Zaburzenia odżywiania

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Zaburzenia odżywiania

Jadłowstręt psychiczny to celowa utrata masy ciała bądź utrzymanie jej na niskim poziomie. Objawy pojawiają się w okresie pokwitania i częściej dotyczą kobiet. Utrata wagi jest wynikiem prowokowania wymiotów, zażywania środków moczopędnych, wykonywania wyczerpujących ćwiczeń fizycznych. Do głównych przyczyn należy zaliczyć cechy osobowości, podłoże kulturowe, biologiczne oraz psychologiczne. Anorektyczne osoby mają zaburzony pogląd na temat własnej figury, uważają, że są za grube, mimo że waga wskazuje poniżej 15 % jednostek BMI. Skutkiem takiego stanu są zaburzenia hormonalne u kobiet w postaci braku menstruacji, a u mężczyzn w postaci obniżenia potencji. Jeśli do tego zaburzenia doszło przed okresem dorastania, to może dojść do chwilowego opóźnienia miesiączki, zatrzymania rozwoju piersi.

dietetykaMożemy wyróżnić dwa typy anoreksji:

  1. ograniczający – w którym nie dochodzi do utraty kontroli obżarstwa
  2. żarłoczno – wydalający – dochodzi to utraty kontroli nad ilością spożywanego pokarmu

Warto zastanowić się nad tym, jak funkcjonuje rodzina, gdzie któryś z członków rodziny doświadcza zaburzeń jedzenia. O anoreksji można mówić w kontekście idei poświęcenia się, czyli relacji małżeńskich rodziców. Bycie dobrym rodzicem przekłada się nad bliskość i więź małżeńską. Czynnikiem spajającym parę jest troska o dzieci i ich wychowanie. Troska i poczucie odpowiedzialności często dotyczy zdrowia i dobrego samopoczucia bliskich. Szczególnie matki są skłonne do poświęceń i rezygnacji na rzecz dzieci i rodziny. Jeśli w grę wchodzi sztywność pary małżeńskiej, to utrudnia to adaptację do zmian i rozwiązywania sytuacji konfliktowych. Częste relacje małżeńskie oparte są na głębokim rozczarowaniu, wzajemnej niechęci i obcości, przy zachowaniu zasady jedności.

Ta rodzina jest rodziną specyficzną. Znacznie częściej rodzina anorektyczna jest rodziną pełną, gdzie są duże wymagania. Chodzi tu o matkę nadopiekuńczą lub odwrotnie. 15 i mniej jednostek BMI to stan wyniszczenia – wtedy konieczna jest hospitalizacja. Wzorcem staje się matką, gdyż dziewczyna będzie się z nią utożsamiać.

Charakterystyczne cechy towarzyszące tej rodzinie to:

  • trzymanie uczuć na wodzy i pozostawanie ze wszystkimi w przyjaznych stosunkach
  • tłumienie uczuć niezadowolenia i przykrości
  • oczekiwanie osiągnięć
  • pilność, obowiązkowość
  • poczucie wstydu w przypadku zagrożenia norm otoczenia

Badania nad rodziną dotyczące kwestii separacyjnych prowadzone przez Humprey?a dowodzą, że córki był bardziej uległe w stosunku do rodziców, a ojcowie z kolei bardziej wycofani. Jeśli włączyli się w interakcje to najczęściej przejawiali postawy kontrolujące i obwiniające. Widoczny jest niski poziom pomagania i ochraniania oraz wzajemnego zaufania i zwracania się do siebie jak również radości ze wspólnych kontaktów. W takiej rodzinie jest więcej sprzecznych komunikatów, pojawia się pseudouczuciowość, czyli ignorowanie wysyłanych komunikatów córki dotyczących pomocy, wsparcia.

coffee-1159011__340Z nielicznych badań wynika, że przyczyn anoreksji należy doszukiwać się w czynnikach biologicznych. Mianowicie, chodzi tu o strukturę mózgu. Osoby dotknięte anoreksją posiadają w organizmie dużą ilość kortyzolu, który gromadzi energię, ale za to mniejszy poziom serotoniny i noradrenaliny, który wpływa na nasze samopoczucie. Sytuacje stresowe również pozostawiają piętno na naszym życiu. Zmiana miejsca zamieszkania, opuszczenie bliskich przyjaciół, zmiana szkoły, dojrzewanie również mają wpływ na przyczyny anoreksji. Oprócz tych biologicznych czynników istotną rolę odgrywają także aspekty psychologiczne oraz kulturowe. Jednakże do każdego pacjenta należy podejść indywidualnie. Dla młodzieży jest to okres poszukiwania sposobności na życie, decydowania o dalszej edukacji, kreowaniu własnej tożsamości oraz interesowania się sylwetką ciała. Takie osoby są bardzo podatne na działania zewnętrzne. Zaczynają doszukiwać się podobieństw w stosunku do swoich idoli zza telewizora bądź koleżanek/kolegów. Jest to wiek, w którym młodzież nie ma jeszcze w pełni rozwiniętego krytycyzmu, dlatego też podążają za trudno dostępnymi ideałami. Wiele badań wskazuje, iż takie cechy jak niewiara we własne możliwości, problemy z kształtowaniem własnej tożsamości, trudności z identyfikacją, podatność na wpływ innych, rozczarowania w stosunku do autorytetów, duże przywiązywanie uwagi do własnego ciała, własnej figury oraz przesadność w rozwiązywaniu problemów, przyczyniają się do zachorowalności na na anoreksję.

Wiele się słyszy o idealnej sylwetce, o dietach i ćwiczeniach na wysmuklenie ciała. Ten panujący trend przyczynia się do tego, że dziewczyny zaczynając od stosowania przeróżnych diet popadają w anoreksję, gdyż swoją sylwetkę zestawiają z tą wyidealizowaną przez społeczeństwo. Przez to kobiety są negatywnie nastawione na poszukiwania drugiej połówki, gdyż są zdania, iż mężczyźni wolą szczuplejsze kobiety. Mowa tu o dysmorfofobii, czyli błędnym spostrzeganiu własnego ciała. Formowanie własnej tożsamości odbywa się poprzez uświadomienie sobie własnego ciała, elementy wartościowania jak również uczestniczenie we wszelakich rolach społecznych. Poczucie ciała jest możliwe za pomocą odczuwania emocji, wyobrażeń dotyczących swojej cielesności oraz dwustronną wymianę informacji dotyczącą stanu organizmu ze strony pozostałych części ciała. Schemat ciała to nic innego jak nasze wyobrażenia o swoim ciele. Z kolei obraz ciała to, to jak spostrzegamy swoje ciało uwzględniając wygląd, emocje. Badania dowodzą, że anorektycy za bardzo skupiają się na swoim ciele przez co przeceniają jego wymiary. Zaczynają oceniać swoje ciało w momencie, kiedy zauważą przyrost wagi ciała.

Żarłoczność psychiczna to stopniowe napady objadania się i obsesja na punkcie kontroli własnego ciała. Metody jakie przyczyniają się do spadku wagi ciała to: prowokowanie wymiotów, zażywanie środków przeczyszczających, głodówki. Takie osoby obawiają się o przyrost wagi ciała. Może to powodować zaburzenia elektrolitowe oraz dolegliwości somatyczne w postaci padaczki, wycieńczenia oraz problemów z sercem.

horizontal-1155878__340Możemy wyróżnić dwa typy bulimii:

  1. nie przeczyszczający – stosowanie okresowych głodówek i ćwiczeń fizycznych
  2.  przeczyszczający – systematyczne prowokowanie wymiotów i/lub zażywania środków przeczyszczającyh lub moczopędnych

W rodzinie bulimicznej przeważnie rodzina jest niepełna. Maka nie pomaga, jest chłodna emocjonalnie, skupiona tylko na sobie i zajmuje się swoimi sprawami. Matka nie angażuje się w sprawy córki. Jeżeli jest ojciec to jest on nieingerujący, pojawiający się sporadycznie i jednokrotnie. Dla niego ważne jest jak sobie poradzić z tym problemem.

W tej rodzinie występują elementy, które zakłócają proces separacji – indywiduacji. Chodzi tu o rozmyte granice wewnętrzne, brak porządku i stabilnej struktury, poszukiwanie zaspokojenia potrzeb własnych głównie w rodzinie, sztywne granice zewnętrzne. Niezdrowe jest włączanie dziecka w konfliktową i burzliwą relację małżeńską.

Cechy charakterystyczne towarzyszące bulimicznej rodzinie:

  • trudność w rozwiązywaniu sytuacji konfliktowych – duże nasilenie konfliktów rodzinnych, impulsywność
  • trudność w komunikowaniu uczuć i zaburzenia rezonansu emocjonalnego
  • sprzeczności i tajemnice

     Z zaburzeniami odżywiania powiązany jest zespół kacheksji ? anoreksji. Jest to choroba wyniszczenia nowotworowego, na którą częściej zapadają osoby chore na nowotwory. Zespół kacheksji powoduje znaczne obniżenie masy ciała oraz zaniki mięśniowe.  Chory traci apetyt, przez co dochodzi do osłabienia organizmu, pogorszenia jakości życia oraz obniżenia nastroju.

Przyczyną powstawania kacheksji są zaburzenia metaboliczne i hormonalne. Chodzi tu o niedokrwistość oraz obniżenia zasobów energetycznych, które z kolei wywołują uczucie bezsilności, osłabienia, braku chęci, a to z kolei prowadzi do astenii.

Sprawdzonym sposobem zapobiegającym powstawaniu kacheksji jest przyjmowanie odpowiednich odżywek. Odżywki te zawierają składniki w postaci białek, węglowodanów i witamin. Są to preparaty płynne lub w postaci proszku.

Samo leczenie kacheksji jest dość problematyczne, gdyż najskuteczniejszym sposobem pozbycia się tego zespołu jest wyleczenie nowotworu. Co niestety nie we wszystkich przypadkach jest możliwe. Jednakże warto zwrócić uwagę na te elementy, które z pewnością przyczyniają się do poprawy jakości życia. Przede wszystkim odpowiednie żywienie. Pokarmy należy przyjmować drogą ustną. Warto mieć na względzie, aby przyjmowana dieta zawierała ulubione potrawy chorego, wtedy istnieje większa szansa, że chory skusi się na taki posiłek. W takiej sytuacji należy spożywać więcej posiłków rano oraz unikać ciężkostrawnych potraw. Skuteczna jest również farmakoterapia, w której stosuje się przede wszystkim leki mające na celu poprawę apetytu oraz samopoczucia.

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