User:Givefreely/sandbox

Dr. Hilde Burch, in her 1973 book, Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within, explains that Anorexia Nervosa is "not a static condition," but one that continually provokes new problems with its various stages. She writes, "The state of starvation is associated by marked psychological changes... camouflaged by rationalizations." She identifies the family interaction becomes difficult, marked by rising anxiety, annoyance and resentment. It also brings about social isolation. (Burch 215).

Dr. Burch believed that anorexia, which is simply not eating enough, as a result from schizophrenia, depression, or esophageal problems often were misdiagnosed as anorexia nervosa. In her assessment, this blurred the definition of anorexia nervosa. For this reason, she distinguished between, what she calls "atypical" and "primary" cases of anorexia nervosa. The atypical cases of anorexia were brought about by a range of stimuli (from schizophrenia to depression, as noted above). (Burch 227).

In contrast to the atypical group, Burch observed primary, or genuine anorexia nervosa, "amazingly uniform". The first outstanding symptom is "disturbance of delusional proportions in the body image". The second outstanding characteristic is "disturbance in the accuracy of their perception or cognitive interpretation of stimuli arising from the body... failure to recognize hunger and denial of fatigue". The third outstanding characteristic is a "paralyzing sense of ineffectiveness". "Anorexics struggle against a feeling of enslaved, exploited, and not being permitted to lead a life of their own. They would rather starve than continue a life of accommodation. In this blind search for a sense of identity and selfhood they will not accept anything that their parents, or the world around them, has to offer." It is a "desperate struggle for a self respecting identity". She understood that the personality disorder (struggle for control, for a sense of identity, competence, and effectiveness) precedes the somatic disorders (such as emaciation, amenorrhea, constipation, etc.). (Burch 250-255).