From the author: Despite the fact that the article is devoted to a specific psychosomatic disorder, it can be found in it a description of one of the mechanisms for the development of a psychosomatic symptom as such. Using the example of anorexia nervosa, such concepts as “communication function of the disease" and "carriage of a symptom", and also considers one of the models of the disease, in which the patient, with the help of a symptom, tries to resolve hidden family conflicts. A mother persuades her daughter: - You need to eat all the soup. You know what girls turn into when they don't eat. - I know. In fashion models. (Anecdote from the people). In an era of rapid change, everything changes extremely quickly. And only the standards of beauty remain unchanged: translucent girls still look at us from the pages of glossy magazines, and even the increasingly frequent Internet reports about the notorious results of women’s desire for an imposed ideal are not able to change the established state of affairs. What is the danger of anorexia nervosa? Everyone knows that anorexia nervosa (mental) is a disorder in which the main features are persistent active refusal to eat and noticeable loss of body weight. But few people know that the very name “anorexia nervosa” contradicts the essence of the disorder: in more than half of patients, appetite is not lost until the last stages of the disease, and there are no signs of neurosis. In fact, anorexia nervosa is a clinical diagnosis of a complex of symptoms caused by a combination of psychological , family, cultural and biological factors. The classic triad of symptoms of anorexia nervosa consists of amenorrhea (absence of menstruation), distortion of body image and a vigorous struggle for thinness. The diagnosis of anorexia nervosa is made in the presence of the following signs (according to G.V. Starshenbaum): 1) refusal maintaining weight at a minimum level for a given height and age; 2) strong fear of gaining weight, despite the fact that the patient does not weigh enough; 3) impaired body image and denial of the seriousness of the problem of reduced weight; 4) amenorrhea in mature women, decreased libido and potency in men. According to modern diagnostic criteria, to make a diagnosis of anorexia nervosa, weight loss must reach a persistent level below 85% of normal. For calculations, the Quetelet index is used: the ratio of body weight in kilograms to the square of height in meters. An index above 17.5 points is considered normal. With a simplified approach, a loss of 25% of initial body weight is enough to make a diagnosis. The disorder is more common among teenage girls who are afraid of gaining weight and girls from wealthy families. One case of anorexia occurs per 50 female university students, in theater schools - per 20 students, in ballet schools and among fashion models - per 14 girls. In recent decades, the disease has been increasingly detected in men. If 50 years ago the ratio of male and female anorexia nervosa was estimated as 1:20, then currently this figure, according to some data, is 1:4 (according to G.V. Starshenbaum). Since the disorder develops relatively slowly and is imperceptible at first, the danger of anorexia underestimated. Many people don’t consider it a disease at all. Meanwhile, this is a fairly serious disease, according to the international classification of diseases (ICD-10) classified as “Behavioral and mental disorders combined with physiological dysfunctions.” In its advanced state, anorexia can be fatal to humans. And the reason for this is a pathologically persistent and obsessive desire to lose weight, often reaching severe cachexia (extreme exhaustion) with possible death. Z. Freud also called such patients “close to death” and pointed out their strong resistance to treatment. This attitude towards themselves and their health is due to the psychological characteristics of the individual. Psychological characteristics of personality It is believed that self-destructive behavior in anorexia is associated with the most important personalexperiences and is rarely suicidal. Fasting is an emotional attempt to cope with or reject feelings, impulses, and behaviors. Psychotraumatic circumstances that lead to such strong experiences include disturbances in family relationships, as well as the loss of a loved one due to death, separation, or even the thought of the possibility of such events. These patients are characterized by dichotomous thinking of the “all or nothing” type. Therefore, assessing her reflection in the mirror not as ideal, but as fat and ugly, a girl with anorexia considers herself weak-willed and disgusting in general. The following personal characteristics are identified that are characteristic of patients with anorexia (according to G.V. Starshenbaum):• prone to significant emotional restraint and cognitive inhibition;• prefer a mediocre, orderly and predictable environment, poorly adapted to change;• treat others with increased respect and obedience;• avoid risk and react to stress pronounced excitement or strong emotions; • focus exclusively on the process of improvement. These personality traits make it difficult to adapt to puberty and the life changes that characterize adolescence. Anorexia often begins after a girl reads about it or someone she knows is hospitalized with this disease. An event that causes anorexia may be frustration associated with being slightly overweight (offensive remarks from peers, refusal to join a choreographic group, etc.). Without control over their own bodies, anorexics feel that they have no control over their behavior, needs, and impulses. Therefore, they often view the ability to control their appetite and body weight as an indicator of autonomy and competence. Such an assessment of control over one’s own eating behavior causes a perverted sense of self-satisfaction in patients. It is this apparent solution to one’s problems and denial of the fact of fasting that prevents a return to normal nutrition (according to D.N. Isaev). Anorexia nervosa as an indicator of family dysfunction In psychology, it is generally accepted that eating style (in other words, eating behavior) is a reflection of a person’s emotional needs and state of mind. At the earliest stage of existence, eating and sleeping are the main life functions. During feeding, the child feels comfort from bodily distress. Skin contact with the warm, soft mother's body during feeding gives the baby confidence that he is loved, and the satisfaction of hunger causes a feeling of security and well-being. Thus, in the baby’s experience, feelings of satiety, security and love remain inseparable (B. Luban-Plozza). Even more decisive than the feeding method is the mother’s attitude towards her child. This was already pointed out by 3. Freud. If the mother does not treat the child with love, if during feeding she is far from him in her thoughts or is in a hurry, this may result in the child developing aggressiveness towards her. The child can often neither react nor overcome these aggressive impulses; he can only repress them. This leads to an ambivalent attitude towards the mother. Mutually opposite movements of feelings cause various vegetative reactions. On the one hand, the body is ready to eat. On the other hand, if a child unconsciously rejects his mother, this leads to the opposite nervous reaction: spasms and vomiting. This may be the first psychosomatic manifestation of later neurotic development. Psychosomatic specialists know that one of the functions of the disease is communication - when a person uses a symptom to express his disagreement or demand attention. In so-called psychosomatic families (see No. 3, 2012), a sick family member becomes a carrier of a symptom, with the help of which he expresses what the family is hiding. The famous child psychiatrist D.N. Isaev, describing the families of patientsanorexia, indicates that they are characterized by disturbances in the relationship between spouses, leadership difficulties, refusals of communication, poor conflict resolution, hidden alliances or rejected coalitions between family members who condemn any changes. In dysfunctional families, as a rule, there is an unspoken prohibition on expressing dissatisfaction and expression of true feelings. Problems, as a rule, are hushed up, and everything is aimed at conforming to a certain ideal laid down by an authoritarian parent or previous generations.N. Pezeshkian, the author of positive psychotherapy, believes that with psychogenic fasting we are talking less about the illness of an individual person than about the illness of the entire family. From this point of view, the patient is the strongest in his family circle, because he dares, putting his life at risk, to discover family problems and social injustice. Thus, positive psychotherapy sees in psychogenic fasting not so much a painful lack of appetite or a strategy of avoiding food, but rather the ability, through fasting, to draw attention to something in oneself or around oneself. But, as practice shows, the sufferer achieves the opposite reaction. Due to difficult relationships with parents, the “rebellious child” only worsens his situation. The dominant mother demands from the child obedience, compliance with social standards, leadership and success in everything, and cultivates the idea of ​​​​an “ideal figure”. The fact that a child becomes ill with anorexia nervosa causes protracted reactive states in her and sharpens her characterological traits. Hidden family conflicts are actualized and become more and more destructive. As a result, the patient loses contact with his parents, which aggravates the course of the disease and complicates the implementation of treatment and rehabilitation measures. A sick child is protected from contact with psychiatrists for a long time, creating their own pseudoscientific explanations of the disease and treatment concepts. As a result, the sick child is left without medical care (according to G.V. Starshenbaum). To confirm this situation, I can give an example from my own practice. The patient’s sister asked for help, and she brought her to a consultation. The mother of the sick girl not only did not notice the problem, but in her youth she herself maintained her slim figure by resorting to getting rid of food by vomiting (this is how the girl learned about the “fingers to mouth” method). Psychotherapy revealed a large number of unresolved family problems that the sick girl found difficult to cope with on her own. The most interesting thing is that the symptom was of a fluctuating nature, and aggravated only when the girl became “unbearable” being in the family and needed to “do something.” Forecast The following statistics are known. If not treated appropriately in a hospital, cachexia can be fatal. Recovery is noted in 40-55% of patients, in 30% of patients the condition significantly improves and in 20-30% it seriously worsens. In a large number of cases, a wave-like recurrent course is observed. Repeated attacks of the disease are usually milder than the first. Some patients subsequently adhere to strict restrictions in food intake throughout their lives, remaining extremely thin, but at the same time maintaining satisfactory social adaptation (according to D.N. Isaev). A good prognosis is associated with success in basic activities, a short duration of the disease, and effective adaptation in the team and normalization of relations with parents. One of the unfavorable factors that worsens the course of the disease is denial of the presence of the disease. The disease cannot be ignored! Anorexia nervosa is not a “girlish whim” or a fashion statement, and the sooner you start treatment, the better. Even the lack of support from loved ones or the lack of good specialists in your city is not a reason to refuse treatment. The possibilities of the Internet are now limitless and the problem.20-22.