Zusammenfassung
Bei der AN kommt es durch Einschränkung oder unzureichende Steigerung der Energieaufnahme (bei Wachstum/intensivem Sport) zur Enstehung oder Aufrechterhaltung eines Untergewichts. Das Körpergewicht liegt unter dem für Geschlecht, Größe und Alter zu erwartenden Gewicht. Betroffene haben trotz ihres Untergewichts Angst davor, zu dick zu sein und/oder zu dick zu werden. Es kann jedoch sein, dass diese Angst nicht berichtet bzw. nicht bewusst wahrgenommen wird. Der ganze Körper oder einzelne Körperteile werden trotz Untergewichts als „zu dick“ empfunden (Körperbildstörung). Das Selbstwerterleben ist bei den meisten Patientinnen in hohem Maße von Figur und Körpergewicht abhängig, bei anderen steht eine Kontrolle des Gewichts für ein Gelingen einer ausreichenden Selbstkontrolle.
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Notes
- 1.
Die 5. BMI-Alterspercentile entspricht bei einer knapp 18 Jahre alten Jugendlichen einem BMI von ca. 17,6 kg/m2. Bei einem 17,11 jährigen Mädchen (162 cm, 48 kg, BMI 18,3 kg/m2): nach Kromeyer-Hausschild (2001): 10. Perzentile, nach KIGGS (2011): 5. Perzentile. CDC: 11. Perzentile.
- 2.
Heritabilität ist ein Maß für die Erblichkeit von Eigenschaften.
- 3.
CT= kognitive Therapie; COT = kognitiv orientierte Therapie („cognitive orientation treatment“); BT = behaviorale Therapie; EBT= edukativ-behaviorale Behandlung („educational behavioral treatment“).
- 4.
TAU-O beinhaltete eine intensive diagnostische Abklärung am Essstörungszentrum, Motivation und Unterstützung bei der Suche nach einer ambulanten Psychotherapie, regelmäßiges hausärztliches Monitoring sowie 4 intensive Folge- und Nachuntersuchungen am Zentrum.
- 5.
IPT = interpersonelle Therapie.
- 6.
Hierbei sollten nicht nur der aktuelle BMI, sondern auch das Ausmaß der Mangelernährung sowie das Ausmaß und die Geschwindigkeit der Gewichtsabnahme in den letzten Monaten berücksichtigt werden.
- 7.
Geschmacksstörung.
- 8.
Dieser umfasst im Erwachsenenbereich – wenn nicht aufgrund der körperlichen Gefährdung eine integrierte klinisch-psychomatisch-psychotherapeutische Komplexbehandlung (OPS 9-642) oder Intensivbehandlung (OPS 9-61) erforderlich ist – eine therapiezielorientierte Behandlung durch ein multiprofessionelles Team (Ärzte, Psychologen, Spezialtherapeuten/Sozialarbeiter, Pflegefachpersonen) mit wöchentlicher Teambesprechung und einer Mindestanzahl von 3 Therapieeinheiten von durch Ärzte und Psychologen durchgeführten Einzel- und Gruppentherapien, sowie wöchentliche fachärztliche Visiten (psychosomatisch-psychotherapeutische Komplexbehandlung, OPS 9-63).
Im Kinder- und Jugendlichenbereich beinhaltet OPS als Regelbehandlung bei psychischen und psychosomatischen Störungen und Verhaltensstörungen bei Kindern (OPS 9-656) und Jugendlichen (OPS 9-666) oder bei drohender somatischer Dekompensation als Intensivbehandlung (OPS 9-672) eine therapiezielorientierte Behandlung durch ein multiprofessionelles Team (Ärzte, Psychologen/Kinder- und Jugendlichenpsychotherapeuten, Spezialtherapeuten, pädagogisch-pflegerische Fachpersonen) mit wöchentlicher Visite und Teambesprechung und Therapieeinheiten in Form von ärztlich und psychologisch durchgeführten Einzel- und Gruppengesprächen und –therapien mit den Kindern und Jugendlichen sowie deren Eltern/Familie und/oder Bezugspersonen aus dem Herkunftsmilieu.
- 9.
Anmerkung: Chronifizierte Patientinnen, bei denen die Zielsetzung mehr auf Verbesserung von Lebensqualität und sozialer Einbindung liegt als auf einer Heilung der Anorexia nervosa, profitieren auch von tagesklinischen Behandlung und einer geringeren Therapiedosis.
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Zeeck, A. et al. (2019). Anorexia nervosa. In: Herpertz, S., et al. S3-Leitlinie Diagnostik und Behandlung der Essstörungen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59606-7_4
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