Anorexia

ANOREXIA (from Greek a- negative prefix, and orexis-appetite), absence of appetite, complete loss of desire to take food. Three forms of A. are distinguished: 1) A. as one of the symptoms of organic disease of the stomach, oral cavity, or nasopharynx (catarrh, cancer, stomatitis, adenoids, etc.); 2) A. on the basis of general intoxication (tuberculosis, Basedow's disease, anemia, etc.) and 3) A. either as a manifestation of general neurasthenia or in the form of a monosymptomatic neurosis (A. nervosa). A. is the result of inhibition of a whole series of psychomotor and visceral reflexes, as a result of which the organism loses the ability to feel the physiological sensation of hunger. In psychiatry, as a special form, mental A. is described, a disorder of drive, or even aversion to food, observed in mental diseases with suppressed sensory tone (so-called depressive states), as well as in hysteria, in which A. may be a symbolic manifestation of a hidden subconscious experience. Mental A. should be distinguished from refusal of food caused by delusional ideas and hallucinations (delusions of poisoning, disgusting smell, etc.). Contrary to the view of older authors, in A. gastric secretion is far from always decreased, but may be normal and even increased. The most serious consequence of A. is general malnutrition, simulating severe organic suffering (catarrh, cancer), especially when accompanied by achylia. Differential diagnosis must exclude catarrh and cancer of the stomach, anemia, initial stage of tuberculosis, cyclothymia. - Treatment should eliminate the etiological factor (intoxication, chlorosis, catarrh, and above all-psychic trauma). Instead of the formerly favored bitter tonics (amara), general stimulation (regimen, arsenic, nervina) and psychotherapy are preferable.

M. Pevzner, S. Tsetlin. Anorexia in children manifests as absence of appetite, refusal to eat. The most frequent complaint of mothers that their children eat poorly by no means indicates true A., absence of desire to eat in the child. Any disease of the oral cavity (such as stomatitis, angina, sometimes-geographic tongue), causing painful sensations and probably distortion of taste, can interfere with the child's eating. Replacing sharp or irritating food (temporarily) with semi-liquid, coating food often corrects the situation. More often A. is simulated by various irregularities in the child's dietary regime, of which the most common are: too prolonged one-sided feeding with liquid food, most often milk, or too concentrated food (especially given in the morning), such as porridge, cream, eggs, much butter; the favorite of many mothers, fictitious or real 'especially nutritious' foods, possessing the ability to suppress the normal sensation of hunger (cocoa, chocolate, yolks, grated with sugar); finally, irregularities in the feeding schedule (short or long intervals, late dinner, quenching the child's thirst with milk, disorderly feeding with bread, sweets). When analyzing the caloric value of all food actually consumed by such children, it often turns out that they not only do not hunger, but often receive some excess. One must also take into account the greatly fluctuating individual food requirements of different children. True A., unwillingness to eat, occurs with different frequency and has different characteristics at various ages. In infants it is generally less common and usually accompanies some acute illness, most often-influenza, measles, pyelitis. The main concern of the physician in these conditions is to ensure adequate fluid intake to prevent dehydration of the child's tissues; feeding should be frequent, from a spoon, with expressed breast milk, the caloric value of which is increased by adding sugar, cottage cheese, or concentrated mixtures. More prolonged A. in older infants is often the result of one-sided food composition (much milk, flour carbohydrates) and is accompanied by clear signs of dystrophy. The struggle with A. here reduces to treating dystrophy; some benefit is sometimes obtained from abundant vitamin introduction; in severe cases-feeding through a tube.-One should also mention the rarely occurring periodic A. in infants, which serves as the first early sign of idiocy. - In early childhood (from 1 to 3 years), when transitioning to food varied in taste and consistency, the greatest difficulties with eating occur even in healthy children. The best prevention is early accustoming of the infant to diverse taste sensations (broths, purees, various kissels), to chewing bread, reduction of milk quantity, and above all-correct alternation between feedings, without excessive frequency, with the aim of creating natural reflex automatism in the functions of the digestive tract. Another category of A. of this age is represented by rachitic children with weak development of static functions, sluggishly reacting to their surroundings. Along with the usual treatment of rickets here measures must be taken to enrich the child's psyche with external impressions (staying among other children, mobility). The most severe group of A. of early childhood is A. of neurotics. Usually these are children physically and mentally excessively active, pale, thin; almost all of them eat unwillingly, especially new dishes, refuse to chew solid food and easily react to coercion with habitual vomiting. They sometimes show prolonged weight stagnation, but their general activity and greed with which they sometimes eat one particular dish clearly indicate the psychogenic nature of their anorexia. The struggle with this form is extremely difficult, as in them inhibitory conditioned reflexes form particularly easily. In mild cases some result can often be obtained if for several days the child is not fed at all, caring only for adequate drinking; hunger eventually forces him to ask for food, which is now given to him, gradually increasing the dose, initially not to full satisfaction of need. Sometimes rare feedings with concentrated food are prescribed; sometimes, on the contrary-more frequent feedings, at the same time caring for general measures to strengthen the organism (walks, hydroprocedures), for sleep and for correct pedagogy (diverting attention from food, calm environment, company of children). More than anywhere else, individualization, rejection of stereotypes is needed here.-Much in common with A. of neurotics is also A. of only children in the family, pampered and spoiled, 'artificial neurotics'. The best treatment here is placing the child in a kindergarten, subjecting him to the will of a healthy children's collective or an outsider.- In older children mainly two forms of A. are encountered; these are A. in chronic infections (tuberculosis, malaria) and A. of schoolchildren. The first requires, besides treatment of the primary disease, systematic application of the above-mentioned methods and frequent feeding of small portions of concentrated food; A. of schoolchildren is caused by disproportion between the intensified demands made on the schoolchild's organism and still insufficient readiness during the period of strong growth. Treatment of this form of A.: regulation of regimen, especially school, hot breakfasts, exercise; sometimes arsenic and iron are used.-Medicines in the treatment of A. bring little benefit; stomachica are sometimes indicated in convalescents, pepsin and hydrochloric acid-in dystrophic conditions, cod liver oil and iron-in rickets, sedatives-in neurotics. Hysterical A. is treated, with greater success, by verbal suggestion and change of environment.