Anorexia Nervosa Summary

In "Anorexia Nervosa and its Differential Diagnosis, psychoanalyst Hilde Bruch argues that a "true" anorexic "actively pursues thinness" and perceives the condition as normal, while the second anorexic possesses a problem with the meaning the act of eating conveys.

She begins her piece by introducing Thomae and Selvini's previous work on anorexia. What they found was that anorexia was evident ii all psychiatric categories. While Thomae discovered that most patients are adolescent, Selvini exposed a major motive: a "concrete striving for independence".

Subsequently, Bruch observes 43 patients, most of which are female, but all of which come from various backgrounds. She pays specific attention to four cases. In her first case, Bruch finds that one girl did not eat unless she knew what her mother ate, signifying her complete dependence on her mother. The second case, on the other hand, depicts a woman who used anorexia as a means of gaining attention, to "dominate through weakness" (108). In the third case, a boy punished himself through starvation as a form of atonement, while the fourth case exhibits a boy who felt he possessed no ownership but that of his own body.

All in all, Bruch concludes these major points. She finds that the most prevalent symptom of anorexia is a deranged perception of the body. Anorexics believe their weight is normal and try to maintain it. Likewise, they lack the ability to listen to their body's stimuli, or don't desire food or even feel hungry. Next, Bruch finds that anorexics have very strong drives to do activities or study, demonstrating their overactivity or denial of fatigue. However, they lack sexual function or feeling. Anorexics lack the ability to confront emotions, often failing to recognize anxiety, emotional reactions, and even depression. Lastly, an anorexic's actions are usually only "in response" to what others want. According to Bruch, this "nature of rejecting ordinary demands of living is a desperate cover-up for an undifferentiated sense of helplessness", which also parallels the anorexic's fear of losing control.

Ultimately, Bruch finds that essential early learning for most patients is disrupted, leading them to develop a sense of helplessness because they feel their strivings are ineffective. What anorexic patients want is control of at least one thing in their lives and they can find that through eating. In conclusion, Bruch states the true anorexic "actively pursues thinness" and perceives the condition as normal, while the second anorexic possesses a problem with the meaning the act of eating conveys.