From the author: The first part, or introductory article about the problem of anorexia and bulimia in society, namely about its external side - what it looks like and what to do about it. My favorite law of pairs pushed me to write this article cases: two patients with this diagnosis were admitted to my department with a short interval. And a couple of months before that, one of them refused treatment. Having tried to understand the problem, I saw its scale and was horrified! According to official data, up to 2% of the population is affected by bulimia and/or anorexia. But this turned out to be very relative (although 2% means 40,000 people in Nizhny Novgorod!!!). 80% of them are women. 90% of them are 12-25 years old. Every fourth girl aged 12-25 years periodically, after overeating, induces vomiting in order to lose weight. 12 times more people aged 15-24 die from anorexia/bulimia than from all other diseases. It’s kind of creepy. When I was 12-25 years old, we somehow didn’t know that such a “topic” even existed. But it turned out that this was a whole big problem. I’ll try to look a little deeper. A few definitions. Bulimia is a mental disorder manifested by the fact that a person, not always controlling himself, including impulsively, consumes a large amount of food, including food that is not always tasty and edible. After this, in order to prevent excess weight gain, he induces vomiting on his own. At the same time, everyone has their own ways and methods, which sometimes turn out to be even cruel. If for some reason it was not possible to induce vomiting (for example, at a dinner party in the palace at a reception with the queen), then as soon as possible they take a large amount of laxative and give themselves enemas. The reasons are the same. A feature of this disease is the great variability in the degree of thinness of patients: from violent cachexia to sufficient plumpness. It all depends on the depth of the disease and its duration. Anorexia is a mental disorder manifested by the fact that a person (and, as we found out, most often this is a girl) gradually begins to adhere to some kind of diet. Gradually, diets become more and more strict. As a result, they almost completely stop eating, drinking only water during the day, sometimes juice and a pellet of something almost inedible and without calories (salad, apple, spoon of low-fat yogurt, etc.). Immediately in my head there is an association with Cinderella - “half a grain of wheat a day.” But imagining this, the smile immediately disappears. Such patients are immediately visible. They lose weight quite quickly and quickly begin to look “sickly.” But more on that later. I’ll try to find something in common. It’s not for nothing that even in ICD 10 (the international classification of diseases, 10th revision) these diseases are listed side by side. Firstly, both are eating disorders. That is, the main external manifestation of the onset and cause of the disease is a certain form of handling food. This is either her “not eating” (anorexia), or her “eating a lot” followed by vomiting or diarrhea (bulimia). This is precisely a physical action. You can see him. “This” can be done or not done. For example, a sandwich or bun can be eaten or not. Or you can eat it and induce vomiting. Extreme degrees give rise to disease. Secondly, in both cases, both the food itself and the way of handling it becomes something special, different from the usual. Food becomes “personality.” They want to “seduce” her. They hate her. They want to take her forever. They want to get rid of it as quickly as possible, “drive it out of themselves.” I saw how people begin to talk to food, asking It not to harm, to “pass right through.” So I’m thinking - if my borscht is a person, how can I eat it and enjoy it... Food, food is a direct source of nutrients, microelements, etc. But they can not only replenish us with energy, but also oversaturate us. And it often happens that an excess amount of food settles in the body, becomes an energy depot, or, more simply, fat deposits. Fat cannot come from air. By waterIt is impossible to either eat enough or “grow big sides.” Therefore, it is food that becomes the cause of trouble and the villain with which thousands of people fight so diligently. On the one hand, this is understandable - I overate and gained weight. But on the other hand, this is an excellent way and object for shifting responsibility. “It’s her fault, this junk food.” And thirdly. That's why all this is being done. For what? For looks, of course! From the media, from the stories of girlfriends/friends, from ideas laid down in childhood, an idea is formed of how a person should look externally. What should be the circumference of different parts of the body, what size. There are ideas about weight and so on. For people suffering from anorexia/bulimia, these numbers are clearly and significantly below average. They literally fall in love with a bony body and desire to lose more and more weight. This is precisely where the so-called “pain point” is located: having reached the height-age norm, it is no longer possible to stop. And the weight continues to fall. It is impossible to stop on your own. Either specialists (psychologist, psychotherapist, psychiatrist) will closely deal with the problem, or, based on vital indications, people are taken to intensive care and this is dealt with by doctors. In any case, this process goes in one direction and without help (with a high degree of probability) will not stop on its own. Why is all this dangerous? The whole world is on a diet. The whole world is trying to somehow change its appearance. Everything seems to be OK. But the problem is still big. With prolonged restriction of food, a lack of nutrients, vitamins, and microelements begins to form. Do you remember what these patients look like externally? The skin is flabby and pale. Due to lack of blood circulation and a strong decrease in the thickness of the fat layer, a lot of small hair appears on the skin (undercoat is formed). These people's eyes are tired. There are permanent bruises around the eyes. The hair on the head is brittle and thin “like straw” and begins to fall out. Also, your nails get damaged. Outwardly, it is exactly the opposite of what we were striving for initially. In addition, with further progression of the disease, interruptions in the functioning of the entire body begin. Heart function is disrupted, menstruation stops in women, and kidney prolapse occurs. The entire endocrine system stops working normally. It is not uncommon to experience “protein edema” that occurs due to metabolic disorders in the blood. And then... And then death. Including suicide. The mortality rate, as I wrote above, is very high. What to do? The patients themselves either do not seek help at all, or at advanced, severe stages. Most often, their relatives ask for help. The work is usually very lengthy and full of pitfalls. It's not uncommon for there to be breakdowns. By its nature, it is often compared to working with addictions. It all starts with symptomatic treatment. Namely, with the normalization of sleep and wakefulness, with the normalization of diet. Monitoring the amount of food eaten and current body weight is mandatory. Afterwards, individual and group psychotherapeutic work begins. And of course - work within the family system. When can a patient be considered recovered? Different sources present different data. Remission of a year or more is considered relatively stable. But even after 5 years of observation and treatment, the status remains. What is considered remission? In the case of bulimia, this is the absence of periods of impulsive overeating for a year or more, followed by inducing vomiting to avoid weight gain. In the case of anorexia, a set of at least the lower limit of height and age norms of weight and the absence of health problems due to a lack of certain substances. One year or more = remission. If after 11 months there is a “failure”, the countdown begins again. Frames are a bit harsh. But it’s worth it. I’ll repeat one of my thoughts. If the disease process has passed the “pain point” or the point of no return (as an option), then it is impossible to stop it on your own. People will be very willing to say that everything is wrong, that they.