Anorexia, known as eating disorder, occurs mostly during adolescence and is 20 times more common in women than in men. According to experts who state that anorexia neurosis is the disease that causes the most deaths after suicide among psychiatric diseases, the basis of the disease is the problematic attachment problem that the person experienced with his mother between the ages of 3-6.
Üsküdar University NPISTANBUL Hospital Psychiatry Specialist Mahir Yeşildal said that anorexia, an eating disorder, occurs mostly during adolescence and is more common in women.
Stating that anorexia has three main features, Yeşildal stated that the first of these is that the disease is more common in adolescence and in women.
Narcissistic investment in the body
Stating that the basis of this condition is the problematic attachment problem experienced with the mother in childhood, Yeşildal said:
"Generally, this disease starts during adolescence. The most common age of the disease is between 12 and 25-30 years old. The reason for this may be biological reasons, but basically, the inability to cope with the problems and conflicts that the person has experienced with his/her mother because he/she does not have healthy defense mechanisms and makes a narcissistic investment in his/her body due to this, that is, he/she tries to perfect his/her own body. This is basically due to the problem in the relationship with the mother in childhood, especially between the ages of 3-6, especially the attachment problem. Because this disease is more common in western society. For the mother, the daughter is more valuable. She tries to live her dreams, hopes and disappointments through her daughter. As individualization increases in Turkey, as the sociological structure of the society changes, we see that mother-daughter attachment patterns turn into a western-type relationship, and we see that anorexia cases increase accordingly."
Body Mass Index decreases by 15
Mahir Yeşildal stated that the second feature of anorexia is that the patient's Body Mass Index decreases by 15 percent, and noted that these people are usually overweight or slightly overweight before the disease. Noting that the patient still sees himself as overweight despite losing weight, Yeşildal said, "Assuming that the lower limit of the Body Mass Index is 20, it decreases by 15%. It falls below 16-17. Despite this, the patient has an appetite, not like in depression, this patient is constantly interested in food. These patients are constantly reading recipes, hiding food in various parts of the house. They want to set the table themselves, but they do not eat because of anxiety and fear of gaining weight."
She still sees herself overweight
Stating that the third feature of the disease is that the patient still sees himself as overweight despite losing a lot of weight, Mahir Yeşildal said, "He claims that he is overweight and is not convinced of this despite being shown otherwise. He is not at peace with his own body."
Stating that there is no definite information that there is a genetic factor at the basis of anorexia, Mahir Yeşildal said, "A gene linked to anorexia has not been found. However, if there is a mother, father or aunt in the family who is anorexic or bulimic, that is, someone with an eating disorder, the likelihood of an eating disorder, anorexia neurosis, is high in these children. Also, people who are in front of the public, such as models, singers or presenters, and who have to earn money with their bodies, are more concerned about protecting their image. These people are at great risk, and when this disease first appeared, it was defined as model's disease."
The disease that leads to the most deaths
Stating that anorexia neurosis is the disease that causes the highest number of deaths among psychiatric diseases except suicide, Dr. Mahir Yeşildal said, "The disease itself can cause death. Because when the patient does not eat or drink, anemia and heart rhythm disorders may occur due to weight loss. Fat and cholesterol ratios in the blood can change, the metabolic structure can be turned upside down. The amount of substances such as sodium, potassium and calcium decreases. When calcium decreases, the bone tries to compensate. Bone resorption occurs, and when the amount of sodium decreases, especially when potassium decreases, the kidneys can fail. Serious kidney failure can occur. We see hypothermia, i.e. a drop in body temperature, very frequently in these patients. In general, constipation due to malnutrition is very common. Hair loss, decrease in hair, skin deforms quickly," he said.
Stating that there are two subtypes of anorexia, Mahir Yeşildal said, "The first is restricted eating, that is, there is appetite but not eating. The second is binge eating, which is a little different from bulimia. There is an eating attack, but he uses laxatives, diuretics or very intense exercise. Half of the patients with anorexia may also have bulimic attacks, that is, they may vomit after binge eating. This can also be seen in anorexia, so the distinction between the two diseases is not very clear."
The rate is high in children of divorced families
Stating that the incidence of anorexia in children of divorced parents is high, Mahir Yeşildal said, "When parents divorce, especially when the child is young, and if this divorce is a traumatic divorce, the risk of anorexia increases in these children. Even if they do not have any problems during childhood, the separation, divorce and any problem in their work life play a facilitating role for the emergence of anorexia."
Professional support should be sought
Stating that the first thing to do for a person suspected of having anorexia is to get professional support, Dr. Mahir Yeşildal said, "This person is losing weight but is still on a diet. Professional support should be sought without delay. There are various stages of treatment here. If the Body Mass Index has fallen seriously below 15, then the metabolic picture of the patient needs to be corrected by hospitalization, hospitalization in a general internal medicine ward or intensive care ward. Anorexia can become fatal if left untreated. However, patients here are very sensitive about weight, so psychiatric support must be provided. These patients refuse to eat orally and are fed intravenously with the legal consent of the family. We see these patients moving around in the ward non-stop, trying to get their calories as soon as possible and going to the toilet and urinating very often. Then they immediately come and weigh themselves and want to see their weight drop. For this reason, it is absolutely necessary to act jointly with psychiatry."
Drawing attention to the psychiatric symptoms of anorexia, Dr. Mahir Yeşildal said, "Depression is the most important of these. Low self-esteem, a serious decrease in self-confidence, an increase in obsessive pursuits. It is necessary to treat the underlying depression of an anorexic patient who is depressed."
Individual psychotherapies are effective
Stating that they benefit from therapies as well as drug treatments in the treatment of anorexia, Yeşildal said, "Individual psychotherapies can be seriously useful in anorexia. We try to help the patient gain insight by applying motivational interviewing techniques with individual supportive and especially cognitive behavioral therapy methods. In the meantime, there may be various medication treatments. Depending on the accompanying psychiatric illness, treatment alternatives ranging from magnetic stimulation therapy to electroshock therapy are possible. It is absolutely necessary for the relatives of the patient to undergo psychoeducation about anorexia and for them to be aware of this disease."
Overprotection prevents the child from becoming independent
Expressing that the most important mistake made while raising children is wrong attachment styles, Yeşildal said, "Mothers who are overly obsessive or controlling perfectionists prevent their children from separating and becoming independent. For example, they do not allow them to fall while walking, they are constantly chasing after them, whereas a human baby falls an average of a thousand times until it learns to walk. But today, these obsessive perfectionist mothers or mothers with serious anxiety problems are constantly trying to protect their children. For example, the child falls while trying to climb on the couch, the mother immediately takes the child up on the couch herself so that the child does not experience that pain, so that the child does not have that feeling of separation from the mother and becoming completely independent and individual. This is the most important mistake mothers make. They see their children as an extension of themselves, as a part of themselves, whereas we don't own the children. We have to accept that those children will be different from our world view, our way of life and our personality structure. Unfortunately, this is one of the biggest mistakes that mothers and fathers make today. They want their own thoughts and dreams to be realized by their children. This is unfortunately the biggest obstacle to individualization."
We cannot raise our children as a project
Stating that the most basic thing a mother and father can give to a child is a peaceful home, Mahir Yeşildal said:
"We are too hard on our children. We send them to piano courses, swimming courses, language courses. We send them to school from the age of 2-3. We don't give the child any opportunity for self-realization. The main thing a parent should do is to facilitate their child's life, not to determine their child's life. We make it easier, and whatever the child has the desire for, whatever the child is capable of, the child will progress in that direction. If he wants to be a painter, he can be a painter, if he wants to be a bus driver, he can be a driver. What we need to do is to provide a peaceful family structure. To establish a peaceful home that will enable the child to come running home when they leave school. Other than that, the property we leave to him/her is meaningless. The relationship the child establishes with his/her parents determines the relationship he/she will establish with men and women later in life. It determines his relationship with authority. He learns what to do when he becomes a manager through his relationship with his father. A girl learns from her father how she should relate to men. Don't think of this as a sexist process, but if there is peace in the home, you don't need to give additional individuals to the child. You don't need to be rich for this either. Children should not be turned into project children."