally denies the illness but complies with medical prescriptions, this defense should not be dismantled.
Briefly: answers to topical questions
What are the stages of the course of anorexia nervosa?
The available materials describe only a single stage in the course of anorexia nervosa (anorexia nervosa).
- Cachectic stage — characterized by rapid weight loss, avitaminosis, and electrolyte disturbances. Clinically manifested by amenorrhea, pallor and dry skin, feeling cold, brittle nails, hair loss, dental destruction, intestinal atony, bradycardia, and hypotension. The condition is accompanied by asthenia and loss of working capacity, and in puberty — by delayed sexual maturation. This stage requires immediate hospitalization of the patient.
Which specific groups of antidepressants and antipsychotics are used to treat eating disorders?
The following groups of drugs are used for the pharmacotherapy of eating disorders:
- Antipsychotics — used to suppress overvalued ideas regarding food, as well as to increase appetite and body weight (olanzapine, risperidone, perphenazine, chlorpromazine).
- Tricyclic antidepressants (TCAs) — prescribed to increase appetite and body weight (amitriptyline).
- SSRI antidepressants — possess a mild anorexigenic effect and are used to decrease appetite (fluoxetine, sertraline).
Which diseases are included in the classical "Chicago Seven" psychosomatic disorders?
The sources do not use the term "Chicago Seven"; however, they list six diseases that belong to classical psychosomatic disorders:
- Hypertension
- Peptic ulcer disease
- Neurodermatitis
- Ulcerative colitis
- Rheumatoid arthritis
- Atopic bronchial asthma
These pathologies are defined as organic somatic diseases in the origin and development of which psychological factors play a significant role.
Class and exam questions
What is the difference between malingering and aggravation?
In malingering, a person fakes an illness they do not have. In aggravation, the patient has a real medical condition, but intentionally exaggerates the severity of its symptoms.
Why do patients with catatonic syndrome refuse to eat?
The appetite in such patients is preserved, but pronounced motor impairments prevent them from satisfying their nutritional needs.
What to do if a cancer patient denies their diagnosis but accepts treatment?
This is a manifestation of anosognosia as a defense mechanism. The physician should not attempt to persuade the patient otherwise as long as the latter complies with the prescribed therapeutic regimen.
What else to study on this topic
- Features of the differential diagnosis of eating behavior disturbances in depression and withdrawal syndrome
- Specifics of delusions of poisoning in involutional age patients
- Drugs used for weight correction in eating disorders
- Techniques for detecting malingering in an outpatient setting
- Patient behavior when fearing disclosure of illness
Master the entire topic in the "Psychiatry" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Psychosomatic disorders" and 499 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 7 video lessons on the subject
Other topics in "Chapter 16. Somatic disorders and disturbances of physiological functions as a manifestation of mental pathology"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.