2023-12-02 18:14:05
by Ruggiero Corcella
Laura Dalla Ragione, director of the Eating Disorder network of the Local Health Authority 1 of Umbria, Biomedical Campus of Rome and representative of the Ministry of Health, invites the families of those affected to never place themselves in a judgmental or aggressive position
Nutrition and eating disorders (DNA) today constitute one of the most worrying pathologies in the Western hemisphere: they are spreading with remarkable rapidity, they are affecting increasingly larger segments of the population in terms of demographic and socio-demographic characteristics, and they are taking on increasingly diversified and serious forms and characteristics.
It fits into this overall picture, the tragic story of Emanuela Perinetti34, years old, influencer and manager in the world of sport and daughter of Giorgio Perinetti, historic sporting director of Roma who is now responsible for the technical area of Avellino Calcio, died November 29 following the worsening of anorexia, a disease she had been fighting against for some time. We asked Laura Dalla Ragione, director of the DCA USl 1 network of Umbria, Biomedical Campus of Rome and representative of the Ministry of Health, to help us understand what lies behind the different manifestations of a condition that is never a whim but an illness to all effects.
What is anorexia
«Anorexia is a psychiatric pathology, included in the Diagnostic Manual of Mental Diseases (DSMV) and is characterized by a series of behaviors aimed at weight loss and achieving an ideal weight which is often incompatible with life. The pathological core, however, is made up of an intense obsession with body shapes, with an alteration of the body image, so people always see themselves as fat even if they are seriously underweight. A sort of bodily hallucination, with alteration of the visual area of the brain – today it is demonstrated by many brain imaging studies – which show us how in a certain sense the brain of the patient suffering from anorexia is “blind” to the reality of the body”.
Other eating disorders
What are the other eating disorders (bulimia nervosa and binge eating disorder) and how do they differ from each other? «In reality there is a common thread that links all these pathologies, and it is the intense fear of gaining weight and at the same time the great fear of living. It is no coincidence that patients can go through all three pathologies, perhaps starting with an anorexic pathology and then evolving towards bulimia, which is characterized by large binges with methods of compensation (self-induced vomiting, laxatives, diuretics, hyperactivity) and can lead to extreme thinness. The symptoms of uncontrolled eating disorder (binge eating), a widespread pathology, at the moment are large binges (ingestion of 3,000 to 30,000 calories in a very short time) without methods of compensation, so in this case the patients increase greatly in weight.
The risk factors
Are there risk factors? «Let’s start by saying that in reality these are new forms of depression, illnesses of the soul, so the motive is always internal, even if what you see refers to the body. There is a very strong internal suffering, an unsustainable fear of living. The risk factors can be some temperamental traits (clinical perfectionism), trauma often leads to the onset of the disorder, bullying episodes present in many patients. It is very likely, given the widespread diffusion, that there are also predisposing genetic and epigenetic factors. There is no doubt that cultural factors, social pressure, on the model of perfection and thinness as an absolute factor, especially with the advent of social media, play an important role. But it is important to underline that cultural factors are factors of diffusion but not causes of the phenomenon.”
When it can occur
What is the age of onset? «Currently the age of onset has dropped significantly, and we have pre-pubescent girls and boys aged 8 to 12, who currently make up 30% of the affected population. This phenomenon has intensified especially during Covid. It is obvious that such an early onset of the pathology presents more serious conditions both for the clinical consequences of malnutrition and for the psychiatric ones.”
A phenomenon that is mostly “feminine” (but not only)
Is there a different incidence between males and females?
«Until ten years ago, males were almost immune to eating disorders. Today, anorexia and bulimia make up 20% of the affected population, and the trend is increasing. In Binge Eating Disorder the percentage is even higher, around 40%. Probably in 10 years it will no longer be a gender disorder.”
In Italy, DNA affects 3 million 400 thousand people
What is the size of the phenomenon in Italy?
«In the latest survey by the Ministry of Health as of 2022 there are 3 million 400,000 people in Italy affected by these pathologies, spread evenly throughout the national territory. Anorexia is not the prevalent pathology, but constitutes 30% of the affected population, 70% is made up of bulimia and binge eating disorder. Let’s say that at this moment pathologies linked to the dis-control of impulses rather than hyper-control are prevalent. An important point is that while the spread of eating disorders is homogeneous throughout the national territory, the mortality data is very different between regions, i.e. more people die where there are no specialized structures”.
The alarm bells
What are the signs to look out for?
«We certainly have to pay attention to the signs relating to nutrition that persist over time (such as eliminating large categories of food, restricting food, doing a lot of physical activity, going to the bathroom immediately after meals) but alongside these behaviors we are witnessing a noticeable change in character, boys and girls who were brilliant, cheerful, full of desire to live fade away, become sad, withdrawn, introverted. Here are the two things that should make us suspect that something is happening.”
The vigor
The eating disorder gives you unexpected strength. On the outside you seem very fragile, but on the inside you find incredible strength: is that right?
«Patients with DNA are totally unaware of having a pathology and therefore a mechanism of omnipotence is triggered, determined by the sensation of being able to dominate such a powerful biological instinct, such as that of appetite. In the first phase this sensation is almost euphoric, it is described as “the honeymoon of illness”, but then it transforms into a very serious depressive situation.”
How to deal with the problem in the family
Parents are often confused: they don’t understand what’s happening and they blame themselves: how can we deal with the problem in the family with those who suffer from it? What words should and should not be used?
«The family is deeply involved in food pathology. But since the 70s, a time when the family was blamed a lot, it has come to be considered a resource in the therapeutic process. First of all because the theories that saw the family as the main culprit have been abandoned, precisely because food pathology has a multifactorial etiology, where the family is one of the elements to take into consideration, but not the only one. Family members must understand, first of all, that the pathology is not a whim, a trend, but a great suffering of their son/daughter without placing themselves in a judgmental and aggressive position. The main thing is that they must slowly convince the patient to seek treatment, accompanying him to the specialized center closest to home.”
Who to ask for help
Who to contact? In Italy there is a network of centers for eating disorders: how do you access it?
«It is very important to get treatment early, which must be specialized and multidisciplinary: early diagnosis and continuity of care are the guarantee of a complete recovery. The Presidency of the Council has made available a national toll-free number 800180969 active from Monday to Friday which provides information on the centers closest to home and provides support to parents, patients and teachers. The latest census in 2023 from the Istituto Superiore di Sanità, available on the ISS website piattaformadisturbialimentari.iss.it, it counted 126 structures spread across the entire national territory, of which 112 were public and 14 belonging to the accredited private sector. The largest number of centers (63 out of 126) is located in the Northern regions, 23 are in the central regions (of which 8 in Lazio and 6 in Umbria), while 40 are distributed between the South and the Islands (12 in Campania and 7 in Sicily)”.
An assistance network present in only half of the regions
Are sufficient?
«In reality, half of the Italian regions do not have a complete assistance network and this causes difficulties for many people both in the diagnosis and in the therapeutic process. Many patients are forced into healthcare migration with serious difficulties and economic costs for patients and their families. The active centers often have long waiting lists. But above all, only 48% of the responding centers declared that they take care of minors up to 14 years old, and this, given the increase in the range between 8-12 years old, has become a great emergency.”
We need an alliance between family, school and friends
What advice do you feel you can give to a person suffering from these disorders and what advice to their family?
«The important message is that these pathologies can be cured, but at the first clinical and psychological signs it is necessary to contact specialized centers, even if it is not always easy to convince the patient to accept treatment. In reality it is an insidious pathology where apparently the scholastic and social functioning seems to be perfect, but inside a sort of serious and profound depression develops. Unfortunately, a spontaneous remission of the pathology is not described, if it is not treated it tends to worsen, therefore the entire family, school, sporting and friendship context must team up to convince the patient to accept help”.
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December 2, 2023 (modified December 2, 2023 | 5:10 pm)
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