A Short History on Eating Disorders

Eating disorder related problems have been prevalent throughout history. For example, in the 1st century the ancient Romans detested being seen as fat, and set aside so-called vomitoriums where citizens who had gorged themselves with enormous amounts of food, could go and purge their food to find relief (and, to their belief, not gain weight).

Eating disorders are not a new phenomenon, but our understanding of these conditions has certainly changed over the centuries. In today’s blog we’ll look at the history of eating disorders by tracing their historical roots, up until current perspectives.

Middle Ages: Self-Starvation As a Religious Act

During the 12th and 13th centuries, the dominant interpretations of self-starvation were founded within religion, especially in Western Christianity. Refusing to ingest food in the Middle Ages was seen by many as a method to become closer to a god, viewed as acts of piety, great faith and holiness. Suffering was considered a way to imitate Jesus in remembrance of Christ’s torments to save humanity. Holy men preferred experienced suffering through physical punishment, whereas women preferred voluntary pain by fasting. They practiced anorexia mirabilis, or holy anorexia, as part of their religious practices.

Food abstinence became a religious ascetic ideal, exemplified by miraculous maidens (i.e. women who starved themselves) and fasting saints. One of the most famous examples was Saint Catherine of Sienna who lived in the 14th century. Saint Catherine died at age 33 of starvation after having survived on eating only bread, raw herbs and water for many years. However, as time passed, these views on holy anorexia changed, and by the late Middle Ages women who fasted excessively were thought to be possessed by evil spirits, rather than viewed as fasting saints.

The First Medical Description of Anorexia Symptoms

There exists some uncertainty over the exact origins of when and how anorexia nervosa as a diagnosis was realised. Recognising that certain types of food abstinence were representative of a medical problem became evident somewhere in the late 17th century.

Many believe that anorexia nervosa was first identified as a medical syndrome in Europe in 1689 by English physician Richard Morton. The medicalisation and understanding of anorexia nervosa culminated in Morton’s textbook Phthisiologia, or, A Treatise of Consumptions. In it, he described two cases of a ‘wasting’ disease of ‘nervous origins’ (‘nervous consumption’) that could be considered the first clear medical description of anorexia nervosa. One such case described an adolescent girl with ‘nervous consumption’ caused by ‘sadness and anxious cares’. Morton managed to rule out any physical cause for the disturbance and underscored ‘nervous causes’ for the observed weight loss.

At around the same time, the French psychiatrist Charles Lasegue reported the loss of appetite as a form of ‘hysteria linked to hypochondriasis’ and emphasised an array of encompassing emotional problems. His theory emphasised the role of the family, as he believed that anorexia nervosa was a disease that could only develop in comfortable homes with an abundance of food. He believed women who interpreted their lives as ‘suffocating’, and could not display emotional distress, would protest by not eating.

Modern History

In the 1920’s and 1930’s, the focus on anorexia nervosa nearly disappeared from psychiatric discussions. Eating disorders were thought to be predominantly physical diseases due to medical conditions. Researchers attributed these disorders to hormone imbalances and endocrine deficiencies. Simmond’s disease, named after its discoverer Morris Simmonds in 1914, which identified a lack of pituitary gland functioning, dominated popular conceptualisations of eating disorders and its development.

Not until the 1930s did psychiatrists’ and physicians’ focus became re-engaged, as they began to understand that the causes of eating disorders were part psychiatric and part emotional – rather than wholly physical. The land-mark case study of Ellen West from 1930 to 1933 provided further support for this shift in thinking. This paper provided West’s subjective perspective, describing her own desperate obsession with food and thinness, which tragically led to end her life by suicide.

In the 1970’s, The Golden Cage was one of the first books to suggest that eating disorders were becoming a serious problem. A broader interpretive framework for eating disorders would come in this era with the publication Eating Disorders by Hilde Bruch (1973). In Bruch’s work, she concluded that patients had delusional proportions of body image and body concepts, a disturbance in their ability to recognise nutritional needs, and a paralysing sense of ineffectiveness which pervades all thinking and activities. These were key contributions in starting to identify and understand specific symptomatic aspects of eating disorders.

The occurrences of anorexia nervosa continued to increase rapidly into the next decade, with some identifying it as the disorder of the 80’s. This notion contributed to suggestions that diseases, particularly psychiatric disorders, could possibly be directly linked to specific cultural contexts. By the mid-1980’s, college campuses in the United States of America were instituting counselling or support systems for those suffering from the disorder. The release of a feature film named The Best Little Girl in the World in 1985 offered the public a glimpse into the life of someone living with an eating disorder. During that same year, public awareness for eating disorders reached a peak when the high-profile pop singer and composer Karen Carpenter died from heart failure, as a direct consequence of her anorexia nervosa.

The 1990’s saw an increase in the momentum of research and development into eating disorders. In 1992, binge eating disorder (BED) was first recognised as a formal diagnosis. Prior to that, when BED was officially introduced at the International Eating Disorders Conference, individuals with these types of behavioural problems were merely labelled as emotional overeaters, compulsive overeaters, or food addicts. In that same year, the National Collegiate Athletic Association in the USA also revealed that eating disorders had taken significant precedence in most men’s and women’s college sports. Also in 1992, Andrew Morton published his biography on the Princess of Wales, titled Diana: Her True Story. It contained intimate details about Princess Diana’s struggle with bulimia nervosa, bringing more public attention to eating disorders and its growing prevalence in society.

The 1990’s was also the era in which researchers’ thinking shifted to a consensus that genetics and brain chemistry could play a significantly larger role than societal pressures in determining whether someone develops an eating disorder.

Conclusion

Eating disorders, particularly anorexia nervosa, are not modern-day phenomenon. The history clearly shows that its origins can be traced to distant times. With the development of the internet and the information age, it’s clear to understand that eating disorders are significant problems that affect many people in our society. In psychological terms, eating disorders may signal deep emotional difficulties for the sufferer, and research has highlighted that underlying factors are multifaceted, ranging from genetics to wider cultural- and media influences.