Hayley Pearce- Anorexia Nervosa and its Differential Diagnosis

In "Anorexia Nervosa and its Differential Diagnosis," Hilde Bruch characterizes anorexia nervosa according to three "outstanding" symptoms -- a disturbed body image, an unbalanced accuracy of stimuli occurring in the body, and a sense of ineffectiveness. Bruch believes that these symptoms are the “core of the problem.”

Bruch also describes his “subjects” socioeconomic backgrounds. He does this to portray the fact that anorexia nervosa can affect anyone—not just upper class, not just middle class, middle children and so on. Of his 43 patients, Bruch recognized that the cases “consisted of two distinct types,” those who were struggling for a sense of identity and those whose “primary concern was with the eating function…” Bruch believes that true anorexia nervosa is illustrated through a distorted body image of outrageous proportions.

Throughout the piece, Bruch mentions certain case studies that effectively prove his theories. A 19 year old girl that couldn’t eat without seeing what her mother was eating, a 32 year old woman who used to be jealous of her ailing sister, a 14 year old boy who would beat his head against a wall when he did something wrong – a trait he learned from his grandmother, and an 18 year old who didn’t want to eat because he felt that if he did, he would belong to his parents. Bruch ties these cases together by noting that encouragement of self expression was never present, “reliance on their own inner resources, ideas or autonomous decisions had remained undeveloped.”

The conclusion Bruch comes to for helping these individuals with their illness is relaying to them that they do have their own identity and feelings. He says that the therapy sessions were the “first…experience [they had] that someone listened to what they had to say and did not tell them how to feel.” In the end, Bruch believes that evoking a sense of self in his patients will eventually lead to a successful treatment of their illness.