Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia

By Kelly D. Brownell; John P. Foreyt | Go to book overview

17
Anorexia Nervosa:
The Therapeutic Task

Hilde Bruch

Anorexia nervosa was first described a little more than one hundred years ago. The emphasis was on "nervous" factors that were presented in terms of the psychology of their time. In 1914 autopsy findings on certain cases of cachectic women prompted the theory of pituitary origin, and this opinion dominated the field for the next three or four decades. During the 1930s it was recognized that the diagnostic criteria of a psychogenic form of anorexia nervosa were decidedly different from those of cachexia of pituitary origin.


The Psychoanalytic View

Psychoanalysis played an important role in the understanding of psychological factors, but it presented its principal theoretical assumptions as fixed knowledge, the way many topics were presented as definite at that time. Anorexia nervosa was viewed as a form of conversion nysteria and as symbolically expressing repudiation of sexuality, specifically of oral impregnation fantasies. This view dominated the field during the 1940s and 1950s, and it has not yet completely departed. I looked eagerly for such fantasies in my first anorexic patient, and when I did not find them

____________________
This chapter is an unfinished draft that Dr. Bruch was working on for this book when she died on December 15, 1984. The chapter is published essentially unchanged in memoriam.

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