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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. Page | 33