Amy Foss- Anorexia Nervosa and its Differential Diagnosis

In “Anorexia Nervosa and its Differential Diagnosis” Hilde Bruch discusses the patients she studied that were suffering from anorexia nervosa disorder. She had 43 patients in her study; it was a diverse group, varying in age, gender, race and socioeconomic status. At the time of her study anorexia was thought of as a rare disease and in most cases patients were treated the same and weren’t diagnosed with any mental illness.

Bruch contended that there are many different diagnoses for this disorder. Therefore each patient needed to be treated and evaluated individually. Throughout the article she explains some of her cases and the uniqueness of each case. Bruch found in her group of patients two distinct types of anorexia. For most of the patients, they had a struggle for control, looking for a sense of identity and effectiveness, and as a result an uncontrollable desire for thinness. They went through large eating binges, followed by vomiting. For the other small group of patients the reason for their weight loss was not intentional and came from another problem or situation. All of these patients varied in the severity of their illness and accessibility to treatment.

During her study Bruch found that most of her patients showed signs of disordered psychological functioning. She explains three symptoms that drew her to this realization; the first symptom being a disturbance in body image and body concept of delusional proportions, second being a disturbance in the accuracy of perception or cognitive interpretation of stimuli arising within the body, and the last symptom is a paralyzing sense of ineffectiveness, everything they do is to please others they never do things for their own happiness. Surprisingly patients explained that they came from normal family homes, and they were very obedient children. Consequently parents looked at their child’s eating problem as solely an eating problem, never considering that there were underlying factors to the problem.

Bruch found that there are many different factors that cause this disorder and that there are treatments that many didn’t consider before. She stressed the importance of looking at anorexia from all angles and treating each patient individually to make sure they get the treatment that they need.