Anorexia Nervosa

Hilde Bruch describes in, "Anorexia Nervosa and its Differential Diagnosis," how anorexia nervosa has been characterized with confusion of its diagnostics. Bruch defines general anorexia nervosa, “the condition of self-inflicted starvation, without recognizable organic disease and in the midst of ample food” (104). In historical reviews Bliss and Branch(1960) concluded that anorexia nervosa was not a distinct clinical entity but only a symptom found at time s (104).

This report was based on the study in 1942-1964 of 43 individuals who had been diagnosed with anorexia nervosa. The rare disease appearing to be on the increase was ranging between adolescence and early adulthood. Also in the study Bruch describes that not all voluntary acts of abstinence from food is the cause of sickness. Many will use food abstinence as a means of strikes for independence, self identity and control or religious traditions. The question arises do these clinical entities need to be separated from other psychiatric conditions of anorexia nervosa?

Following the study three areas of disordered psychological functioning were recognized. First was the symptom that there is a disturbance in the body image and concept of delusional proportions. Different relations of what are normal and right and recognizing abnormal body images are important for diagnosis and treatment. The second outstanding characteristic is a disturbance in the accuracy of perception of stimuli arising within the body, failure to interpret signals indicating nutritional need. Another characteristic is denial of fatigue or over activity. This symptom usually occurs before absence of eating, is self initiated behavior and is overlooked as a diagnosis. The third outstanding feature is paralyzing send of ineffectiveness. Better referred to as negativism and stubborn defiance, patients appear to lack awareness of their own resources and reject demands.