Alexa Dayton - Summary of "Anorexia Nervosa and its Differential Diagonsis"

Hilde Bruch argues in, "Anorexia Nervosa and its Differential Diagnosis," how anorexia nervosa has often uprooted confusion within its diagnosis. Bruch states that anorexia nervosa and its pursuit for thinness can easily be confused with other psychiatric conditions associated with weight loss and formally defines anorexia nervosa as, "self inflicted starvation without recognizable organic disease and in the midst of ample food." (Page 104) Bruch dissects the definition of anorexia nervosa into two essentially different problems. The first is when the patient is preoccupied with his or her body appearance and has a demanding need for thinness and avoiding appearance of fat. The second is a person that is preoccupied with the process of eating and its symbolic values.

This piece is focused around studies that have been conducted and centers in on particular cases of patients with this disorder. It is important to remember that these case studies started in the early 1940’s and run until the mid 1960’s. The participants in this study ranged in age, gender, social and economical backgrounds, treatment history, culture, and religion. At this time, anorexia nervosa was considered a rare yet increasingly popular issue. The primary goal of the study at Bruch’s standing was to see if her definition of anorexia nervosa should be diagnosed and treated differently from other psychiatric conditions pertaining with weight loss.

There were four spotlighted cases in this piece. The first case featured a 19-year-old college student who suffered dramatic weight loss in college. After her mother underwent a surgical procedure with doubtful recovery, this girl found she was unable to consume food unless directly witnessing that amount her mother consumed. The second case was about a 32-year-old intelligent professional women who began losing considerable weight at the age of 16. She felt that her sister was being favored by her family so as to obtain attention, she began to not eat. Through long evaluation of her case, it was revealed that the theme of her existence was to gain attention and dominate through her own weakness.

The third case was a 14-year-old boy with schizophrenia who would punish himself for his sins. This ‘punishment’ existed in founds of self-inflicted abuse and starvation. He was hospitalized and fed through a tub for three years. It seems as if there are direct connections from his starvation to his religion. In the Jewish culture, a ritual exists called the Day of Atonement that was a day of fasting. The last case that was highlighted in this article was an 18-year-old man who weighed 49 pounds and stood at 49 inches tall. He began to witness difficulties in his diet at age 12. He was considered the perfect child until teenage rebellion stuck. He felt indebted to his parents and as if he were their property because everything he was, in sense, was due from them. He began to be obsessed with his fitness and soon rejected food because it came from his parents.

In the end conclusion, Bruch observed that failure in treatment arose when a therapist simplu listened to what the patient had to say. The success came from treatment plans where patients were told how to feel. It is essential to evoke awareness that there are feelings and awareness that originate in them. The patients need to realize the appropriateness of their issue and consider it with the realistic possibilities of their future plans ans desires.