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Clinical symptoms and psychodynamic data on 12 patients with the classic anorexia nervosa syndrome were examined as manifestations of disturbances in the perceptual and conceptual fields. Disturbances in body image of delusional proportions were present in all patients. This is an important diagnostic and prognostic sign. Disturbance in the accuracy of perception or recognition of bodily states is the second pathognomic sign. Failure to recognize signs of nutritional needs is the outstanding aspect. The paradoxical overactivity of these patients is related to the same cognitive deficit. The third characteristic these patients had in common, an all-pervading sense of ineffectiveness, is of more general significance. It is the outcome of a personality development with a deficit of confirmation of child-initiated behavior. "Insight-giving" psychotherapy is ineffective. Evoking awareness of impulses originating within the patient is essential if the treatment is to succeed.
Hilde Bruch (Thu,) studied this question.