Bruch offers a new theoretical formulation, based on the genetic interrelation of drive and interpersonal factors, which links severe eating disturbances with schizophrenia. The patients studied demonstrated a delusional self-concept with inability to recognize the internal signals of hunger and satiety. The symptoms in such cases involve the falsification of a bodily need which serves as a solution to an interpersonal conflict within the disturbed family group. Case histories are used to demonstrate that this condition has its genesis in an incorrect, pathological learning experience in which the mother or her substitute feeds the child according to her own needs and wishes, thereby preventing differentiation. Unless the underlying cognitive defect is corrected, treatment will be ineffective.