Psychosomatics of anorexia, refusal to live. Bulimia

The interaction of hunger and food intake involves structures at various somatic levels: energetic, humoral, nervous. Movement, muscle work, heat transfer from the body and any form of activity are carried out under the condition of energy balance and thereby thanks to food intake. The state and activation of energy depots such as glycogen stores and adipose tissue are also influenced by adrenaline, acetylcholine and, finally, blood sugar levels. This in turn is regulated at the level of the central nervous system through the hypothalamic centers and their connections with the olfactory brain and cerebral cortex. The influences of the situation and the personality itself also take part in this somatic regulation.

Comparative studies of animal behavior show that eating requires a special environment: absence of danger, convenience, good relations with the “company of eaters,” a harmonious environment. Pets also need safety when eating. For example, dogs are very sensitive to the situation: in the presence of a stranger or when an attempt is made to take away even a piece of food from them, their mood for food can easily turn into aggression.

The act of eating - sucking, biting, chewing, swallowing, etc. is a set of processes with high affective intensity. Since childhood, they are associated with a joyful feeling of satisfaction and saturation. Many other affects can be expressed in eating behavior and deviations in the act of eating, up to refusal of it: love, protest, rage.

For a person, from the moment he first touches his mother’s breast, eating is an act of uniting the child and the mother, the child and the family, the child and the environment. In the future, eating is facilitated by the presence of company at the table, an atmosphere of frankness and sincerity. Eating together brings people together. If in the East people eat together, then they will not be enemies in the future. Friendship and love are cemented by eating together.

The presence of companions improves appetite, and even children who are indifferent to food become good eaters when they come to the group; incentives and rewards also improve their appetite. A study of animal behavior showed the same patterns. A well-fed chicken begins to peck again if it is locked together with hungry chickens.

However, food intake occurs not only at the elementary level of psychosomatic needs and emotions. Appetite is more than just hunger; human food culture is highly developed, but it is easily destroyed. Sitting at the table has made this culture more sophisticated and humane. Forming habits and creating personal values ​​also matter when eating. In different cultures we see a choice of certain directions of tastes, which vary in accordance with one or another acquired experience.

When a person is freed from the dominance of elementary physical needs, and thanks to the food intake necessary to sustain life, the feeling of hunger has turned into appetite, it becomes possible to use this to express cultural and religious characteristics, as well as for personal self-expression. But refusing food can also become a manifestation of asceticism and overcoming oneself. Eating can be suppressed as a base, animal instinct, just as through the culture of feasting it becomes refined and human. But there is also a pronounced feeling of shame associated with eating, which reaches the level of shame in the sexual sphere. Since childhood, food intake has been burdened with special significance; it can be used to express interpersonal and internal conflicts.

Eating disorders

Eating disorders such as anorexia, bulimia and obesity deserve special attention due to their prevalence and significance in psychosomatics. Since many questions regarding these types of eating behaviors remain open, they should be carefully distinguished from purely somatic or endocrine diseases. Given the often absent awareness of the disease and the still vain search for primary somatic causes, one can doubt that we are talking at all about disorders that are usually regarded as a disease. Historically, body weight has been valued differently in different cultures. However, the supra-individual typical mental and somatic data available in eating disorders and the possibility of developing health-threatening consequences make it inevitable to classify these characteristic changes in eating behavior and the corresponding body structure as painful. There is no doubt that in the presence of internal mental and situational conflicts, the diagnosis and treatment of these disorders are within the competence of psychosomatic psychotherapists.

Anorexia

The term “anorexia” defines a painful condition that occurs during puberty (almost exclusively in girls), associated with the desire to lose weight, become elegant and remain that way. In the chronic course, there is a local fear, which can be called phobic, of normal food, weight gain and achieving the average levels necessary to maintain health. Primary somatic or hormonal disorders are usually not detected. This disorder is based on an adolescent developmental conflict without awareness of the latter and a realistic attitude towards one’s own somatic state.

Symptoms. The following symptoms are characteristic of this disorder.

1. There is a significant decrease in body weight (by at least 25%, but it can reach 50% of the required norm for a given age and height). Body weight decreases to at least 45 kg, but mostly ranges between 30 and 40 kg, and in extreme cases approaches 25 kg. If you have an overvalued idea and fear of becoming too fat, conscious reduction of body weight is achieved in three ways.

A. With so-called fasting anorexia, the focus is on limiting the quantity and calorie content of food. All high-calorie foods, primarily fats and sweets, are rejected. Vegetables, lemons, unripe apples, etc. are preferred. Eating with family is usually rejected; women eat little by little alone and outside of school hours. Increasingly bizarre eating habits arise, and those around us usually overlook or underestimate the consequences of this avoidance of food. Even if the girls seem to be eating at the table, they manage to put their food away somewhere under any pretext.

A 23-year-old patient was admitted to the clinic due to excessive thinness (35 kg). She emphasized that she acted of her own free will and only on the condition that she would regulate her food intake herself. She was on bed rest and, although staff made sure she ate every meal, after 10 days she had lost another 2kg. When she was taken from the room for examination to the doctor and her nightstand was checked, they found the entire lunch there, wrapped in a package. Undoubtedly, she threw all her food into the toilet at night.

B. Some patients achieve low body weight and maintain it through vomiting. This is always done secretly, most often immediately after eating. Women, under a plausible pretext, go to the toilet and empty their stomachs with amazing ease.

B. The next way to reduce body weight is to take laxatives, which is motivated by an unbearable feeling of fullness in the stomach and often actual constipation. Many women come to the hospital with a large number of laxatives that they hide. As potassium levels decrease due to loss of fluids and salts, this can cause further harm to health. Patients report a feeling of relief when, after taking laxatives, the perceived as alien feeling of fullness in the stomach is eliminated. They talk about achieving cleanliness, neatness and good physical well-being in this way.

1. In the vast majority of cases of teenage desire to lose weight, secondary amenorrhea occurs. It usually develops 1-3 years after the start of normal menstruation. In some cases, amenorrhea extends beyond the time frame of weight loss noticeable to people around and often continues after recovery from this state. The average body weight limit at which amenorrhea occurs is 47 kg [A. Crisp, 1970].
2. In the behavior of patients, one initially notices motor and intellectual hyperactivity, which is not typical for people with reduced nutrition, who should be rather lethargic, passive, and emotionally poor. Patients with anorexia love walks, play sports, they are constantly engaged in some activity, they talk about the need to work, go to school, study something, or at least knit. Most girls have a mild or severe tendency to constipation, often accompanied by problems with bowel function.

It remains unclear to outside observers how people with anorexia lose their rational attitude towards food, body weight and their appearance. Even extreme weight loss is considered beneficial by patients. Many people say that they find the feeling of fullness and even a full stomach unbearable. They want to quickly achieve thinness and grace, which, in their opinion, makes their appearance more attractive and leads them to an “etheric” and “spiritual” existence in higher “higher” spheres of life. They always feel like they are still taking in too much food and are still at risk of overeating.

A 20-year-old anorexic patient with a height of 175 cm had a body weight of 38 kg. During her lunch break, she quickly went to the nearby swimming pool. In a swimsuit, she was truly “skin and bones”, swam throughout the entire session, not paying attention to other swimmers, and then returned to her workplace.

For patients with anorexia, a complete lack of awareness of mental and physical illness is very typical; they don't complain about any conflicts. The physical and mental state is synchronous with one’s own “I”; in the center of consciousness are refusal to eat, achieving grace, losing weight and maintaining this thinness. Restriction in food and its results in the form of graceful figure and weight loss are perceived with satisfaction, as a triumph.

If a breakthrough occurs in an increasingly suppressed feeling of hunger with a secret nightly meal from the nightstand or refrigerator, then this is experienced as a defeat, which, if possible, is kept secret and overcome by vomiting or taking laxatives.

History and epidemiology.

In European history, people seeking to lose weight have been known for a long time, but it was not considered a disease. Characteristic descriptions of starving women date back to the early Middle Ages; The fasting of these women was given religious significance and they were seen as living in holiness. Even in our time, only severe cases of the disease lead to observation and treatment by specialists and in specialized clinics. Therefore, there is a large discrepancy between morbidity rates (primarily mild forms) and morbidity, which is determined by the number of cases of treatment.

A study using a questionnaire among schoolgirls and students aged 15 to 25 years found that the incidence of anorexic episodes was between 2 and 4% per 100,000 women, and other estimates put it higher. It should be noted that high rates of morbidity, especially in the last two decades, can be regarded as signs of an increase in the incidence of the disease. Those who get sick first of all are representatives of the wealthy population (in terms of education and standard of living).

Pubertal anorexia is more common in economically developed countries.

Cases of anorexia among young men are rare, but very common. The diagnosis is made on the basis of characteristic eating behavior, the presence of the ideal of “grace”, motor hyperactivity and bizarre, but synchronous behavior.

A 17-year-old boy was hospitalized in a therapeutic clinic due to the fact that in 6 months, with a height of 168 cm, his body weight decreased to 31 kg. The patient complained of a feeling of pressure in the stomach and lightheadedness, worsening after eating. After excluding organic diseases, the patient showed external readiness to carry out the course of weight restoration that was offered to him. But in 3 weeks he lost another 1.5 kg. Upon inspection of his bedside table, all the food he had been given over the past week was found in plastic bags. He hid all the food there secretly from other patients. In a detailed conversation with the doctor, the patient reported his desire to be slim. His ideal is a gymnast with a completely flat figure. In recent weeks, in order to remain graceful, he secretly ran through the forest and climbed mountains every day. He categorically rejected contacts with women. The patient reported that his model was his father, who suffered from peptic ulcers and was very prone to asceticism. When the patient was prescribed strict bed rest and his clothes were taken away, he chose to escape from the hospital. He walked in hospital pajamas along busy streets, bought a coat and boots at a store and drove 30 km to his parents, refusing to return to the hospital. When examined 4 years later, he reported that he was interning in the police. He is still slim and looks athletic. He did not receive any treatment after being discharged from the hospital. He doesn't have a girlfriend, but he is completely immersed in his police work. In his spare time, he is engaged in rescue work in extreme situations. So, recently, by jumping into cold water, he saved people from a boat that was threatening to sink in the Kama.

The occurrence of the disease, personality, causes.

There are usually no sudden changes in fate or trauma for the disease to occur. Rather, we are talking about new tasks that arise during physical maturation and psychosocial development. There are so-called threshold situations that young women expect in order to break off their childhood relationship with their parents and leave their father’s house, enter into new relationships with people of their age and get used to their new role as a woman, i.e. face sexual problems. What is easy and self-evident for other women in their quest for independence seems unattainable for them.

Situationally, the occurrence of anorexia seems to be associated with the physical maturation of a woman and the perception of the female role in puberty, which are experienced as alien and excessive and manifest themselves primarily emotionally, and not in the form of normal sexual ‘attraction to a partner. A permissive situation is described as a situation in which sexual intimacy is, as it were, imposed on a young woman from the outside or she herself determines its necessity, often under the pressure of the surrounding world. Women suffering from anorexia are often plump before the onset of the disease, have normal body weight from birth, and often develop normal “pubertal fat.” They usually start menstruating 14 months earlier than the average for this age group and their sisters. Earlier sexual maturation, as evidenced by age at menarche, has been complemented in recent decades by an earlier average age at sexual debut, leading young women to expect early sexual intercourse.

That is why, in terms of their personal structure and internal maturation, women with anorexia are not ready for their maturity. More than other girls, they experience physical maturation, primarily menstruation and the growth of mammary glands, as their preparation for playing the female role, considering it, however, alien and excessive for themselves. This often leads to ambivalence regarding their puberty in women (less often in men), manifested in the desire to lead an ascetic lifestyle, characteristic of the puberty period, with young people internally and externally distancing themselves from gender roles and from endogenously arising needs and intensively looking for other activities .

Experience shows that it is least of all one’s own sexual fantasies or specific desires that would lead to conflict situations. Data on sexual dreams and early or intense masturbatory activity among anorexics are sparse. The anorexic reaction and chronic development lead a woman to an image of gender neutrality that is not interesting to anyone. Sexual problems take a back seat to the idea of ​​losing weight.

The pathogenic influence lies in these seemingly everyday and banal situations, which cause emotional and empathic restrictions and thereby the increased vulnerability characteristic of puberty. This means that it is in the original personality that one should look for the decisive significance of the causal factor in the form of a corresponding predisposition.

Hereditary factors have to be considered due to the increasing incidence of anorexia and personality traits in some families. When observing twins with anorexia, impressive results were obtained. 13 pairs of twins with anorexia nervosa were described (6 own observations and 7 observations of other authors. This indicates the participation of a hereditary component in the appearance of anorexia nervosa.

Personal predisposition manifests itself in anorexia by special differentiation in the intellectual sphere and vulnerability in the emotional sphere. The increase in intellectual quotient, which reaches 128, is obvious, as noted by all researchers. Sensitivity and insufficient contact in the anamnesis are also noteworthy, although the girls do not attract attention to themselves in any way. In the language of the theory of neuroses, women with anorexia more often exhibit schizoid personality traits: in 28% of cases in women with anorexia nervosa and in 9% of cases in other patients who turned to a psychotherapist. In many cases, autistic attitudes and social isolation are detected even before the onset of the disease. It is necessary to take into account psychosomatic connections in the sense that the factors of the original personality in adolescence, under the influence of somatic maturation and psychosocial development, enter into a crisis, which causes a painful process with a tendency to become chronic, and sometimes even leads to death. It may also be fair to assume that there are specific families of people with anorexia. Such families are described as being particularly closely knit.

The course of this disease is difficult to predict; it often leads to the death of patients, but in this age group one can detect a number of variants of normal mental processing. As already mentioned, puberty asceticism is a normal phenomenon, even if it is pronounced. This is explained by the transfer of one’s own impulses to other persons, which is characteristic of adolescents (A. Freud). In this case, a repression or shift of the sexual conflict situation into the oral sphere and regression to early presexual levels are detected.

If family doctors describe the family environment in patients with anorexia as very closely related, with the child’s strong desire for independence and with the achievement of individuation as a goal, i.e. willingness to exercise and defend one's desires and rights, combined with a sense of responsibility towards other people, i.e. remaining within the family, this reflects the normal theme of the pubertal group and characterizes the problems of adolescence as a whole.

The patient, 21 years old, a student, was brought to the clinic by her mother on the referral of the therapist who treated her. She lost weight over the course of two years (from 55 to 38 kg); now, with a height of 168 cm, her body weight is 42 kg. Due to a tendency to constipation, the patient takes laxatives.

Left alone with the doctor, the patient reported that she had problems with nutrition. It is difficult for her to eat because she is afraid of possible vomiting. After eating, she induces vomiting on her own; The patient did not want to say how often this happens, but recently the vomiting has become more intense. According to the patient, this disorder developed on the eve of her adulthood. The freedom that allowed her to do whatever she wanted was unexpected for her. During a ski trip in winter, she met a man who later visited her only once. She now fell in love again with a 28-year-old bank employee, who then had a conflict with her father and was probably trying to turn her against her father. It became easier for her when in 2014 she moved to her aunt in another city and helped her with the housework there. She recovered (up to 48 kg), and her menstruation returned. Now she is studying at university and lives far from her parents.

Her family is dominated by her father, who comes from a family of employees and holds a high position in the company. He is very strict, works a lot, is extremely punctual and clean, conservative, and does not know how to give in. He expected active activity from his daughter. All members of my father’s family are inflexible and unemotional people. The mother, with whom the patient has a good relationship, comes from a large family from a small town, worked as a teacher of the Tatar language, but in the family she showed herself to be a dependent, weak person. The patient herself had few friends, was always calm, willingly played with animals, and was a successful student at school. She always wanted to do something practical. She started menstruating at age 12. During the conversation, the patient gives the impression of being depressed, but communicative and open, insecure and anxious. The illness began in the normal situation of leaving the parental home, with which she was closely connected, although this connection was ambivalent. Her fears are focused on the need to live independently, to find herself as a woman.

For some patients with anorexia, the situation causing the disease seems banal and ordinary, as does the further development of the condition during treatment and in later life.

The patient is 17 years old, a good student, a lively, intelligent girl, with a height of 162 cm, after two years of food restriction and taking laxatives due to severe constipation, but without vomiting, she lost weight from 42 to 32.5 kg. Over these two years, menstruation became shorter and more scanty, and then stopped completely. The patient’s father, a 37-year-old employee of Russian Railways, goes in for sports himself and involves his children in this. The mother is not independent, sacrifices everything for the sake of the children, without identifying her needs. The patient is the second of five children, born a year after her sister and a year before her brother. Her attitude towards her younger sisters is curious: she finds that her 11-year-old sister is a loser, and her 10-year-old sister eats too much and is too fat. The patient torments everyone in the family with this topic, scolds her sister at the table, eats nothing herself, and complains of a feeling of fullness in her stomach after only a small meal. She had few contacts outside the family and had no conflicts. During a 3-month inpatient treatment with careful monitoring of food intake, and then during outpatient treatment (individual therapy, gestalt therapy, kinesitherapy, intensive and then supportive individual therapy), her conflict was revealed: in her younger sister she found and defended herself . She was disappointed in her father and was jealous of his younger sister, whom her father preferred. In her suffering, she completely identified herself with her mother. (Family conflict issues were discussed twice in conversations with parents, but only the mother accepted this; she subsequently attended counseling sessions, and her position in the family was somewhat strengthened.) After treatment, the patient recovered to 52-54 kg, menstruation was restored after a year and became regular. Constipation and constant detachment in relation to friends and the doctor persisted for the longest time. In her dreams and drawings there was a pronounced tendency towards the formation of an Oedipus complex due to disappointment in her father. In the end, disappointment and even anger were processed by her. But she became less active at school, marked things down in her notebook, and began spending more money on herself. Relationships with her peers were more important to her than relationships with her doctor, and after 2 years she interrupted treatment. Talking a year later about what helped her the most, she said: “It was very important for me when new patients were admitted to the hospital and I, as the more experienced one, could help them. It strengthened my self-awareness. Of course, without treatment this would not be possible. But hospital treatment was only one type of practice for me. After it, I tried at home everything that they taught me in the hospital. I would not have achieved this with outpatient treatment alone.”

Flow.

Pubertal anorexia with pronounced symptoms is a serious progressive disease. Mortality (depending on the selection of patients and the quality of follow-up) ranges from 8 to 12%. Death occurs due to cachexia, hypokalemia, circulatory failure, pneumonia, infections, or due to refusal of food for suicidal purposes. If left untreated, in approximately 40% of cases the disease enters the chronic phase. But the majority of patients with an improvement in their condition remain still preoccupied with the topics of food and body weight. Many of them exhibit bizarre, fanatical and autistic personality traits, and some live in ascetic communities. They marry less often than women with other eating disorders, such as bulimia and obesity, and significantly less often than healthy women.

In some cases, almost normal family relationships can be established. As for individual variants of the disease, the prognosis is more favorable in those patients who become ill between the ages of 10 and 15 years, and less favorable in patients from an older age group; In patients with bulimic components, the prognosis is also more favorable than in patients with purely ascetic forms. Women with hysterical and depressive personality traits have a relatively better prognosis than patients with an expression of schizoid personality structure. During the treatment process, readiness to establish a psychotherapeutic relationship and the ability to analyze past and possible upcoming conflicts are among favorable prognostic criteria. An early age of onset of the disease, bulimic elements and awareness of conflicts, generally assessed as prognostically favorable criteria, are not always decisive, as the course of the disease in the next patient shows.

A 23-year-old female patient, a medical student, reported herself to the helpline (“Talk about losing weight”). On examination, she was described as “a small, dark-haired, generally pleasant woman in a loose pullover, animated, with dark eyes and a large head of hair. The patient smiles in a friendly manner, tries to give the impression of being open and friendly, but is somewhat depressed. Behind her openness there was a deep concern and loneliness. Only when she left did I notice her fragility and her very thin figure hidden under her wide clothes.”

The disease began at the age of 11 years, when the patient was in sixth grade at school. Then for the first time she lost weight to 37 kg (she simply did not eat anything). “Maybe I wanted to be noticed, but what else could I come up with?” At this time, her only friend left their small town with her parents. The difficult years of loneliness came. Even in kindergarten and elementary school, the girl pretended to have stomach pains in order to attract attention. She became more and more timid and withdrawn. When she turned 12, her parents were very worried because they discovered some kind of “gang” at school in which their daughter willingly spent time. But when she went to university, she was faced with the troubling problem of meeting people. She gradually lost weight (up to 37 kg), sometimes vomiting spontaneously. When the patient was dissatisfied with something, she might vomit repeatedly during the day, and then she would eat everything again. Currently she has a friend, who, however, has many acquaintances. Therefore, the patient feels that she is only a burden to her friend. Friendly relationships with men are problematic for her. She cannot come to terms with her role as a woman, finds flirting and coquetry ridiculous, but at the same time passionately desires to have a male friend.

About the family situation, the patient reported that her father, a school director, is completely absorbed in work, her mother is a teacher and also a deputy. Little by little she got used to the fact that her parents were always busy. The father easily falls into aggression and rage, but can also be friendly; he never noticed that his daughter was ill. Her parents were never strict, but she experienced it as neglect. The mother was warm-hearted and loving, but she had too little time for her daughter. Her two sisters, one and two years younger than her, have no complexes. The younger sister already had two male friends, goes to discos, the middle sister has had a boyfriend for two years, but she still has close ties with her father. Both sisters attended school and are now studying economics. The patient was always at the top of her class, worked hard, and was ambitious without overexerting herself. She had excellent achievements in various sports and was involved in professional sports.

Now she is busy with herself and cooking, she has bulimia attacks, frequent headaches, insomnia, sometimes she lies awake until 5 o'clock in the morning. She can no longer concentrate on her studies and does not maintain contact with students in the dormitory.

Individual depth psychotherapy was conducted. She was recommended to keep a diary in which she should note all her experiences, describe attacks of bulimia, etc. So, one day she was forced to eat and vomit when she was waiting for a friend, but she did not come. It was obvious that she was experiencing her complete isolation. She talked about her dream in which she soared on wings over Kazan, having a plan in front of her, and all the time she looked at the plan, and not at the city. After awakening, she felt annoyed that she lived according to the plan and did not see anything outside it, and she does not want to be controlled by circumstances. She also had the feeling that she was fooling others. She could hardly force herself to study, and went home on weekends and holidays; when her parents were not at home, she played the guitar alone and was disappointed when her parents were at home, since she could not have anything in common with them.

Finally, after 3 months of unsuccessful outpatient treatment, the patient agreed to be admitted to the hospital. There she received individual psychotherapy and, in addition, group psychotherapy and symboldrama; she lived in a therapeutic community. Body weight was not a significant problem for her. At the first visit, her body weight was about 43 kg and 3 months later, after a vegetarian diet, which she chose for herself, it remained the same. During the ongoing individual therapeutic treatment, deep trusting relationships with the psychotherapist were not established. Further treatment was carried out by a female therapist whom the patient knew from group therapy. In the group she showed herself to be friendly and open, but she did not have a sense of belonging to the group as part of it. And she did not have a close connection with her new psychotherapist, her body weight remained the same (43-44 kg), menstruation was irregular. A year later she left the university and returned home.

Three years later, in response to a written request, the patient’s mother reported that she died 2 months ago in a university clinic. After leaving Kazan, she looked for other methods of treatment from internists, logotherapists, and psychoanalysts, but quickly gave up everything. (Before treatment in 2015 in Kazan, she was treated for a year in different clinics, receiving behaviorally oriented and even religious treatment.) Then she decided to go to the south of the country, hoping to recover in a warm climate. There she developed a friendly relationship with a student studying anthroposophy, whom she greatly valued. But her somatic condition became worse, her body weight decreased to 26 kg, and the patient returned to Kazan, lived with her anthroposophical friend, and again attended lectures. Due to her increasingly deteriorating physical condition, she decided to go to a local clinic herself to “feed herself.” There she received a course of artificial feeding, visits were limited. A week later, she had to be transferred to an intensive care hospital, where she was diagnosed with severe metabolic disorders, “shock lungs,” and renal failure; she had to perform artificial respiration. Then there was an improvement for several weeks, after which pneumonia developed, from which the patient died. The mother wrote: “Of course, this was the only way out for her. She was so sensitive and learned and experienced so much through suffering. This is a difficult loss for us. She left behind many diaries in which she described in detail the cruel properties of this common disease and her desperate attempts to get rid of it: “From the point of view of reason, I understand my illness and can overcome it, but from the point of view of feelings, I am powerless.”

Of course, the patient, neither in the clinic, nor in everyday life, and even in communication with her parents, could not experience “from the standpoint of feelings” what she was looking for in life and what led her to the desire to lose weight. Perhaps the answer should be sought in her family situation: the rapid successive birth of two younger sisters, the constant employment of parents who did not pay enough attention to her. However, neither the father nor the mother, in the eyes of the researcher, seems cold and indifferent to their daughter. They were unable to provide a satisfactory explanation for why the patient developed differently from her younger sisters. The patient could not blame her parents, girlfriends and friends, or the psychotherapist for the lack of showing feelings of affection towards her.

In this regard, the natural question is whether we are talking about the initial inability to empathy as the main violation of the patient’s personality, which led to the development of the disease. “Inability to maintain relationships with partners and parents,” as well as “substantially impaired self-confidence in comparison with other people,” are cited as prognostically important factors at the time of the fullest development of the disease and thereafter. Many psychotherapists consider the criterion for discharging patients not to be an increase in body weight, but for the patient to become confident that he has one or two people who will help him later and with whom he can maintain contact. This condition is also the main target of subsequent outpatient therapy. The limited possibilities of such psychotherapeutic efforts are, unfortunately, visible in the example of the patient described above.

Relationship between therapist and patient

Patients usually make energetic attempts to attract the attention of the psychotherapist and staff with their childish helplessness and at the same time refinement and prudence. But all attempts to achieve real influence on them, to penetrate their personality, to establish a community are initially rejected by them. They consider treatment, especially inpatient treatment, which reveals their tricks in connection with the food ritual, as something completely unnecessary, since they do not consider themselves sick. If admission to the hospital is inevitable, they strive to determine the course of treatment themselves, achieve certain privileges, and, first of all, try to delay the moment of artificial feeding using a gastric tube. For medical staff, every new patient with anorexia is a new hope of having a patient in the department with whom there will be few problems, but this hope is invariably not justified.

Usually, after weeks or months, it becomes obvious that the body weight curve, despite the fact that the patient seems to be taking a lot of food, remains at the same level or even goes down, and then the patient’s tricks of refusing food, secret vomiting, and abuse of laxatives are revealed means, maneuvers involving deception during weighing, and later theft from the kitchen or complaints from nearby grocery stores; everything that exhausts the patience of doctors and medical personnel. The task of doctors and medical personnel is to actively work with the intact sphere of the patient’s personality and at the same time assess severe psychopathological disorders of his behavior, without falling into a state of irritation. There is always a danger that the next measure will remain ineffective, and relatives will despair of achieving an increase in body weight “at all costs,” even if there is not yet or no longer a threat to life, which only obliges more active intervention. An angry and hostile attitude on the part of nurses and doctors leads the patient to isolation and autistic isolation, which in severe cases increases

Just like establishing a relationship with a patient, it is difficult to find a common language with his parents, who find it difficult to agree with the recognition of their son or daughter as sick. There is a danger for psychotherapists and nurses of becoming “scapegoats” for mothers and fathers, and in our time, for grandparents. When multiple therapists are involved in a family therapy conversation, it increases the chances of shared responsibility in the eyes of individual family members; It becomes easier to understand why everyone, based on their experience and conditions of development, becomes what they are.

Treatment. It is impossible to unconditionally compare the results of treatment with different methods, since they are influenced by different prognoses for mild or severe reactions or for a chronic course of the disease. Treatment outcomes are likely to determine disease duration and quality of outcome as determined by research studies. In this case, both somatic data and psychosocial state and psychosocial development should be taken into account. Once achieved by a certain method, the success of treatment may not be repeated.

Hopes of finding the key to the mysterious field of anorexia through therapy based on etiological theories (behavioral therapy, systemic or psychoanalytic method) have not been realized in recent decades. Yet experiments with various therapeutic techniques have led to the pragmatic consensus described below, at least with regard to severe conditions requiring hospital treatment.

1. A symptom-oriented attitude towards food and weight gain is inevitable at the first stage of treatment. Conflict-focused, disclosive, individual-based, or family-systemic treatments seem inappropriate. The first goal is to increase body weight; its achievement is achieved by the therapeutic group in the process of working with both the patient and his family. Both parties enter into a “therapeutic alliance”, for which the goal is to achieve a certain body weight. The treatment group uses the same program for all patients with anorexia nervosa, aimed at reducing possible attempts to evade treatment and the distress experienced in connection with the need to comply with treatment instructions. Treatment programs range from strictly prescribed three meals a day in the presence of nurses to artificial feeding through a tube.
2. Relief of the condition is achieved by prescribing bed rest, limiting visits and subsequent participation of patients in general activities until discharge upon achieving somatic improvement, i.e. initial body weight (mostly 50 kg).
3. It is necessary to make attempts to achieve a closer personal connection with patients with the help of doctors, psychologists (men and women), and nurses in order to break through their “shell”, penetrate into their inner world and gain the opportunity to influence it. This contact is focused on the conflict, but not so much on the past, but on possible future expectations, fears and concerns.

The 21-year-old student described above was initially admitted to the hospital for a trial, since she came from afar and it was necessary to resolve the issue of upcoming treatment costs. With the freedom she needed and was given, she lost 3 kg in 2 weeks (to 38.1 kg). She then agreed to a nutrition program with the goal of achieving a body weight of 50 kg. She was on bed rest, receiving 2,500 calories for 4 meals, maintaining contact with a trusted nurse and psychotherapist, receiving psychotherapy for 2 hours a week, and then, as her body weight increased, individual psychotherapy for 3 hours. She spent all the time in bed , then began to get up, eat with other patients, and went to the psychotherapist’s office.

In the first weeks, she had crises of protest with self-destructive actions: she burned her face with cigarettes, registered her weight gain with fear, and in the end it was established that she drank 1.5 liters of water before weighing herself. Then she was prescribed nutrition through a gastric tube, strict bed rest was resumed, and smoking was allowed only in the presence of a nurse. Although the patient now protested, these measures were retained as a condition of discharge. Then there was a sharp increase in body weight to 48 kg within 4 weeks. After this, she was allowed to eat with other patients, leave the department, first with accompanying people, and then alone, and after 4 months she was transferred to a day hospital, and she began training classes. The patient was discharged when the goal of increasing body weight to 50 kg was achieved.

The themes of psychotherapeutic treatment were an ambivalent attitude towards her idealized and rejected father, her labile state of health, uncertainty when approaching other people, and elements of extreme lability and resentment in relationships with other people. After psychotherapy lasting 2.5 years, the patient’s condition stabilized. The extremely valuable significance of the topic of food in her ideas did not respond well to therapy and retained its relevance for a long time. The patient herself noted that this topic constantly breaks into her consciousness and she herself is forced to destroy everything that has been achieved. Nevertheless, the patient’s life improved.

Family therapy has the most pronounced effect. It should be noted that only half of the patients after family therapy did not resort to other types of psychotherapy (individual, group, in mutual help groups). The data that the authors of the family therapy technique report to other therapists who refuse this treatment are astonishing. Avoiding contact with family members, previously practiced by psychoanalysts, is now considered erroneous. For family therapy, important information is that which facilitates contact with the family, familiarization with its problems and allows you to attract the help of the family for the treatment of patients with anorexia.

A number of behavioral therapists have moved from the former single-method approach of operant conditioning to integrated intervention. It involves the use of behavioral and educational techniques in the first stage, and treatment aimed at psychosocial problems in the second stage. With this combined approach, after 1–2 years, good results are observed in 55% of patients, satisfactory results in 25%.

Thus, it can be argued that anorexia can rightfully be classified as a psychosomatic disease. Forms and approaches to psychotherapeutic treatment are strictly individual and do not lend themselves to template prescriptions.

Anorexia often develops against a background caused by excess weight. Some people even use hunger as a way to change consciousness to gain inspiration, which, of course, cannot be called a constructive method. But this is far from the only possible cause, risk factor and prerequisite for the development of anorexia.

Most often, the causes of anorexia lie in childhood. For example, this is how a dual attitude towards parents manifests itself due to harsh upbringing, corporal punishment, and other forms. Anorexic, on the one hand, hates his parents for the torment they cause, but on the other hand, he loves them. Refusal to eat is a manifestation of hidden .

Refusing to eat can also mean trying to gain control when you have lost control. The impetus in this case is the divorce of parents, the death of one of the relatives or separation.

As a rule, all anorexics have difficult relationships with their parents, in particular with their mother:

• For example, conditions are unfavorable when the mother has hysterical and high demands on the child, the ideal figure is cultivated everywhere and in everything. At the time of the child’s illness, these character traits of the mother become even more acute, which leads to even more pronounced and destructive
• The prognosis is equally unfavorable in cases where the mother has paranoid accentuations and follows the myth of the ideal family. The child is subject to high, primarily moral, demands. Following the myth of a prosperous family, the mother for a long time protects the child from others and especially psychiatrists, finds supposedly rational explanations for behavioral changes, and selects treatment herself. When it is no longer possible to ignore the problem, the disease reaches severe and advanced stages, and the mother simply abandons the child.
• In a symbiotic relationship (found in single-parent families), the mother supports any word and choice of the child. She denies the child’s anorexia and even in the final stages helps in “finding an ideal body,” continuing to work or study, and ignoring seeking help from specialists.
• In conflict families, where the father is an aggressor and the mother is timid, the child is subjected to indulgence from the mother and severe physical punishment from the father. He tries to force the child to stop “bullying” (eating disorder). In isolated cases, parents eventually unite and help the child recover. More often, one of his caring relatives refers him for treatment.

Initially problematic relationships with parents and their even greater deterioration at the time of illness make it difficult to treat anorexia. Family psychotherapy is required.

In men, additional ground for the development of anorexia in the future is created by hereditary schizophrenia, schizoid psychopathy, delusional psychoses, anxious depression, character anomalies, phobias, etc.

Mara Selvini Palazzoli, one of the founders of the Milan Institute of Family Psychotherapy, developed the theory of anorexia as a family disease. A portrait of such a family includes:

• absence of a leader in the family, subordination of behavior to external factors;
• open cooperation is contrary to family morals;
• None of the family members takes responsibility for the gradually accumulating problems.

In addition, the specifics of an anorexic family are as follows:

• The family is not flexible; the idea of ​​fidelity and devotion to the family is stronger than the idea of ​​self-realization and personal independence.
• The child develops perfectionism and obsessive-compulsive behavior due to the desire to win the love and attention of parents.
• Overprotection prevails in the family, the child is deprived of autonomy. His life and every action is controlled by “caring” parents. Selflessness towards the family, loyalty, and its protection are encouraged. Initiative and objections are regarded as betrayal.
• Relationships outside the family are frowned upon and strictly controlled.
• Intrafamily boundaries are blurred, but external boundaries are strictly defined. Coalitions are often formed with the older generation; the child is used as a means of avoiding conflicts between generations.
• Family priorities are nutrition and somatic functions.

Thus, in general, four mechanisms for the development of anorexia can be distinguished (two internal and two external):

1. Hunger is a means of fighting parents. Not receiving attention and love through acceptable behavior, the child forces his parents to worry about his health and force him to eat.
2. Excessive parental coercion regarding nutrition, control, and punishment provoke loss of appetite and vomiting.
3. Anxiety is caused by the thought of real or fictitious obesity and remarks from others about a sharp and pronounced change in weight (including in terms of weight loss). Anxiety causes decreased appetite.
4. Hunger causes biochemical processes that are perceived as an anxiety state. Without feeling hungry, but experiencing this state, an anorexic person refuses food with special zeal.

Almost all psychoanalysts claim that food is subconsciously perceived as safety, love, pleasure. The desire to bite is a manifestation of oral aggression (innate aggression). With the development of conscience, these tendencies cause a feeling of guilt and self-punishment, which is manifested by refusal of food.

Other reasons

Possible causes of anorexia include personal immaturity. In response to the demands of others to be independent, independent, active (socially, sexually, professionally), a person reacts with anxiety, which results in anorexia.

Unpreparedness for sexual activity is the most popular cause of anorexia in young girls:

• fear of separation from mother;
• fear of pregnancy and obesity (not necessarily conscious);
• fear of intimacy.

In men in this area, the prerequisites for anorexia are considered to be Oedipus and the castration complex. Narcissism and the desire to renounce any carnal needs, the idea of ​​​​becoming a superman is another popular reason.

The problem of hidden aggression and denial of sexuality (anorexics look like sexless creatures, eternal teenagers) is taken into account primarily when working with patients.

Risk factors

Risk factors for anorexia include biological, cultural, familial and intrapsychic conditions:

• female gender (90-95%);
• cult of thinness;
• stress caused by high demands on oneself;
• low ability to understand your feelings;
• family conflicts or dependent relationships;
• early onset of adolescence;
• insulin-dependent diabetes;
• twin factor.

An alternative popular name for anorexia is “disease of excellent students.” Very often it affects teenage girls who strive to be the best, good, exemplary in everything, and meet the expectations of their parents.

Anorexia can be an incorrect option for self-medication in adolescents who are dependent on their parents. Gaining control over the body, they want to achieve autonomy from their parents.

Treatment

It is worth noting that the true causes of anorexia may not be recognized by the patient himself, even if he admits the fact of the problem. For example, in adolescents, anxiety is caused by psychosexual development, which slows down with weight loss. Anorexia is not a disease that you can cope with on your own. You definitely need to seek help from specialists.

Treatment is complex: it includes taking medications, working with a psychiatrist and psychologist, and a nutritionist. In the first stages, the goal of treatment is to refocus the patient’s attention from his somatic problems to problems of a psychosocial nature, problems in relationships with others.

The treatment plan is approximately as follows:

1. Discussion with a psychologist and (or) psychiatrist of individual fears and interpersonal problems. Drawing up recommendations for self-control.
2. Discuss your diet with a nutritionist.
3. Concluding an agreement with the patient to improve well-being, sleep, mood and relationships with others; achieving a specific weight with the help of bed rest and monitoring by medical staff.
4. Eating behavior training. First, a liquid diet and/or intravenous or tube feeding is prescribed. Meals take place under the supervision of staff; medical workers observe for another 2 hours after consumption to avoid attacks and inducing vomiting in the patient.
5. Restoring psychomotor skills and restoring eating behavior through rewards. For example, a weight gain of 200 grams means lunch in the common canteen.
6. Cognitive individual and group psychotherapy. The main focus is on the discussion of the patient's self-observation diary. This allows us to identify cognitive distortions that are unconscious to the individual.
7. Group therapy for patients to understand their feelings and true needs.
8. Family therapy or other forms of relationship work if parents refuse to participate in the process.

According to the causes of anorexia, the work of a psychotherapist is aimed at:

• to weaken by providing the patient with more individual space, sharing ties with the family;
• elimination of overcompensation;
• training in conflict resolution tactics and stopping avoidance;
• the fight against the rigidity of the family as a system.

During cognitive therapy, the anorexic learns:

• more accurate understanding of your thoughts and their expression;
• be aware of the relationship between destructive thoughts and;
• analyze your beliefs and check their correctness;
• form realistic and adequate ideas, change distorted ones.

In parallel, work is carried out with a feeling of inferiority, looking for flaws in one’s appearance and incorrect self-perception. The field for assessment expands, categorical judgments and duality of thinking (“black and white”) are eliminated.

Read more about anorexia in the article, about the signs in the article.

To start analyzing the “flights” with weight, nutrition, accepting yourself at a given weight and body, I recommend reading this article. Continuing the topic of such a science as psychosomatics.

Eating style is a reflection of a person’s emotional needs and state of mind. In the early days of our existence, eating is the main vital function. Satisfying hunger causes a feeling of security and well-being. During feeding, the child feels comfort from bodily distress. Skin contact with the mother's warm, soft body while feeding gives the baby the feeling of being loved. In addition, with his lips and tongue he feels the sucking of his mother’s breast as something pleasant. By sucking the thumb, the child tries to repeat this pleasant experience later. Thus, feelings of satiety, security and love remain inseparable in the infant's experience (Luban-Plozza et al., 2000).

There is a danger that infants will be left with developmental disorders if they are too early to be frustrated in their vital needs in a way that is incomprehensible to them. If such a child does eventually receive food, he often swallows hastily without feeling full. This type of behavior is the infant's response to an insecure, damaged relationship with the mother. It is assumed that in this way the basis is laid for the later development of tendencies towards capture, envy and jealousy.
Even more decisive than feeding method is the attitude of a mother to her child. This was already pointed out by 3. Freud. If the mother does not treat the child with love, if during feeding she is far from him in her thoughts or is in a hurry, this may result in the child developing aggressiveness towards her. The child often cannot react or overcome these aggressive impulses; he can only repress them. This leads to an ambivalent (* my note: instability, extreme) attitude towards the mother. Mutually opposite movements of feelings cause various vegetative reactions. On the one hand, the body is ready to eat. If the child unconsciously rejects the mother, this leads to a reverse nervous reaction, spasms, and vomiting. This may be the first psychosomatic manifestation of later neurotic development.
Thus, eating is not only closely related to the need for loving care, it is also a communicative process.

OBESITY

Personality picture
Obesity can be caused by parents when they systematically respond to any external expression of need by the child with an offer of food and make their expression of love for the child dependent on whether the child eats. These relational structures lead to a lack of self-strength, with the result that frustrations cannot be tolerated and worked through and must only be erased through “reinforcement” (Bruch, 1957).
Patients with obesity often experience a very close attachment to the mother, dominance of the mother in the family, in which the father plays only a subordinate role (Petzold, Reindell, 1980). The mother, with her excessive care, delays motor development and readiness for social contact and fixes the child in a passive-receptive position (Brautigam, 1976).

Psychodynamically, increased calorie intake is explained as protection against negative, especially depressive emotions and fear.
It is not possible to describe any single type of patients. Patients exhibit traits of internal twitchiness, apathetic-gloomy despair and signs of flight into loneliness. The act of eating shifts - albeit temporarily - negative emotions into a depression-free phase.
Patients feel imperfect, vulnerable, and incompetent. Hyperphagia, decreased activity and, as a result, excess weight provide a certain protection against a deep feeling of insufficiency: having become massive and impressive, an obese person seems stronger and more protected. In some cases, there is a clear temporal connection between the appearance and intensification of food cravings and some kind of frustration.
By regressively equating the meanings of love and nutrition, an overweight person consoles himself with food for his lack of self-love.
The clinical follow-up method made it possible to identify a significant frequency of stress in personal and family relationships, i.e., the sphere of interpersonal interaction seems to be the most problematic for patients with obesity. They show increased sensitivity towards interpersonal conflicts.
In obese patients, a noticeable increase in stable personal anxiety was found, which is considered as a basal mental property that predisposes to increased sensitivity to stress. Situational (reactive) anxiety reaches a neurotic level in severity.

A distinctive feature of psychological defense in such patients is the predominance of the psychological defense mechanism of the type of reactive formations (hypercompensation). The substantive characteristics of this version of psychological defense assume that the individual prevents the awareness of unpleasant or unacceptable thoughts, feelings, and actions through the exaggerated development of opposite aspirations. There is, as it were, a transformation of internal impulses into their subjectively understood opposite. Immature protective mechanisms of psychological defense are also typical for patients, one of which is associated with aggression, transferring one’s own negative ideas to others (projection), and the other with a transition to infantile forms of response, limiting the possibilities of alternative behavior (regression).
It should be assumed that the factors that lead to obesity in one person do not necessarily affect another.
Psychologically, different constellations are also found. The most commonly cited causes of obesity are:
Frustration at the loss of a love object. For example, obesity can be caused, more often in women, by the death of a spouse, separation from a sexual partner, or even leaving the parental home (“boarding obesity”). It is generally accepted that the loss of a loved one can be accompanied by depression and at the same time an increase in appetite (“bite the bitter pill”). Children often react with increased appetite when the youngest child in the family is born.
General depression, anger, fear of loneliness and feelings of emptiness can lead to impulsive eating.
Situations requiring increased activity and increased stress(for example, preparing for exams, professional overload), awaken in many people increased oral needs, which lead to increased eating or smoking.

In all these “revealing situations,” food has the value of vicarious satisfaction. It serves to strengthen connections, security, eases pain, feelings of loss, disappointment, like a child who remembers from childhood that when he was in pain, illness or loss, he was given sweets to console him. Many obese people had similar experiences in childhood, which led them to unconscious forms of psychosomatic reactions.

For most obese patients, it is important that they have always been fat, and already in infancy and early childhood they were prone to being overweight. It is interesting that in frustrating and tough life situations, feeding and excess food can become a stress-regulating factor for both parents and their growing children. Obesity and food as a substitute for satisfaction are therefore not a problem for one person, but for the whole family.

These situational conditions must be associated with the characteristics of the patient’s personality and its processing.
In a psychodynamic interpretation, one can give preference to the concept of regression with fixation on oral gratification. Food is a substitute for absent maternal care and a defense against depression. For a child, food is more than just nutrition, it is self-affirmation, stress relief, and maternal support. Many obese patients have a strong dependence on their mother and fear of separation from her. Since 80% of parents of obese patients are also overweight, we can think about a predisposition factor, as well as particularly intense family ties and adherence to traditions, a relationship style where direct expressions of love are rejected, and their place is taken by oral habits and connections . Adopted children are less likely to be obese if their parents are obese than their siblings (Meyer, 1967).
Certain forms of early childhood development and family environment in children with a tendency to obesity are described. Mothers of such children show hyperprotection and over-attachment. Parents who allow everything and prohibit nothing, who cannot say “no,” compensate with this their remorse and the feeling that they are not giving enough to their children. Fathers in such families are weak and helpless (Bruch, 1973).

Oral spoiling is often motivated by parents getting rid of the feeling of guilt for their emotional alienation, for their indifference and internal rejection of the child. Feeding children is the only possible means of expressing affection for them, which parents are not able to show by talking, touching, or playing with them. Oral refusal is the result of different forms of behavior of both an overprotective and indifferent mother.

Psychotherapy

Weight loss courses, as a rule, turn out to be ineffective if it is not possible to induce the patient to change his instinctive-emotional behavior, in which hyperphagia and excess weight would cease to be necessary for him. The success of therapy in practice is so low because the balance of pleasure of the patient is ignored, for whom, in general, it is more acceptable and tolerable to maintain his excess weight than to deal with his problems. During dietary treatment, over 50% of patients demonstrate symptoms such as nervousness, irritability, increased fatigue, and a wide range of depressive symptoms, which can also manifest themselves in the form of diffuse fear.

The reasons for the frequent failure of psychotherapeutic treatment of obesity may be:
- An exclusively symptom-oriented approach with an explanation of organic and functional disorders is not only inadequate to the problem of a patient with obesity, but also often has the consequence that he ultimately feels not so much sick as unreasonable and emotionally rejected.
- Lack of a thorough analysis of behavior, its conditions and motivations in the treatment of behavioral disorders.
- Difficulties in overcoming sociological factors, for example, family or national habits of eating high-calorie foods. Patients do not comply with psychotherapist's orders much more often than one might think. It is this behavior of patients that irritates the therapist, especially because he assumes that a patient who does not follow instructions is not ready to cooperate. Many studies, however, show that the patient is often unable to understand or remember the therapist's instructions because they are too complex, but does not dare ask for clarification or repetition. How can a patient be motivated to cooperate and comply with therapeutic instructions? The most important thing is the patient's active participation in therapy. To do this, the psychotherapist must first find a bridge of contact with the patient. The better he can understand the patient, the easier it will be for him. He must determine how deeply personally affected the patient is by the loss that has become familiar to him, find opportunities to cope with the conflict and gain pleasure in other ways.
An individualized treatment plan must then be created taking into account personal and work circumstances. The patient should be given the opportunity to train and control unusual eating behavior.

Behavioral therapy
Most authors testify to the effectiveness of behavioral psychotherapy aimed at changing inappropriate behavioral stereotypes (Basler, Schwoon, 1977; Brownell, 1983; Stunkard, 1980).
The principle of losing weight is extremely simple - limit calorie intake, according to modern nutritional concepts, primarily fat (Ginsburg et al., 1997). The most difficult thing is to put this principle into practice. The behavioral psychotherapy program proposed by Uexkull (1990) includes five elements:

1. Written description of eating behavior. Patients should write down in detail what they ate, how much, at what time, where and with whom it happened, how they felt, and what they talked about. The first reaction of patients to this tedious and time-consuming procedure is grumbling and dissatisfaction. However, usually after two weeks they notice a significant positive effect from keeping such a diary. For example, one businessman who spends a lot of time on the road first began to analyze that he abuses food mainly only in the car, where he had large stocks of sweets, nuts, potato flakes, etc. Realizing this, he removed food items from the car and was able to After this you will lose a lot of weight.

2. Control of stimuli preceding the act of eating. It involves identifying and eliminating food-provoking stimuli: easily accessible supplies of high-calorie foods and sweets. The number of such products in the house must be limited and access to them made difficult. For those times when you can't resist the urge to eat something, keep low-calorie foods on hand, such as celery or raw carrots. The incentive to eat can also be a certain place or time of day. For example, many people eat while sitting in front of the TV. As in Pavlov's experiments on the development of a conditioned reflex in dogs, turning on the TV serves as a kind of conditioned stimulus associated with food. To reduce and control excessive conditioned stimuli, the patient is advised to eat in only one place, even if it is just one bite or sip. Most often this place is the kitchen. It is also advisable to create new incentives and enhance their exceptional impact. For example, the patient may be advised to use separate fine dishes, silver cutlery, and napkins of a striking color for meals. Patients are asked to use these utensils for even the most minor meals and snacks. Some patients even take their cutlery with them if they eat out.

3. Slowing down the eating process. Patients are taught the ability to independently control their food intake. To do this, they are asked to count every sip and bite while eating. After every third piece, you need to put the cutlery down until this piece is chewed and swallowed. Gradually the pauses lengthen, reaching first a minute, and then longer. It is better to start lengthening pauses at the end of meals, as then they are easier to tolerate. Over time, the pauses become longer, more frequent, and start earlier. Patients also learn to avoid all simultaneous activities during meals, such as reading a newspaper or watching a TV show. All attention should be focused on the process of eating and on enjoying food. It is necessary to create a cozy, pleasant, calm and relaxed atmosphere around, and, of course, avoid talking at the table.

4. Increased concomitant activity. Patients are offered a system of formal incentives for changing their behavior and losing weight. Patients receive points for each achievement in changing and controlling their behavior: keeping a diary, counting sips and bites, pausing while eating, eating only in one place and from a certain utensil, etc. Additional points can be earned if, despite great temptation, they managed to find an alternative to food. Then all previous points can, for example, be doubled. The accumulated points are summed up and converted into material value with the help of family members. For children, this could be a trip to the cinema; for women, it could be freedom from housework. Points can also be converted into money.

5. Cognitive therapy. Patients are encouraged to argue with themselves. The therapist helps to find suitable counterarguments in the patient’s monologue. For example, if we are talking about losing weight, then in response to the statement: “It takes so long to lose weight,” the counter-argument could sound like this: “I’ve been losing weight, but now I’m learning to maintain the weight I’ve achieved.” Regarding the ability to lose weight, the doubt may be: “I’ve never succeeded in anything. Why should it happen now? Counterargument: “Everything has its beginning, and now an effective program will help me.” If we are talking about the goals of work, then in response to the objection: “I can’t stop sneaking pieces of food,” the counter-argument could be: “But this is unrealistic. I'll just try to do it less often." Regarding the thoughts that arise about food: “I constantly notice that I think about the fabulous taste of chocolate,” you can offer the following counterargument: “Stop! Such thoughts only frustrate me. It is better to think about how I am sunbathing on the beach” (or about any other activity that is especially pleasant for the patient). If excuses arise: “Everyone in my family is fat. “It’s hereditary for me,” a counter-argument could be: “This makes losing weight more difficult, but does not make it impossible. If I stick it out, I will succeed.”

Suggestive psychotherapy
It reinforces the attitude toward correct eating behavior and is most effective in patients with psychological defense of the regression type and hysterical personality traits.
At all stages of treatment, elements of neuro-linguistic programming are used as a modern direction of behavioral psychotherapy with a non-behaviorist orientation. NLP promotes “tuning” to the patient and increasing the effectiveness of interaction with him based on clinically detectable mental characteristics.

Methods of Gestalt therapy, transactional analysis, art therapy, psychodrama, body-oriented therapy, dance therapy and family psychotherapy are also successfully used.

Obesity Questionnaire

1. Do you have the impression that you often “eat yourself for something” or “the way to the heart leads through the stomach”? Do you have a “mouth full of worries” or do you think that “everything that fits into your mouth is useful”? Do other proverbs and catchphrases come to mind regarding your illness?
2. What does it mean to you that each person has his own balance to which he returns, despite any diet? That the diet can even become the cause of subsequent excess obesity, since if you refuse it, fat cells not only fill up, but also multiply? That weight problems cannot be solved by diet alone, without taking care of other causes at the same time?
3. Do you take your prescribed medications regularly? Do you know how these medications work, what you can expect from them, and what side effects are possible?
4. Do you have professional problems that you compensate for with food? What current abilities do they relate to?
5. What would your partner have to do for you to lose weight?
6. Does “food bind body and soul” for you or your partner?
7. Does a “subsidence” of needs and a “pushing aside” of the feeling of displeasure occur during eating, as happens in young children?
8. Do you eat in public the same way as others because you are embarrassed to ask for more or what you like best (courtesy)?
9. What would you do if we had a famine?
10. Do you hope that the problem of world hunger will be solved in the foreseeable future? What can you do about this?
11. Can you use part of the money you spend on food to satisfy your other needs or the needs of other people (for example, education, housing, leisure, travel, entertaining, donations)?

ANOREXIA NERVOSA

Personality picture
The term "anorexia" is defined occurring during puberty(*my note - adolescence) (almost exclusively in girls) a painful condition associated with the desire to lose weight, become elegant and remain so.

In the chronic course, there is a local fear, which can be called phobic, of normal food, weight gain and achieving the average levels necessary to maintain health. Primary somatic or hormonal disorders are usually not detected. This disorder is based on an adolescent developmental conflict without awareness of the latter and without a realistic attitude towards one’s own somatic state.

In terms of personality structure and internal maturation, women with anorexia are not prepared for their maturity. More than other girls, they experience physical maturation, primarily menstruation and the growth of the mammary glands, as their preparation for playing the female role, considering it alien and excessive for themselves. This often leads to ambivalence regarding their puberty in women (less often in men), manifested in the desire to lead an ascetic lifestyle, characteristic of the puberty period, with young people internally and externally distancing themselves from gender roles and from endogenously arising needs and intensively looking for other activities .

Personal predisposition manifests itself in anorexia by special differentiation in the intellectual sphere and vulnerability in the emotional sphere. Also noteworthy are the sensitivity and lack of communication traced in the anamnesis, although the girls do not attract attention to themselves in any way. In the language of the theory of neuroses, women with anorexia are more likely to exhibit schizoid personality traits. In many cases, autistic attitudes and social isolation are detected even before the onset of the disease. As the disease progresses, more and more difficult-to-perceive schizoid autistic symptoms, similar to delusions, predominate.

My personal experience. M, 22 years old, applied 3 years after being diagnosed with anorexia and partial withdrawal. The request was not related to anorexia, but had its roots there.

M, 22 years old.
The mother is an authoritarian, independent woman. A brilliant specialist in the field of linguistics.
The stepfather is much older than the mother; at the time of working with the client he was 60 years old.
AN (anorexia nervosa) developed from the age of 14, reaching its peak at the age of 15.
The client was aware that this was due to the high demands placed on her as the daughter of an “ideal mother.”

The provoking situation for disordered eating behavior is often the first erotic experience, which patients cannot process and experience as threatening; Strong sibling rivalry and fears of separation are also reported, which may be activated by the death of grandparents, divorce, or siblings leaving the parental nest.

On the one hand, patients direct self-destructive aggression against themselves, with which they punish themselves for impulses to part with their mother, perceived as “betrayal.” On the other hand, refusing food is an attempt to achieve loving care or, if this fails, a means of at least angering other family members, including the mother, and using eating behavior to establish control over them. And in fact, in many families of such patients, the patient's eating behavior is an all-consuming topic, causing predominantly negative reactions. In treatment, patients try to transfer this relationship scheme to clinical staff.

In anorexia nervosa, oral aggressiveness is not only suppressed. It is rather a question of denial of all oral urges, and the ego tries to establish itself and raise its value by rejecting all oral urges.
With anorexia nervosa, the idea “I must lose weight” becomes an integral component of the personality. This feature is found, however, only with symptoms caused by psychotic processes. In severe forms of anorexia nervosa, the ego does not fight against the ideas that suppress it. This explains the lack of awareness of the disease and the rejection of all help.

Anorexia nervosa is, however, not only a struggle against the maturation of female sexuality. It is also an attempt to defend against growing up in general, based on a feeling of powerlessness in the face of the increasing expectations of the adult world.

In addition to individual psychodynamics, the field of relationships in families sick. Family relationships are often defined by an atmosphere of perfectionism, vanity and a focus on social success. They are characterized by a family ideal of self-sacrifice with corresponding competition among family members.

For families with anorexia patients, such behavioral characteristics as viscosity, excessive care, conflict avoidance, rigidity and children's involvement in parental conflicts have been described.
In such a family, everyone strives to impose their own definition of relationships on the other, while the other, in turn, rejects the relationship imposed on himself. No one in the family is ready to openly take over leadership and make decisions on their own behalf. Open unions between two family members are unthinkable. Overlapping coalition generations are negated at the verbal level, even if they can be established at the non-verbal level. Behind the façade of marital consent and harmony lies deep mutual disappointment, which, however, is never openly admitted.
In general, in families, female authority is often noticeably dominant, be it mother or grandmother. Fathers are mostly outside the emotional field, as they are hidden or openly suppressed by mothers. This reduces their value as perceived by the family, to which they respond by further withdrawal, which gives mothers room to further develop their dominant positions.

Psychotherapy

Family therapy has the most pronounced effect.

Methods of Gestalt therapy, transactional analysis, art therapy, psychodrama, and dance therapy are also successfully used.

BULIMIA

Personality picture
Bulimia (bullish hunger) is referred to as compulsive eating/vomiting or eating/defecation (Drewnowski et al., 1994).
Like anorexia nervosa, bulimia occurs predominantly in women.

Leading symptoms the disease consists of:
- frequent occurrence of time-bound bouts of overeating;
- active weight control through frequent vomiting or use of laxatives.

Patients with bulimia are outwardly well: they have an ideal figure, they are successful and active. The excellent facade, however, hides extremely low self-esteem. They constantly ask themselves what others expect from them, whether they are behaving correctly. They strive for greater success and often confuse the love they seek with recognition

The personality structure of patients with bulimia is as ambiguous as with anorexia. In general, bulimia can be explained by the social contradictions in which modern Western women grow up. Exploring the historical conditions for the emergence of bulimia, he characterizes it conflict in mid and late adolescence, which has common features in all women with bulimia. This is, firstly, leaving the parental family and the task of developing one’s independence; secondly, a developmental problem in connection with rejection of one’s sexually mature body and conflict in connection with sexual identification.
At first impression, patients often appear strong, independent, purposeful, ambitious and self-possessed. This, however, is significantly different from their self-esteem, which is marked by feelings of inner emptiness, meaninglessness and a pessimistically depressive background as a consequence of patterns of thinking and behavior leading to feelings of helplessness, shame, guilt and ineffectiveness. The perception of oneself and the “I-ideal” diverge sharply, patients put this splitting into an outwardly good and poorly hidden picture.

They often come from families in which communication is impulsive and there is a significant potential for violence. The structure of relationships in families is marked by high conflict and impulsiveness, weak connections between each other, high levels of life stress and unsuccessful problem-solving behavior with a high level of expectations of social success.

In this situation, patients assume responsible tasks and parental functions early. One’s own fears of not being able to cope and being at the mercy of the arbitrariness and unreliability of parents are controlled and compensated for by caring behavior; the weak and dependent aspects of one's personality are held back and will eventually react in bouts of overeating and purging.

Emotional instability, impulsiveness with fear of loss of control.

Hunger is distortedly interpreted as a threat resulting from a loss of control, control over bodily functions is overgenerally equated with the ability to cope with problems. The bout of overeating itself has the function of reducing tension, integration, and comforting self-satisfaction, which, however, is short-lived.
This is perceived by the patient as a loss of control, radically questioning her autonomy and ability to cope with life. Vomiting is induced to maintain a constant body weight, which for the patient is a measure and indicator that self-control and self-determination have been regained. Feelings of shame and guilt in this regard often cause social and emotional regression, as well as splitting into outwardly presented prosperous and hidden poor self-esteem.

The discrepancy between perception and presentation of oneself can cause a feeling of internal emptiness and tension, which is activated in stressful triggering situations and re-starts the disease relay.

Bulimics usually:
- perfectionists (strive to do everything perfectly);
- prone to sadness, depression, obsessive thoughts or actions;
- impulsive, chaotic, ready to take risks;
- have low and unstable self-esteem;
- are not satisfied with their own body;
- set unrealistic goals for themselves;
- fall into despair when these goals cannot be achieved;
- they also build personal relationships according to the “bulimic” pattern: ardent passion - abrupt break;
- have unpleasant childhood memories associated with eating (food as punishment, force feeding, scandals, etc.).

Psychotherapy
As with psychosomatic diseases in general, to select adequate treatment in each individual case of bulimia, one should take into account the characteristics of the patient - age, motivation, chronicity, ability for adequate self-esteem, physical and mental state, severity of personality disorder, alcohol abuse, risk of suicide, etc. d.
Representatives of different schools report the effectiveness of almost any treatment - from classical psychoanalysis to family therapy, from behavioral therapy to Indian meditation, from feminist groups to inpatient or long-term outpatient therapy.
Comparative data on the indications and prognosis of various treatment methods can be presented as follows (Lacey, 1985; Fairburn et al., 1991; Fairburn et al., 1992; Ricca et al., 2000)
Outpatient treatment, in which the patient remains in his or her usual environment, is adequate for most sick women and is often sufficient.

The following steps must be included in any form of psychotherapy.
1. In one or more diagnostic conversations with the patient, her current eating behavior and general life situation are clarified, mostly chaotic and hidden from others and from herself, eating behavior in all its details - the number of meals, its quantity, preparation for food, situations , in which such behavior arose, and first of all the mood preceding it, and then the emotional background in the current life situation with its difficulties and conflicts and external and internal circumstances.
2. The patient is offered a new eating regimen in the form of a written program with clear regulation of the frequency and time of intake, quantity and type of food. To do this, all nutritional details are noted in a notebook that the patient keeps daily.
3. On a specially dedicated page of the notebook, the most important events of the day, mood and, above all, situations in which relapses of bulimia occur, with their dependence and connection with the emotional state, are described.
4. The development of the general life and conflict situation, as well as the symptoms of relapses of bulimia are discussed once a week in an individual half-hour conversation with a psychotherapist (woman or man). The nutrition and life plan for the next week is drawn up taking into account physiological needs. The patient weighs herself in the presence of her psychotherapist, who thus “documents” responsibility for her body weight and health status.
5. Next, group conversations with patients with bulimia are added.

This stage of treatment lasts more than 10 weeks; conversations are carried out in the afternoon or evening at the clinic individually or in groups or by combining these methods. The treatment tactics are such that after a 10-week intensive program it is necessary to conduct individual conversations with patients, first at small and then at increasingly large intervals of time (after several weeks, then months), but always within a fixed time frame. For patients, the fact that someone is constantly interested in them and will share responsibility with them if they report subsequent relapses is a great support. As numerous observations show, bulimic attacks can also occur during subsequent crisis situations.

Family therapy, as with anorexia nervosa, produces positive results.

Methods of Gestalt therapy, transactional analysis, art therapy, psychodrama, body-oriented therapy, and dance therapy are also successfully used.

Positive psychotherapy for appetite disorders
Anorexia nervosa and bulimia - the ability to get by with little money, the ability to share the hardships of world hunger.

Current conflict.
With psychogenic starvation, we are talking less about the disease of an individual person, but rather about the disease of the whole family, where the starving person becomes a carrier of the symptom. With his illness he expresses what the whole family suffers from, but no one can express it or dare only think about it. From this point of view, the patient is the strongest in his family circle, because he dares, putting his life at risk, to discover family problems and social injustice. What powers these weak and outwardly helpless people possess is manifested in the consistency with which they refuse to eat and express protest, as well as in their ambition, their activity and iron self-control. The latter, of course, often leads to the opposite actions: in order not to have to justify themselves to themselves because of their ravenous appetite (courtesy/sincerity), they often consume mountains of food and then throw it out of themselves.

Basic conflict.
Hungry families are usually those with a strong financial position. Typically, in these families or in one of the parents, neatness, neatness, politeness, achievement and, in relation to religion, obedience are highly valued. The attitude towards the body, sensuality and sexuality is, as a rule, one-sided, in the direction of “spirituality”, “dematerialization”. In this regard, they talk about “ascetic families.” There is no joy from the sensual, “instinctive” delights of life and tenderness. Love serves only achievement and well-being, there is no time for each other, there is no contact with the outside world. The dominant concepts here are: “time for business is time for fun,” “if you can do something, then you are something,” “everything on the table should be eaten,” and “what people say” (courtesy).

Current and basic concepts.
When children raised in such a family, gaining independence, leave their home, they inevitably find themselves in a conflict between what they have learned at home and their own desires and attitudes. The path to somatics does not mean “escape” for them, but rather a dramatic action, a visible rebellion against conventions and conformity through a demonstration of autonomy. Thus, symptoms can sometimes reflect family conflicts (a sense of injustice: “why me?”), and in other well-adapted families they can be understood as a reaction to social injustice (for example, world hunger). Physical evidence forces the family to respond in a positive way: to pose problems, to reconsider concepts. Thus, positive psychotherapy sees in psychogenic fasting not so much a painful lack of appetite or a strategy of avoiding food, but rather the ability, through fasting, to pay attention to something in oneself or around oneself.
Those suffering from anorexia, on the one hand, show by their example how small means can be used (asceticism and loneliness). On the other hand, they have the altruistic ability to cook for others and share the world's hunger with others.

Current ability: "justice".
Definition and Development: Justice is the ability to balance all interests in relation to oneself and others. What is perceived as unfair is treatment that is dictated by personal preferences and rejections or partial orientations instead of detailed reflections. The social aspect of this relevant ability is social justice.
Every person has a sense of justice. The way loved ones treat the child, how fair they are to him, his brothers and sisters and to each other, is reflected in the individual’s attitude towards fairness.
How they ask about it. Which of you values ​​justice more, in what situations and towards whom? Do you consider your partner to be fair (to children, siblings, other people, to you personally)? How do you react if you are treated unfairly (at work, in
family)? Do you have or have you had problems due to injustice (someone was preferred to you)? Which of your parents emphasized justice to you or your siblings more?

Synonyms and disorders: proportionate, deserved, objective, impartial, unacceptable, unreasonable, in comparison with..., feel left out, infringed on one’s interests, confidence in one’s own justice.
Hypersensitivity, competition, struggle for power, feelings of weakness, injustice/retribution, revenge, individual and collective aggression, depression, retirement neuroses.
Features of behavior: justice without love sees only achievement and comparison; love without justice loses control over reality. Learn to combine justice and love. To address two at the same time is to treat one unfairly.

Various somatic structures are involved in the feeling of hunger and food intake. The work and movement of muscles, heat exchange in the body and other forms of activity are carried out under the condition of energy balance, in this case food intake is mandatory. The feeling of hunger is regulated by the central nervous system through the cerebral cortex.

Also, the person’s personality and the surrounding situation also participate in these processes. Special studies were conducted in which animals took part. In order for the body to take food, a special atmosphere must be created.

You should make sure that there is no danger, you need to ensure comfort and good relationships with others. Even pets should feel safe while eating.

The act of eating involves biting and sucking, chewing and swallowing. All these processes occur together and are also quite stressful. From childhood, every living being feels joyful satisfaction from food. Eating behavior and various deviations are expressed in protests and rage, adoration and hatred.

When a baby touches his mother's breast for the first time, he feels unity with the person closest to him. After this, the child learns to eat socially, he needs to create a sincere and pleasant atmosphere at the table. For other people, eating may improve their appetite.

Eating directly depends on the emotional state of a person and the environment. Appetite is not just a feeling of hunger; food culture can easily be destroyed. When eating, a person’s values ​​and habits are of great importance. Different cultures are accustomed to different taste sensations and directions, which have a direct relationship with experience.

Psychophysiology also influences appetite. Some people view food as a gift from God, but sometimes people give up food completely to overcome themselves. There are individuals who perceive food as an animal and a base instinct, but a feast makes it more humane.

Some people also experience shame when eating, which is very similar to sexual shame. From childhood, a child feels the great importance of food in life, this can provoke internal conflicts.

It is quite possible that it was the parents who provoked obesity. In response to any children's hysterics or discontent, mom and dad offered the baby food, this is how they showed love for their child. As a result, the child did not feel his independence and his own needs; all he had to do was eat in time.

Eating disorders and obesity mostly occur in those people who have a strong attachment and dependence on their mother. The woman in the family takes a leading position and forces everyone to obey. The mother cares too much about her child, does not respond to the father’s comments, the baby becomes passive and apathetic.

In such cases, patients feel their imperfection and vulnerability; they prefer to lead a passive lifestyle and eat away all their problems. Also, obese people think that the more they weigh, the more protection they provide themselves from the outside world. The psychosomatics of obesity can be short-term and long-term.

A person uses food to try to protect himself from negative emotions, his state of mind is unstable, he cannot accept himself at his weight, thereby only worsening the situation.

There are several most common causes of obesity:

• Frustration when the object of adoration is lost. Typically, women begin to suffer from obesity after the death of a spouse or separation from a permanent partner, or when their parents leave home. Usually, when a divorce or loss of a loved one occurs, a person is depressed, so his appetite increases greatly. Many children begin to actively eat food when a brother or sister is born.
• A person feels depressed and afraid, is very afraid of being alone and worries about this, sometimes without any reason. That is why he begins to eat food in huge quantities. This can also occur during periods of intense brain activity and overstrain, preparing for exams or passing a project. People start eating or smoking too much.

All these situations reveal food as a substitute for satisfaction. It is nutrition that strengthens self-confidence and a sense of security, helps to ease mental and physical pain, and disappointment.

From childhood, children remember that during illnesses they were given the best and most delicious things. Many people who are obese were addicted to food as children and had poor eating habits. As a result, they developed psychomatic illness and unconscious reactions.

Most obese patients consider it an important fact that they have always been overweight; since childhood, food has replaced pleasure for them. Parents suffer from this no less than their child, so the problem of obesity becomes a problem for the whole family.

Psychological illness here implies only oral satisfaction of human needs. Food replaces the lack of attention from family and friends and protects the child from depression. Children perceive food as self-affirmation; it helps get rid of excess stress and provides support to the mother.

Many obese individuals are highly dependent on their mother and are afraid of losing her. It is worth considering that about 80% of parents are also obese, which is why you might think that they are predisposed to becoming obese. In these cases, there are no manifestations of love and care; they are simply replaced by oral satisfaction. Adopted children are less likely to be obese than their parents.

The causes of obesity according to somatic data in children can be an overly caring or indifferent mother. Some parents allow their child everything; the father cannot say anything. Mothers believe that they give too little to their children, are alienated from them on an emotional level, and are tormented by feelings of guilt. That is why feeding becomes exclusively an expression of love for your child.

Psychotherapy

Typically, weight loss courses do not have a positive effect if an obese patient is not able to change his own emotional behavior. He feels that excess weight is vital for him. Therapy often does not produce any results, because the patient experiences real pleasure from eating. He strives on a psychological level to maintain his own weight, because this is easier than getting rid of psychological problems. During the diet, patients show symptoms of nervousness and irritation, quickly get tired and become depressed.

Reasons for the lack of treatment results in psychotherapy:

• a person does not feel sick, he is satisfied with everything on a subconscious level;
• the specialist cannot carefully analyze the patient’s behavior and motivations when treating behavioral disorders;
• a person cannot overcome sociological factors, he is simply not able to refuse to eat fatty foods with his family;
• patients refuse to follow the specialist’s instructions during behavioral therapy;
• some patients cannot understand what the doctor suggests, but are embarrassed to ask again and ask for additional explanations.

It is necessary to take an active part in therapeutic treatment. The psychotherapist should establish contact with the person. He must understand him and his motives. The specialist is also obliged to determine how the loss of his usual way of life affects the patient, and whether he suffers greatly from this. After this, an individual treatment plan is drawn up. The patient must learn to control his behavior.

Eating disorders

Obesity, anorexia and bulimia occur due to eating disorders. They should be given special attention in psychosomatics. A person may not even realize that he is sick, so specialists cannot always call somatic causes a disease. It is imperative to identify the psychological causes of unhealthy eating behavior in order to eliminate the psychosomatic disease.

Anorexia and bulimia are very well-known diseases, but few people think about the fact that a huge number of people dream of getting them. Anorexia and bulimia are psychosomatic disorders in which people experience a strong fear of being fat. Their energy depot is greatly weakened; people believe that if the soul suffers, then the body should not feel good.

With anorexia, a woman always considers herself too fat and completely refuses to eat. She may be very thin, but she doesn’t consider herself that way. Usually young girls suffer from this disease. Some end up dying, others instinctively start eating a lot and become fat.

Then they look at themselves in the mirror and are horrified. They induce a gag reflex in themselves in order to get rid of food in the body and dream of becoming thin again. This provokes bulimia. Signs of bulimia are that a person constantly wants to eat, he cannot control it, he eats in incredible quantities, as if the last crumb is about to be taken away from him.

The personality picture of an anorexic patient shows that the person generally refuses to eat. The common feature of these diseases is that a person’s image of his body is subject to distortion. Even if a person is very thin, he still thinks he is fat. A huge number of women suffering from anorexia and bulimia categorically refuse to consider themselves sick; they are sure that everything is fine with them. This is why they are very difficult to treat.

Women have a strong degree of denial. They can persistently prove for several years that they are absolutely healthy and look great, they just need to lose a little weight. People begin to constantly keep their weight under control; this is their main goal in life. In some cases, death occurs, but still women believe that in this way they can get rid of their problems.

Model of behavior that provokes psychomatic illnesses:

• unresolved emotional and psychological problems, inability to get out of a stressful situation;
• dislike of parents in childhood provokes rejection and non-compliance with standards;
• a tragic situation or loss of a loved one.

A person perceives the world through his own beliefs and beliefs. This is what affects your emotional state and physical health. If a person experiences negative experiences and emotions, then he becomes unsure of himself, his energy field is destroyed. A person believes that there is nothing to love him for, he cannot open up.

Bulimia shows a person’s inner fears, because he is afraid that he will not be able to keep his own life under control. A person loses his purpose in life and completely switches to his own body. He experiences satisfaction from eating, but then begins to reject and vomit.

Each person independently sets the boundaries of his own reality and controls his health. His beliefs and views on life, awareness of spirituality, all this affects the state of the body. Such diseases must be eliminated and a person’s internal problems must be solved through long work.

Psychosomatics of anorexia and bulimia

When a person sees a girl who is too thin, he thinks that she doesn’t eat anything. However, this is absolutely not true in most cases. The girl can eat a lot more than people can imagine, she just induces a gag reflex and suffers from bulimia.

Difference between anorexia and bulimia

Bulimia and anorexia are psychosomatic disorders in which eating behavior is disrupted. With anorexia, a person loses appetite and completely refuses to eat. The consequences of this can be severe and almost irreversible. First, a person strives to lose weight, goes on a diet, then reduces food intake, and subsequently the appetite completely disappears. Such individuals can also cause themselves to vomit, despite eating a tiny amount of food.

With bulimia, a person is unable to control his gluttony, but then forcibly rids the body of food. Such people do not always suffer from being overweight or underweight. Gluttony occurs due to psychological reasons and emotional stress. Patients pounce on food, swallow large pieces, and then feel a strong sense of guilt.

Psychosomatics of bulimia

What causes bulimia? Some psychological problems contribute to this:

1. Violation of family relationships. The mother cannot find a common language with her child, as a result he develops gluttony. Children eat too much, if they lack maternal attention, they consider themselves abandoned and unnecessary.
2. Psychological isolation of the child. He was sent to a camp or boarding school, the only source of joy is eating in huge quantities.
3. An adult experiences dissatisfaction with life, he is haunted by failures, interest in life decreases, and he begins to eat to get pleasure.

Psychosomatics of anorexia

Anorexia is a female disease. Usually girls begin to give up food in order to become beautiful, attractive and slim. However, many on a subconscious level strive for exactly this. To be loved and worshiped by men.

Anorexia usually occurs in those who have many unresolved psychological problems. The person did not feel enough love in childhood, he has a difficult relationship with his mother, he felt betrayed and unnecessary, inferior in society.

As a result, the woman decides to change her own appearance in order to change her life. Eating is tightly controlled and anorexia occurs.

Suggestive therapy

It is imperative to help patients with anorexia and bulimia, because almost all patients, without exception, do not understand that they are seriously ill. Most girls believe that they are infinitely happy in the form of a skin-covered skeleton and do not want to change anything.

Patients cannot realistically look at the situation and begin a normal life again. It often happens that a person has bulimia and anorexia at the same time.

Positive therapy

Anorexia and bulimia nervosa are the ability to consume minimal amounts of food and maintain world hunger.

Conflict situation

With psychosomatic fasting, it is necessary to judge not only the individual, but also the situation of the family as a whole. The starving person carries a symptom within himself; through his behavior he expresses all the suffering of his family, but no one says this out loud. If you judge a person from this point of view, you might think that the patient is the strongest among his family and friends. He puts his own life at risk to show family problems and unfair treatment.

Only truly strong individuals are able to almost completely refuse to eat and protest against normal behavior. They are able to control their body much better than others and not succumb to provocations. However, control also plays a bad joke on them. They break down, consume countless amounts of food, and then throw it out of themselves, suffering from remorse.

Basic problems

Typically, families in which there is a hungry person have a stable financial situation. Parents are serious about raising their children, forcing them to be impeccably polite and neat, obedient and religious individuals. All this is aimed at being no worse than others, and possibly better. In such families there is no place for tenderness and sensuality, it is not customary to show one’s love, and as a result, children lack the attention of their parents. They begin to feel worthless.

Conflict concepts

When children grow up in such families and become independent, they leave their parents' home and find themselves in an unusual situation. After all, in the world around us, everything is far from being as calm and joyful as they are used to thinking. As a result, psychosomatic deviations occur, people begin to protest against generally accepted norms and rules.

Therapy is carried out together with the family of a starving person, so that all relatives and friends reconsider their attitudes, life principles and concepts. Only in this case will it be possible to see a positive result. After all, a person first of all seeks, through fasting, to attract attention to himself or to show the real surrounding reality.

Those people who suffer from psychosomatic anorexia show that it is quite possible to exist in complete solitude and get by with too little. They also enjoy cooking for others while sharing in world hunger.

Fight for justice

Justice is a person’s ability to equally distribute his own interests and the interests of others. Every person has these feelings.

In therapy, many questions are asked about a person’s perception of fairness, whether he believes that life is unfair to him and for what reason.

Typically, sick people feel disadvantaged and unsure of themselves. The roots of this come from deep childhood; often a person does not even realize it without the help of a specialist.

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