In “Anorexia Nervosa and its Differential Diagnosis” Hilde Bruch discusses the separation of anorexia nervosa from other psychiatric conditions associated with weight loss. Bruch defines this condition as “self-inflicted starvation, without recognizable organic disease and in the midst of ample food.” However, there are actually two different underlining problems that can both be characterized as anorexia, whether it’s a pursuit of being thin, or if thinness is only a by-product. Through his study of 37 females and six males diagnosed with anorexia nervosa between 1942 and 1964, Bruch aims to find whether anorexia nervosa should be separated from other psychiatric conditions and what would be its “characteristic symptomatology, proper classification, prognosis, and treatment.”
It is important to study each case separately in order to understand each patient’s needs and diagnosis. The group studied was a very wide range of people, with different religions, ages, communities, and net worths. Within the group there were two distinct types. Thirty patients had a struggle with control and sense of identity and thinness was a final step. They also developed strange food habits and often would binge or vomit, while the other thirteen patients had a concern with the eating function in various symbolic ways – the weight loss was secondary.
It is important for both the one diagnosing the problem and the patient to recognize their nutritional needs. The patient must be able to recognize the feelings and impulses they have in order to be able to understand where they come from and control them. Without judging it is possible to change their plans and hopes for their future health.
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