Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within

By Hilde Bruch | Go to book overview
lifeline is interrupted during preadolescence. Sullivan (12) has stressed the paramount importance of this phase in human development, as the era during which a child forms his first important extra-familial relationships. It is through relationships with his peers and in the intimacy of a meaningful friendship that he can emerge from the family bonds and can develop a more realistic self-concept, and find his self-worth. The interruption of such ties at this critical period proved so traumatic for these boys because their excessive performance had been achieved with constant strain. The spurious nature of their success story was revealed before they had achieved an independent identity, and the weak underlying structure crumbled.It is an often discussed question why anorexia nervosa is so conspicuously less frequent in males than in females. It may well be related to pubescence itself, to the psychobiological effects of the male sex hormones. If one considers the figures of preadolescence alone, there are 6 boys and 6 girls with primary anorexia nervosa. It is quite possible that the characteristic slave-like attachment of a child to the mother is more apt to develop in a girl, and efforts to solve psychological problems through manipulation of the body are also considered characteristically female. It is probable that it is unusual for a boy to be caught in this developmental impasse. In addition, male pubescence will flood a boy, even one who has this type of attachment, with such powerful new sensations of a more aggressive self-awareness that the event of puberty makes a new self-assertion possible, something he was not capable of in prepuberty. Once they are caught in the vicious cycle of self-starvation and distorted body experience, endocrine treatment appears ineffective, even disturbing, and becomes of value only after the underlying psychological problems have been clarified.
BIBLIOGRAPHY
1. Bliss, E. L., and Branch, C. H. H., Anorexia Nervosa--Its History, Psychology, and Biology, Paul B. Hoeber, Inc., New York, 1960.
2. Blitzer, J. R., Rollins, N., and Blackwell, A., "Children who starve themselves: Anorexia nervosa", Psychosom. Med., 23:368-383, 1961.
3. Bruch, H., "Anorexia nervosa and its differential diagnosis", J. Nerv. Ment. Dis., 141:555-566, 1966.
4. Bruch, H., "Anorexia nervosa in the male", Psychosom. Med., 33:31-47, 1971.
5. Crisp, A. H., and Roberts, F. J., "A case of anorexia nervosa in a male", Postgrad. Med. J., 38:350-353, 1962.
6. Dally, P., Anorexia Nervosa, Grune and Stratton, New York, 1969.
7. Falstein, E. I., Feinstein, S. C., and Judas, I., "Anorexia nervosa in the male child", Amer. J. Orthopsychiat., 26:751-772, 1956.
8. Gull, W. W., "Anorexia nervosa (Apepsia hysterica, anorexia hysterica)", Trans. Clin. Soc. London, 7:22, 1874.
9. Kuenzler, E., Pubertaetskonflikte eines maennlichen Patienten mit einer Anorexianervosa

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