Essstörungen werden im DSM-IV auf der sogenannten Achse I (Klinische Störungen, andere klinisch relevante Probleme) als eigene Gruppe „Essstörungen“ aufgeführt. Im ICD-10, Kapitel V, dem hier verbreiteten Kodierungsmanual psychischer Störungen, werden sie ebenfalls als eigenständige Untergruppe („F50 Eßstörungen“) unter der Rubrik „F5 Verhaltensauffälligkeiten in Verbindung mit körperlichen Störungen und Faktoren“ aufgeführt.
Im wesentlichen verteilen sich die Essstörungen auf die beiden bekannten Krankheitsbilder Magersucht (Anorexia nervosa) und Bulimie (Ess- /Brechsucht, Bulimia nervosa). Daneben werden Essstörungen aus bekannten körperlichen oder reaktiv-psychischen Gründen sowie Mischformen unterschieden.
Hilde Bruch (1973) beschrieb als gemeinsame Merkmale essgestörter Menschen die
- Störung des Körperbildes
- Wahrnehmungsstörungen nach innen und aussen sowie im Gefühlsbereich und
- ein tiefes Gefühl eigener Unzulänglichkeit.
Es ist unklar, ob die Magersucht in den letzten Jahren zugenommen hat (Habermas1994; Fichter 2000). Sicher ist aber das Bewußtsein für Essstörungen gewachsen, so wie auch die Bedeutung des Körpergewichtes und des Körperbildes in der Gesellschaft zugenommen hat. Deshalb stieg die Behandlungsinzidenz anorektischer und bulimischer Störungen.
Klinisch werden innehalb der übergeordneten Bezeichnung „Essstörung“ im wesentlichen drei Störungsbilder unterschieden, die Anorexie (Magersucht), die Bulimie (Ess-/Brechsucht) und die sogenannte Binge eating disorder (BED). Die beiden ersteren Störungen sind aber die bedeutsamsten, sie zeigen Übergänge und trotz Unterschieden in der Leitsymptomatik viele Gemeinsamkeiten in der vermuteten Entstehungsgeschichte inkl. genetischer Konstitutionen und den psychodynamischen Ursachen. Auch die körperlichen Komplikationen und Gefahren sind vergleichbar. Die Bulimie gilt aber als die insgesamt gutartigere, weniger dramatische und prognostisch ebenfalls etwas günstigere Störung.
Essstörungen sind nicht selten schwere psychische Störungen, sehr komplex und spiegeln komplizierte Wechselwirkungen konstituationeller, soziokultureller, psychodynamischer und somatischer Faktoren. Die Therapie folgt gewissen etablierten Grundstrategien, die neben der Vorbeugung bzw. Behebung von Komplikationen und der Remission der Störungssymptomatik auf eine Verbesserung sozialer Kompetenzen sowie eine verbesserte Selbstwahrnehmung im emotionale und im Körpererleben abzielen, weil Defizite in diesen Bereichen wesentlich für die Entstehung und Aufrechterhaltung der Störungen verantwortlich gemacht werden und am ehesten einer Therapie zugänglich sind. Die Behandlung ist oft langwierig und mit „Widerständen“ behaftet, deren Behebung viel therapeutisches Gespür, aber auch geeignete Strukturmerkmale in der Patientenpersönlichkeit und die nötige „Passung“ zwischen Therapeut und Patient voraussetzt. Im Endeffekt ergeben sich dann doch recht individuelle Therapieverläufe. Medikamente spielen in der Behandlung dieser Störungsgruppe eine eher untergeordnete Rolle. Zum Einsatz gelangen v.a. Antidepressiva. Bei der Behandlung der Anorexie zwingen die drohenden und z. T. lebensgefährlichen Komplikationen in der Regel zur Wahl eines interdisziplinären Behandlerteams, zwischenzeitliche stationäre oder sogar intensiivmedizinische Kriseninterventionen sind nicht selten.
Die Diagnostik der Störungen richtet sich im deutschsprachigen Raum nach den „diagnostischen Leitlinien“ der ICD-10, es gibt eine ganze Reihe von Störungen des Essverhaltens, die im Zusammenhang mit anderen psychischen oder körperlichen Erkrankungen auftreten können und von den eigentlichen Essstörungen abgegrenzt werden müssen.
Die Prognose ist sehr abhängig von der Stabilität der therapeutischen Beziehung, die wiederum von einer Vielzahl Faktoren abhängt. Therapiewiderstände von Seiten der PatientInnen sind aber verglichen mit anderen psychischen Störungen häufiger und führen nicht selten zum Therapieabbruch. Andere prognostisch relevante Faktoren sind körperliche Komplikationen und suizidale Handlungen, der Zeitpunkt des Krankheitsbeginns und der Zeitpunkt des Therapiebeginns. Gesamthaft gibt es eine große Variabilität der Therapieergebnisse von der spontanen Heilung nach einmaliger Episode bis hin zu jahrzehntelangen Verläufen, wobei die Mortalität mit zunehmender Verlaufsdauer ebenfalls ansteigt. Die Bulimie hat insgesamt die günstigere Prognose und führt seltener als die Anorexie zu schwerwiegenden körperlichen Komplikationen.
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