Haley Tellesbo "Anorexia Nervosa and its Differential Diagnosis"

In "Anorexia Nervosa and its Differential Diagnosis" Hilde Bruch argues that the pursuit of thinness,the main condition in anorexia nervosa syndrome, is a separate issue from other psychiatric conditions connected with losing weight. She reports that anorexia nervosa deals with two essentially different problems. Patients can either be obsessed with being thin or they are concerned with the eating function itself (and thinness is just a result). Through her own studies, Bruch explores the differences in psychological manifestations and their significance, as well as different types of eating disorders and their clinical course. By further distinguishing anorexia nerovosa, Bruch believes the condition and treatment will be better understood.



The basis of her report is seen in the 43 case studies (37 females and 6 males) done between 1942 and 1963. At the time anorexia nervosa had been thought to be a rare disease, but Bruch notes that there has been an increase in cases. After making observations two very different types of anorexia nervosa emerged. Refusal to eat was seen in 13 cases with no real understanding of the issue since weight loss was incidental. Yet in the other 30 cases there was a need for control, to find one's self and constant "pursuit of thinness." These 30 cases were seen as "true anorexia nervosa." All of the patients varied in age, personal and social background, and religion. Bruch also worked closely with the families of the patient in order to see if family interaction and concern played a role in the onset of the disease.

Out of the 30 patients recognized with anorexia nervosa there was a pattern of three different syndromes. The first is that the patient has a disturbed body image and do not see the way they really look. In order to treat, the patient must change the way they see their body and accept the truth or they will fall into relapse. The second symptom is an inability to sense hunger. They do not listen to the signals in their body indicating hunger. The third characteristic is a "sense of ineffectiveness." These patients lack the ability rely on their own thoughts and feelings which are undeveloped as a child. Bruch discovered that "insight giving" therapy has been detrimental to the improvement of the patient. Yet therapists that listened to the patient and did not give advice were more successful in helping the patient realize their own feelings and actions. This step is crucial for patients to recognizing that impulses originate within themselves.