TheI-anorexia ingqondo iyingxenye yezinkinga zokudla noma iziyaluyalu zokudla (ADD) njenge-bulimia nokudla ngokuzitikayo.

Umuntu ophethwe yi-anorexia uhola impi enzima neyingozi ngokumelene nanoma yikuphi ukuzuza isisindo. Uyisisulu sokwesaba okuningi okungenangqondo okungafaniswa nokwesaba kwangempela ngokuphathelene nemiphumela yokudla, njengokukhuluphala noma ukukhuluphala. Umphumela uba inkani futhi ngokuvamile eyingozi imingcele yokudla.

Ukulawula okwenziwa abantu abane-anorexia ekudleni kwabo kudlulele futhi kuhlala njalo. Isifiso sokudla isikhathi esiningi siyagcinwa kodwa umuntu ulwa nesidingo kanye nesifiso sokudla. Kudinga ukuncipha kancane kancane kwesisindo esingafinyelela ekuwohlokeni (ukuba mncane ngokwedlulele).

Enhliziyweni yokuziphatha kwe-anorexic, kune-phobia yangempela yokuzuza isisindo, enamandla kangangokuthi iphoqa umuntu ukuba agweme izimo noma ukuziphatha okungaholela ekukhulupheni: ukudla ukudla okungajwayelekile, ukudla ngaphandle kokuzivocavoca, njll Ngenxa yalokho, umuntu uyaye anciphe kancane kancane kodwa ukwaneliseka akuzwayo kuyadlula futhi ngokushesha afune ukwehlisa isisindo futhi.

Umbono anawo ngomzimba wakhe uhlanekezelwe, sikhuluma ngawo i-dysmorphophobia. Lokhu kuziphatha okungalungile kuzodala izinkinga zezokwelapha ezingathí sina kakhulu noma ezingaphansi (ukungakhululeki, ukuhlaselwa uvalo, i-amenorrhea, njll.) futhi kuzoholela umuntu ekubeni ahlukaniswe nabanye abantu.

I-Anorexia noma i-Anorexia nervosa?

Igama elithi anorexia lisetshenziswa kabi ukuze libhekisele ku-anorexia nervosa, kodwa i-anorexia nervosa iyinhlangano yezokwelapha ngokwayo. I-Anorexia iwuphawu olutholakala kuma-pathologies amaningi (i-gastroenteritis, umdlavuza, njll.) okuhambisana nokulahlekelwa ukudla. Ku-anorexia nervosa, isifiso sokudla siyalondolozwa kodwa umuntu uyenqaba ukudla. 

Izimbangela

I-Anorexia nervosa iyisifo esicwaningwa kabanzi mayelana nokudla. Izimbangela eziqondile ngemuva kokuqala kwalesi sifo ziyinkimbinkimbi futhi ngokuvamile zihlangene.

Abacwaningi bayavuma ukusho ukuthi izici eziningi zisuka ku-anorexia okuhlanganisa izici zofuzo, i-neuroendocrine, ezengqondo, zomndeni kanye nezenhlalo. 

Nakuba lungekho isakhi sofuzo esikhonjwe ngokucacile, ucwaningo lukhomba ku-a ingozi yomndeni. Uma emndenini oyedwa wamalungu awo wesifazane ehlushwa i-anorexia, kunengozi ephindwe izikhathi ezingu-4¹¹ ukuthi omunye wesifazane walo mndeni ufinyelelwa yilesi sifo kunomndeni “ophilile”.

Olunye ucwaningo olwenziwe kumawele afanayo (i-monozygotic) lukhombisa ukuthi uma iwele elilodwa liphethwe yi-anorexia, kunamathuba angama-56% okuthi iwele lakhe nalo lithinteke. Amathuba anyuka aze afike ku-5% uma bengamawele ahlukene (ama-dizygotes)¹. 

Izici ze-endocrine ezifana nokuntuleka kwamahomoni zibonakala zidlala kulesi sifo. Ukwehla kwehomoni (LH-RH) ehilelekile ekulawuleni ukusebenza kwe-ovarian kuyagqanyiswa. Kodwa-ke, lokhu kushoda kubonwa lapho kukhona ukwehla kwesisindo futhi izinga le-LH-RH libuyela esimweni esijwayelekile ngokuzuza kwesisindo. Ngakho-ke lokhu kuphazamiseka kungase kubonakale kuwumphumela we-anorexia kunokuba imbangela. 

Au izinga le-neurological, izifundo eziningi zibeka phambili ukungasebenzi kahle kwe-serotonergic. I-Serotonin iyinto eqinisekisa ukudlula komyalezo wezinzwa phakathi kwama-neurons (ezingeni lama-synapses). Kuhileleke ikakhulukazi ekukhuthazeni isikhungo sokusutha (indawo yobuchopho elawula ukudla). Ngezizathu eziningi namanje ezingaziwa, kukhona ukwehla komsebenzi we-serotonin kubantu abane-anorexia.².

Use izinga lengqondo, izifundo eziningi zenze ukuxhumana phakathi kokubonakala kwe-anorexia nervosa kanye nokuzethemba okungalungile (umuzwa wokungasebenzi nokungafaneleki) kanye nesidingo esikhulu sokufuna ukuphelela.

Ama-hypotheses kanye nezifundo zokuhlaziya zithola ukungaguquguquki okuthile kubuntu nemizwa abantu abane-anorexia ababhekana nayo. I-anorexia ngokuvamile ingathinta intsha egwema izimo zengozi ephansi kakhulu futhi encike kakhulu ekwahluleleni kwabanye. Imibhalo ye-Psychoanalytic ivame ukuvusa ukwenqatshwa komzimba njengento yocansi. Lawa mantombazane asemancane angafisa ngokunganaki ukuthi ngabe ahlala amantombazane amancane futhi abe nobunzima bokwakha ubuwena kanye nokuzuza ukuzimela. Iziyaluyalu ezibangelwa ukuphazamiseka kwemikhuba yokudla zilimaza umzimba “ohlehlayo” (ukungabi khona kokuya esikhathini, ukuncipha komumo ngokuncipha, njll.).

Okokugcina, ucwaningo olwenziwa ngobuntu babantu abathintwe yi-anorexia, luthola izinhlobo ezithile zobuntu ezithinteke kakhulu yile pathology njengokuthi: ubuntu obugwemayo (ukuvinjwa komphakathi, umuzwa wokungafaneleki emsebenzini, ukuzwela ngokweqile ekwahluleleni okungekuhle. 'abanye... ), ubuntu obuncikile (isidingo esiningi sokuvikelwa, ukwesaba ukwehlukana,…) kanye nobuntu obucindezelayo (ukufuna ukuphelela, ukulawula, ukuqina, ukunaka imininingwane, isimo sengqondo sokucophelela,…). 

Au izinga lokuqonda, izifundo ziqokomisa imicabango engemihle ezenzakalelayo eholela ezinkolelweni ezingamanga evame ukuba khona kuma-anorexics nama-bulimics njengokuthi "ukuba mncane kuyisiqinisekiso senjabulo" noma "noma yikuphi ukuzuza kwamafutha kubi".

Okokugcina, i-anorexia iyisifo esithinta kakhulu inani labantu bamazwe anezimboni. Ngakho-ke izici zezenhlalo namasiko zidlala indawo ebalulekile ekuthuthukisweni kwe-anorexia. Imibandela yezenhlalo yobuhle evezwa amamodeli asemancane anemizimba emincane emincane futhi ecishe ifane nobulili ithonya kakhulu intsha yethu lapho ifuna ukuzazi. Inkolo yokuba nomzimba omncane igcwele yonke indawo kwabezindaba, “esithengisa” ngokungapheli inqwaba yokudla okuyisimangaliso futhi ngokuvamile ikhuthaza ukulawulwa kwesisindo sobude bekhava yomagazini ngaphambi, phakathi nangemuva kwamaholide namaholide ehlobo.

Izinkinga ezihlanganisiwe

Kukhona ikakhulukazi ukuphazamiseka kwengqondo okuhlobene ne-anorexia nervosa. Nokho, kunzima ukwazi ukuthi ukuqala kwe-anorexia yini okuzobangela lezi ziphazamiso noma uma ukuba khona kwalezi zinkinga kuzoholela ekutheni lowo muntu abe ne-anorexia.

Ngokwezinye izifundo^{3, I-4,5}, izinkinga eziyinhloko zengqondo ezihlobene ne-anorexia yilezi:

• I-Obsessive-Compulsive Disorder (OCD) ethinta i-15 kuya ku-31% ye-anorexics
• phobia social 
• ukucindezeleka okungase kuthinte u-60 kuya ku-96% we-anorexics ngesikhathi esithile ekuguleni 

Izikhathi zokuzila ukudla ngokweqile kanye nokuziphatha okuyisinxephezelo (ukuhlanza, ukusetshenziswa kwama-laxative, njll.) kuholela ezinkingeni ezingabangela izinkinga ezinkulu zezinso, inhliziyo, ithumbu kanye namazinyo.

Ukuvama

Ichazwe ngokokuqala ngqá ngesifundo esiyisibonelo ngo-1689 ngu-Richard Morton, kwaze kwaba ngama-50s ukuba nencazelo eningiliziwe ye-anorexia nervosa ngenxa yomsebenzi obalulekile ka-Hilde Bruch ngale ndaba. 

Kusukela ngaleso sikhathi, izifo zanda kancane kancane. Ngokocwaningo lwakamuva, 

ukwanda emhlabeni wonke kwe-anorexia kubantu besifazane kulinganiselwa ku-0,3%, nokufa okuphezulu (phakathi kuka-5,1 no-13%). Kungathinta abesifazane ngokuphindwe ka-10 kunabesilisa^{6, I-7,8}.

kwesifo

Ukuhlolwa kwengqondo

Ukuze kutholakale ukuxilongwa kwe-anorexia nervosa, izici ezihlukahlukene kufanele zibhekwe ekuziphatheni komuntu.

ENyakatho Melika, ithuluzi elijwayelekile lokuhlola i- Incwadi Yokuhlola Nezibalo Zezinkinga Zengqondo (DSM-IV) eshicilelwe yi-American Psychiatric Association. EYurophu nakwezinye izindawo emhlabeni, ochwepheshe bezokunakekelwa kwempilo ngokuvamile basebenzisa Ukwahlukaniswa Kwezifo Komhlaba Wonke (ICD-10).

Kafushane, ukuvusa ukuphazamiseka kwe-anorexic, kuyadingeka ukuhlola ubukhona bezinqubo ezimbalwa, eyinhloko kuba ukwenqaba ukugcina isisindo esivamile. Ngokuvamile, umuntu one-anorexic wenqaba ukuhlala ku-85% wesisindo sakhe esifanele (esitholakala ekuphakameni nasemathanjeni). Kuphinde kube nokwesaba okukhulu noma okwesabekayo kokukhuluphala okuhlotshaniswa nokuphazamiseka okuphawulekayo komdwebo womzimba (umbono osontekile mayelana nesisindo, ubukhulu kanye nokuma komzimba). Okokugcina, ukuziphatha okuhlukene okuhlobene nokudla kujwayelekile kubantu abane-anorexia efana fihla ukudla noma ngisho thola abanye ukuthi badle. Ukudla ngakunye kulandelwa umuzwa wecala ohlasela umuntu one-anorexia futhi umholele ekubeni amukele ukuziphatha okuyisinxephezelo (ukuzijwayeza kwezemidlalo okujulile, ukuthatha izihlanzi…).

Ukuhlola kwe-Somatic

Ngaphezu kokuhlolwa kwengqondo, ukuhlolwa okuphelele komzimba kuyadingeka ukuze kutholakale ukuxilongwa kwe-anorexia nervosa kanye nokuhlola isimo sokungondleki kahle kanye nemiphumela yokuntuleka kokudla empilweni yomuntu.

Ezinganeni ezingaphansi kweminyaka engu-8 ubudala, udokotela uzobheka izinkomba ezingase ziphakamise i-anorexia. Ukuncipha kokukhula kwesiqu, ukuqina noma ukuwa ku-BMI, ukuba khona kwesicanucanu kanye nobuhlungu besisu obungachazeki buyofunwa.  

Ebhekene nentsha engase yethule i-anorexia nervosa, uchwepheshe uzobheka ukubambezeleka kokuthomba, i-amenorrhea, ukungasebenzi komzimba kanye / noma kwengqondo.

Kubantu abadala, izinkomba ezimbalwa zingase ziqondise udokotela ekuxilongweni kwe-anorexia nervosa. Phakathi kwezinto ezivame kakhulu, udokotela uzobe eqaphile lapho ebhekene nokuncipha kwesisindo (okungaphezu kuka-15%), ukwenqaba ukuzuza isisindo naphezu kwe-low body mass index (BMI), owesifazane one-amenorrhea yesibili, indoda enokwehla okuphawulekayo ukungasebenzi kahle kwe-libido kanye ne-erectile, ukungasebenzi ngokomzimba kanye / noma kwengqondo kanye nokungazali.

Izindlela zokuziphatha ezenziwa ngumuntu okuhloswe ngazo ukunciphisa ukudla zinemiphumela emibi kakhulu noma encane kakhulu empilweni. Udokotela uzokwenza ukuhlolwa komtholampilo kanye ne-paraclinical (ukuhlolwa kwegazi, njll.) ukuze afune izinkinga:

• izinkinga zenhliziyo njengokuphazamiseka kwesigqi senhliziyo
• amazinyo, kuhlanganise nokuguguleka koqweqwe lwawo lwamazinyo
• ukuphazamiseka kwesisu njengokuphazamiseka kokuhamba kwamathumbu
• ithambo, kuhlanganise nokuncipha kwamathambo amaminerali
• izinso
• i-dermatological

Ukuhlolwa kokuhlolwa kwe-EAT-26

Ukuhlolwa kwe-EAT-26 kungahlola abantu okungenzeka bahlushwa izinkinga zokudla. Lolu uhlu lwemibuzo olunezinto ezingama-26 isiguli esilugcwalisayo sodwa bese silunikeza uchwepheshe oluhlaziyayo. Imibuzo izosivumela ukuba sibuze ubukhona kanye nezikhathi zokudla, ukuziphatha okunxephezela kanye nokulawula umuntu akusebenzisayo phezu kokuziphatha kwakhe kokudla.

Umthombo: Ngenguqulo yesiFulentshi yokuhlolwa kwe-EAT-26, u-Leichner et al. 1994⁹

Izinkinga

Izinkinga eziyinhloko ze-anorexia yiziphazamiso ezibucayi kakhulu noma ezincane ezibangelwa ukuncipha kwesisindo.

Ezinganeni ezine-anorexia, ukuncipha okukhulu kwesisindo kungabangela ukukhula okugobile.

Izinkinga eziyinhloko ze-anorexia yiziphazamiso ezingathi sína kakhulu noma ezingathí sina ezibangelwa ukuziphatha okuvinjelwe ukudla kanye nezinxephezelo zokuhlanza.

Imikhawulo yokudla ingaholela ekuwohlokeni kwemisipha, i-anemia, i-hypotension, ukuncipha kwenhliziyo, kanye namazinga e-calcium aphansi okungaholela ekwakhiweni kwamathambo. Ukwengeza, abantu abaningi abane-anorexia bane-amenorrhea (ukungabikho kokuya esikhathini) kodwa lokhu kuvame ukungabonakali, kufihlwe izikhathi zokwenziwa ezenziwe ngokuthatha iphilisi lokuvimbela inzalo.

Ukuhlanza okuphindaphindiwe kungase kubangele izifo ezihlukahlukene ezifana nalezi: ukuguguleka koqweqwe lwamazinyo, ukuvuvukala komminzo, ukuvuvukala kwezindlala zamathe nokwehla kwezinga le-potassium elingabangela ukuphazamiseka kwesigqi noma ukuhluleka kwenhliziyo. .

Ukuphuza ama-laxative nakho kubangela ukuphazamiseka okuningi lapho umuntu angabona khona i-atony yamathumbu (ukuntuleka kwethoni yendlela yokugaya ukudla) okubangela ukuqunjelwa, ukuphelelwa amandla kwamanzi, i-edema ngisho nokwehla kwezinga le-sodium okungaholela ekuhlulekeni kwezinso.

Okokugcina, izinkinga ezimbi kakhulu nezibuhlungu kakhulu ze-anorexia nervosa zihlala ziwukufa ngenxa yezinkinga noma ukuzibulala, okuthinta kakhulu abantu abane-anorexia engapheli. I-anorexia yangaphambili itholwa futhi ilawulwe kusenesikhathi, kuba ngcono ukubikezela. Ngaleyo ndlela, izimpawu ziyanyamalala ezimweni eziningi phakathi nenkathi yeminyaka emi-5 kuya kwemi-6 ngemva kokuqala.