Anorexia Nervosa

In the article "Anorexia Nervosa" and its Differential Diagnosis", Hilde Bruch argues that the pursuit of thinness is the key issue in anorexia nervosa syndrome and this separates it from various other psychiatric conditions associated with weight loss. Bruch supports this claim by using a study of 43 patients and observed them from 1942 to the middle of 1964. Bruch noticed that anorexia nervosa was an important issue to study because the number of cases continued to rise each year. What was interesting about this study is the range of diversity that these subjects had. The differences between the subjects included social economic standing, religious background and number of siblings.

However, Bruch states that abstaining from food is not always psychiatric and can be used as a political weapon to make a statement or could be related to religious traditions, such as fasting. Nevertheless, Bruch does find that preoccupations with ritualistic problems did play a role in some of her cases (106). Bruch also found that in the typical anorexia nervosa there were two different types: some struggled for control or a sense of identity and others used it as a symbolic tool. Bruch then goes on and shows four different cases from her study. The first was a 19 year old girl who would not eat unless she observed the amount of food that her mother ate. The second case was a prominent 32 year old women who had a recurrent theme of gaining attention and dominating through weakness. The third case involved a 14 year old boy who would not only starve himself but also beat his head if he thought he did something he was not suppose to do. Bruch later found that he would be himself because he observed how his grandmother would whip herself whenever any of her grandchildren misbehaved. Likewise his religion also played a role in his condition due to the notion of atonement. Since his Bar Mitzvah, the client felt that he was responsible for his sin and fasting was one method for atonement. From these clients, Bruch was also able to recognize three areas of disordered psychological functioning. These included disturbance in the body image and body concept, disturbance in the accuracy of perception or cognitive interpretation of stimuli arising within the body and a paralyzing sense of effectiveness (109-110). This "paralyzing sense of effectiveness" was apparent in the fourth case. This subject was upset that everything was given to him and that he could not produce anything.