[Malnutrition in anorexia nervosa: psychosomatic approach and multidisciplinary treatment].
OBJECTIVE
Using the quantitative and statistical method to study the psychopathology of this disorder, we feel that melancholy underlies all anorexia, a structural psychological failing in the primary narcissistic personality instituted at the beginning of life. Melancholy entails its opposite, mania, manifested in anorexia through exhausting physical exercise and a perpetual binge-purge cycle, with continuous vomiting that damages teeth and the oesophagus, leading to malnutrition, dependence on laxatives, colic and inflammation of the anus. Amenorrhea increases the levels of cortisol, thus facilitating osteoporosis. Other symptoms observed include: cold skin, pain on sitting, lanugo, hair loss, low blood pressure, bradycardia, prolapses of the mitral valve or pericardial effusion. Less commonly, oedema or anaemia, despite the sufficient intake of iron and proteins. Sleep disorders and abandonment of normal activities have also been reported.


METHODS
Population of 30 patients previously diagnosed as having anorexia nervosa according to DSM-IV or CIE-10 parameters, without election by gender, either institutionalized or attending day hospital. Over 18 years of age and with their mental personality structure somewhat consolidated so that the results would not be altered by a lack of stability in this variable. This is a first exploratory statistical analysis with a transverse description of only 30 anorexic patients without any contrasting control group and is therefore not conclusive. The variables will have to be adjusted through larger subsequent studies to weigh up our observations.


RESULTS
From melancholic mania, the patients feel unique and special, through being able to go so long without eating. There is a corporal pleasure in all asceticism, as consumption modifies the perception of enjoyment. This triumph in solitude may recycle the anorexic eating pathology and turn it into something hard to reverse. Poor self-esteem often surrounds this condition. Patients, fixated on the maternal image, tend to undervalue their own, unable to withstand the development of the body or the internal tension this entails.


CONCLUSIONS
Controlled exercise, improved nutrition and hormone treatment are currently the combined therapies applied in AN, with agreement being reached with patients on a specific personal diet of low volume, attempting to ensure the necessary minimum of fat and carbohydrates. With simultaneous psychological attention through an integral multidisciplinary approach in order to reduce the high prevalence of partially treated cases that accumulate over time.
Sección de Seguimiento, Secretaria General, Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Sinesio Delgado, 6, 28029 Madrid. icabetas@isciii.es
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Cabetas Hernández
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D010348:Patient Care Team; D011611:Psychosomatic Medicine