Brianna Fischer-Anorexia Nervosa and its Differential Diagnosis

In the article "Anorexia Nervosa and its Differential Diagnosis" Bruch argues that the pursuit of thinness is the key issue in anorexia nervosa, which separates it from other psychological disorders than have weight loss as a secondary symptom.  Branch beings by explaining a historical trend of food withholding and looks at some religious and cultural reasons for it.  He states that he wants to "question whether there is a clinical entity that deserves and needs to be separated from other psychiatric conditions" and then what would be the characteristics and proper diagnosis.

In the first case Bruch describes, a 19-year-old female lost 30 pounds during her first year of college.  This seems to be because her mother had undergone major surgery, and her recover was doubtful.  During this time, the patient had be come obsessed with only eating what her mother did, and only when she could see portion sizes.  This caused for major weight loss when she moved away from home because she could not see how much her mother was eating.  There was no obsession with weight, the patient did not like being so thin; but she had developed a psychoneurosis in clinging to her mother and eating habits.

The second case was a 32-year-old professional woman who used her weight as a way to gain attention and "dominate through weakness".  This started at at young age when she felt her sickly sister was getting more attention.  This patient had learned all the ways to use her disorder as a means of attention, even using suicidal actions to gain attention when lack of eating wasn't getting the results she wanted.  Because there is no direct eating disorder, only weight loss as a means to another disorder, this woman is considered part of a group of pseudo-anorexia nervosa.

The third and fourth cases were both boys.  The first was a 14-year-old who had symptoms of imitation habit in which he hit himself when he had done something wrong.  This started after his Bar Mitzvah when he was responsible for all of his sins.  His eating disorder was not directly related to weight or body appearance, but not eating was a way of punishment for sinning and making his life harder.  The second was a boy who weighted 49 pounds at age 18.  He understood eating as a way of taking things that belonged to his parents, as he belonged to his parents.  He did not like that feeling of being owned, so he did whatever he could to avoid that feeling.  He wanted to own his own body.

Bruch concludes in the discussion of the symptoms that differentiate between anorexia nervosa and pseudo-anorexia nervosa.  He also discusses that the best way to treat and diagnose this is by talking to the patients and getting to the point of hearing them, and listening to their thoughts.  This discussion will often be the first time these patients have not been told how to feel.  This allows them to be able to recognize their own feelings, which makes progress towards recovery.