Dergi Ara >>
Yıl:2007; Cilt: 1; Sayı: 1>> Özet
TAM METİN
Psikiyatride Derlemeler, Olgular ve Varsayımlar (RCHP); 2007;1(1):21-28
Yeme Bozuklukları
F Maner
Bakırköy Ruh ve Sınır Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Yeme bozuklukları son 40 yıldır giderek ilgi çeken psikiyatri konuları arasındadır. Anoreksiya nervoza,
vücut ağırlığının sağlıklı normların yüzde 85’inin altına düşmesine yol açacak kilo kaybı, büyüme
devam ederken uygun ağırlığa erişmeyi reddetme, kilo almaktan ve zayıf olmasına rağmen şişmanlamaktan
yoğun korku, beden imgesinde, beden biçimini algılamakta bozukluk ve kadınlarda üç
ardışık menstruel siklusun kaybı ile belirgindir.
Bulimiya nervoza, yineleyen tıkınırcasına yeme epizodları, tıkınma sırasında yemeyi kontrol edememe
duygusu, kilo almayı önlemek için uygunsuz dengeleyici davranışlar (örneğin kusma, laksatif, diüretik
kullanımı, aşırı diyet yapma, oruç tutma, yoğun egzersiz), beden ağırlığı ve biçimi ile sürekli zihinsel
uğraşı ve 3 ay içinde haftada ortalama 2 tıkınma epizodu ile belirgindir.
Başka türlü adlandırılamayan yeme bozukluğu ise bu iki bozukluğun tanı ölçütlerini tam karşılamayan
durumlar için kullanılır. Bu kategorideki tıkınırcasına yeme bozukluğu, daha yaşlı kişilerde ortaya
çıkmakta, kadın erkek oranı eşit olmakta ve obez kişilerin yüzde 4’ünde saptanmaktadır.
Ülkemizde 14-19 yaş arası kız öğrencilerde bulimiya yüzde 4.3, anoreksiya yüzde 0.3 bulunmuştur.
Yeme bozukluklarının biyolojik yatkınlık, psikolojik predispozisyon ve sosyal etkilerin bileşimi sonucu
oluştuğu düşünülür. Otuz yıllık takipte bu oran %25 bulunmuştur.
En sık olarak majör depresyon, anksiyete bozuklukları (obsesif kompulsif bozukluk, özgül fobiler,
agorafobi), kişilik bozukluğu (sınır kişilik bozukluğu) görülür. Bulimiya, alkol ve madde kullanım
bozukluğu için yüksek risk oluşturur.
Tedavi 3 aşamada olur:
1- Hastanın beslenme durumunun düzenlenmesi
2- Hastanın bozulmuş yeme davranışlarının değişmesi.
3- Kilo kaybının yararları konusunda hastaların hatalı inanışlarının değiştirilmesi
Anoreksiya ve bulimiya nervozada psikoterapi olarak davranışın değiştirilmesine yönelik davranış
terapisi, bireysel psikoterapi ve grup psikoterapileri uygulanır.
Eating Disorders
Eating disorders have been of great interest for the last 40 [year]s. Anorexia nervosa is a disorder characterized by symptoms such as refusing to maintain body weight at or above a minimal normal weight for age and height, intense fear of gaming weight though underweight, disturbance in body image and amenorrhea. Bulimia nervosa is characterized by recurrent episodes of binge eating, a sense of lack of control over eating during the episode, recurrent inappropriate compensatory behavior in order to prevent weight gain, such as- self-induced- vomiting, misuse of laxatives, diuretics, fasting and excessive exercise. Binge eating and inappropriate compensatory behaviors occur at least twice a week for 3 [month]s.- The term eating disorders, if not otherwise specified, is used for eating disorders that do not meet the criteria for any specific eating disorder.Binge eating disorder is classified in this category. The prevalance of bulimia and anorexia-is 4,3 % and 0,3 %, respectively. Biological vulnerability, psychological predisposition and social influences are the main factors in the etiology of eating disorders.
The mortality rates are 25 % in 30- [year] follow-ups. Major depression, anxiety disorders, personality disorders and alcohol and substance use disorders are the most frequently seen comorbidities. Regulation of nutrition, modification of disturbed eating behavior, changing distorted assumptions about the benefits of weight loss are the main principles in treatment. Cognitive behavioral therapy, individual therapy, group psychotherapy, family therapy and medical therapy have been beneficial in eating disorders.

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