NEDA TOOLKIT for Parents
Symptoms Laboratory Findings
Anorexia nervosa generally starts gradually.
Losing weight can either be very rapid or very
slow. Generally the patients continue to go to
school; they go on with their hobbies and feel
great about themselves. Therefore, the families
are usually surprised to find that their child
suffers from malnutrition.
A screening questionnaire is helpful in the
assessment of patients with suspected eating
disorders (each positive answer gives one point;
two or more points suggest an eating disorder).
Do you try to vomit if you feel
unpleasantly satiated?
Are you anxious with the thought that
you cannot control the amount of food
you eat?
Have you lost more than 6 kg of weight
during the last 3 months?
Do you consider yourself obese although
others say you are underweight?
Does food/thinking of food dominate
your life?
Anorexic adolescents deny their symptoms, and it
takes time and patience to motivate them to
accept treatment.
Somatic symptoms include the following:
Disappearance of menstruation
The slowing of metabolism, constipation
Slow pulse, low blood pressure
Flushed and cold limbs
Reduction of subcutaneous fat
Bulimic adolescents are aware that their eating
habits are not normal, but the habit causes so
much guilt and shame that seeking treatment is
not easy.
Bulimia also causes physical symptoms, including
the following:
Disturbances of menstruation
Disturbances in electrolyte and acid-
alkali balances created by frequent
vomiting Damage to tooth enamel
In anorexia nervosa:
anemia Blood glucose levels on the lower border
of normal
In bulimia:
Hypokalemia Increased serum amylase
Differential Diagnosis
Severe somatic diseases, for example, brain
tumors Psychiatric diseases — severe depression,
psychosis, and drug use
Treatment If the symptoms correspond to the diagnostic
criteria of anorexia nervosa, the situation should
be discussed with the family before treatment is
arranged. The adolescent and his/her family should be made
aware of the seriousness of the disorder.
Sometimes it takes time to motivate the patient to
participate in the treatment.
The treatment is divided into:
Restoring the state of nutrition
Psychotherapeutic treatment
If the state of malnutrition is life threatening, the
patient is first treated in a somatic ward, and
thereafter the adolescent is guided into therapy if
possible. The forms of psychotherapy vary: both individual
and family therapy have brought results; in cases
of bulimia cognitive therapy and medication
(Lewandowski et al., 1997; Whittal, Agras, & Gould,
1999) [C] have been successful.
With adolescents between the ages of 14 and 16
years, positive results have been obtained by
treating the entire family. This is because the
adolescent’s symptoms are often connected with
difficulties to “cut loose” from the family.
With older patients, individual, supportive, and
long lasting treatment has been the best way to
promote recovery.
A prolonged state of malnutrition and insufficient
outpatient care are reasons to direct a patient into
forced treatment.
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