Nach ICD-10:F5 – Verhaltensauffälligkeiten in Verbindung mit körperlichen Störungen und Faktoren:
- Anroexia nervosa (F50.0)
- Anorexie ohne aktive Maßnahmen zur Gewichtsabnahme (Ebrechen, Abführen etc.) (F50.00)
- Anorexie mit aktiven Maßnahmen zur Gewichtsabnahme (F50.01) –> dazu gehört auch die sogenannte „bulimische Form der Anorexie“, welche mit Heisshungerattacken einhergeht
- atypische Anorexia nervosa (F50.1)
- (bei Fehlen eines oder mehrerer wichtiger Merkmale trotz typischem Erscheinungsbild)
- Bulimia nervosa (F50.2)
- atypische bulimia nervosa (F50.3)
- (bei Fehlen eines oder mehrerer wichtiger Merkmale trotz typischem Erscheinungsbild)
- Essattacken bei sonstigen psychischen Störungen (F50.4)
- (z. B. übermäßiges Essen bei Kummer und Trauer oder nach anderen Belastungen)
- Erbrechen bei psychischen Störungen (F50.5)
- (z. B. bei dissoziativen Störungen, hypochondrischen Störungen, in der Schwangerschaft)
- sonstige Essstörungen (F50.8)
- (z. B. psychogener Appetitverlust, nicht-organische Pica-Krankheit)
- nicht näher bezeichnete Eßstörungen (F50.9)
Diagnostische Kriterien der einzelnen Krankheitsbilder nach ICD-10
Anorexia nervosa:
- es handelt sich um einen „absichtlich selbst herbeigeführten oder aufrechterhaltenen Gewichtsverlust“
- diagnostische Leitlinien (Symptomatik):
- tatsächliches Körpergewicht mindestens 15% unter dem erwarteten oder Quetelets-Index = Body Mass Index (BMI) (W (= Körpergewicht in Kilogramm) dividiert durch H (= Körpergröße in Metern) zum Quadrat, gültig ab dem 16. Lebensjahr
- selbst herbeigeführter Gewichtsverlust durch
- bewußt unterkalorische Ernährung
- selbstinduziertes Erbrechen
- selbstinduziertes Abführen
- übertriebene körperliche Aktivitäten
- Verwendung von Appetitzüglern und/oder Diuretika, Abführmittel etc..
- Vorliegen einer Körperschema-Störung mit einer überwertigen Angst, dick zu werden oder zu sein und einer im Vergleich erheblich reduzierten Gewichtsschwelle
- Vorliegen einer endokrinen Störung auf der Hypothalamus-Hypophysen-Keimdrüsen-Achse, die bei Frauen zum Ausbleiben der Regelblutung (Amenorrhoe) und bei Männern zu Störungen des sexuellen Verlangens (Libidoverlust) und der Potenz führt sowie zu Störungen des Schilddrüsenhormon- und des Insulin-Stoffwechsels
- bei Erkrankung vor der Pubertät kann es außerdem zur Verzögerung bzw. Hemmung der Geschlechtsreife und des Wachstums sowie zur mangelhaften Ausbildung der sekundären Geschlechtsmerkmale kommen. Diese Hemmung wächst sich nach Rückbildung der Eßstörung später meist aus.
- nach Hänsel (1995) finden sich bei Patienten mit anorektischem Fehlverhalten häufig folgende Persönlichkeitsmerkmale:
- zwanghafte Struktur
- Störungen in der Einschätzung der eigenen Befindlichkeit
- ausgeprägt angepaßtes Verhalten (Konformität)
- Angst vor emotionaler Nähe
Bulimia nervosa:
- kennzeichnend für diese Störung sind die wiederholt auftretenden „Anfälle von Heisshunger (Essattacken) und eine übertriebene Beschäftigung mit der Kontrolle des Körpergewichts“. Vor dem Stattgeben des Anfalls bestehen unerträgliche seelische Spannungen, die während des Freßanfalls dann kurzfristig nachlassen, um anschließend ausgeprägten Scham- und Schuldgefühlen Platz zu machen.
- diagnostische Leitlinien (Symptomatik):
- es besteht eine andauernde Beschäftigung mit der Nahrungsaufnahme, verbunden mit einer unwiderstehlichen Gier nach (hochkalorischen) Nahrungsmitteln, die Betroffene sich dann in Eßattacken in großer Menge und in sehr kurzer Zeit einverleiben
- (Anmerkung des Autors: Hänsel (1995) unterscheidet „4 verschiedene Arten von Überessen“:
„1. die hyperphage Reaktion, also vermehrtes Essen bei emotional-affektiven Spannungen
2. das impulsartige „Fressen“,
3. das phasenweise bzw. kontinuierliche Überessen,
4. das Übergehen von Sättigungs-Signalen nach normaen Mahlzeiten.
Das impulsartige, zwanghafte und suchtähnliche Überessen (Eß-Attacken mindestens 2 mal pro Woche und über einen Zeitraum von mindestens 3 Monaten!) gehört als wesentliches Symptom zum bulimischen Fehlverhalten.“ (in Faust 1995, S. 656))
- (Anmerkung des Autors: Hänsel (1995) unterscheidet „4 verschiedene Arten von Überessen“:
- gleichzeitig und/oder zeitversetzt werden aktive Gegenmaßnahmen unternommen, um den dickmachenden Effekt der zugeführten Nahrung zu neutralisieren (Fastenkuren, Erbrechen, Einnahme von Abführmitteln (Laxantien) oder Entwässerungsmitteln (Diuretika), Appetitzüglern, Schilddrüsenpräparaten. Diabetiker mit einer Eßstörung reduzieren oft die Dosis des Insulins und riskieren damit lebensgefährliche Blutzuckerentgleisungen!)
- es besteht eine Körperschema-Störung mit einer krankhaften Furcht, dick zu sein oder es zu werden, wobei das tatsächliche Gewicht und die tatsächliche Figur ganz offenbar falsch eingeschätzt wird.
- es besteht eine andauernde Beschäftigung mit der Nahrungsaufnahme, verbunden mit einer unwiderstehlichen Gier nach (hochkalorischen) Nahrungsmitteln, die Betroffene sich dann in Eßattacken in großer Menge und in sehr kurzer Zeit einverleiben
- Nach Hänsel (1995) sind bulimische Störungen häufig mit folgenden Persönlichkeitsmerkmalen assoziiert:
- Störungen der Impuls- und Affektkontrolle
- Störungen der Selbstwertregulation
Bezüglich der genauen „Differenzierung“ zwischen Anorexie und Bulimie muß man wohl davon ausgehen, daß es viele Gemeinsamkeiten zwischen beiden Störungsformen gibt und auch „Übergänge“ von der einen in die andere Form (z. B. nach einer frühen Magersucht die spätere Entwicklung einer Bulimie) sowie „Übergangsformen“ wie etwa die o. g. „bulimische Anorexie“. Die „Diagnose“ kann sich also im Störungsverlauf ändern.
Binge eating disorder (BED)
- es handelt sich um übermässige Nahrungsaufnahme (Hyperphagie) ohne gegenregulatorisches Verhalten außer ggl. Fasten und Diäten ( wichtigstes differentialdiagnostisches Kriterium gegen die Bulimie!) und entsprechender Gewichtszunahme (Adipositas).
- bis auf die fehlenden „gegenregulatorischen Maßnahmen“ (Erbrechen, Laxantien etc..) gleiche Symptomatik wie Bulimie
Orthorexie
Diese Störung ist in der ICD-10-Klassifikation (noch) nicht enthalten.
Die Untersuchung (körperliche Untersuchung, Erhebung der Krankengeschichte und des psychopathologischen Befundes) bei Essstörungen
Die Erhebung „Krankengeschichte“, muß neben der genauen Erforschung des Essverhaltens und der körperlichen (Folge-) Symptomatik auch die Erfragung der sozialen und familiären Beziehungen, der Konfliktlösungsstrategien und der Primärpersönlichkeit umfassen. Neben der psychiatrischen und psychotherapeutischen Untersuchung und Befundung müssen also auch internistische, laborchemische und ggf. weitere spezialärztliche (z. B. neurologische, endokrinologische, zahnärztliche etc..) Untersuchungen durchgeführt werden, eingangs und immer wieder im Therapieverlauf, um nicht gefährliche körperliche Folge- und Begleiterkrankungen zu übersehen. Insbesondere durch das selbstinduzierte Erbrechen und den Laxantien- und Diuretika-Abusus herbeigeführte Störungen im Elektroly- (Kalium) und Wasserhaushalt können in extremen Fällen zu lebensbedrohlichen Komplikationen mit Kammerflimmern (Herzstillstand) führen. Alle diese Störungen sind aber fakultativ und nicht pathognomonisch (zwingende Kennzeichen) für eine bestimmte Eßstörung!
Zur weiteren Befunderhebung stehen auch diverse Selbst- und Fremdbeurteilungsfragebögen zur Verfügung, auf die hier aber nicht weiter eingegangen wird.
Eine besondere Rolle zur Erfassung der Gewichtsabweichung wird der Body Mass Index (BMI) verwendet:
Körpergewicht in Kg
BMI = —————————————————————————
Körpergrösse in Quadratmetern
Der ermittelte BMI-Wert muß noch mit altersbezogenen erzentilwerten in Verbindung gesetzt werden, die entsprechenden Tabellen entnommen werden können.
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