Anorexia nervosa historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Joseph Nasr, M.D.[2]
Terminology
The term anorexia is derived from the Greek an- (without) and orexis (appetite), literally meaning “loss of appetite.” However, this term is a misnomer in anorexia nervosa, as affected individuals typically retain appetite but consciously restrict food intake due to an intense fear of weight gain.[1]
The term “anorexia nervosa” was introduced in the late nineteenth century to distinguish the condition from organic causes of weight loss and to emphasize its psychological components.[2] In clinical and scientific literature, “anorexia nervosa” is often abbreviated to “anorexia,” although this is technically imprecise, as anorexia alone refers to the symptom of reduced appetite rather than the psychiatric disorder.[1]
Colloquial terms such as “ana” and “pro-ana”, commonly used in online communities, are not recognized medical terminology and are associated with the normalization or promotion of disordered eating behaviors. These terms are generally discouraged in clinical practice due to their association with increased illness severity and resistance to treatment.[3]
Background
Anorexia nervosa was first clearly described as a distinct medical condition in the late nineteenth century, independently by Sir William Gull in England and Charles Lasègue in France.[2] Early descriptions emphasized severe weight loss in young women without identifiable organic disease, establishing anorexia nervosa as a psychiatric illness rather than a gastrointestinal or endocrine disorder.
During this period, public fascination with so-called “fasting girls” blurred the boundaries between religious asceticism, superstition, and emerging medical science. While such cases attracted cultural attention, modern historical analyses caution against equating them directly with anorexia nervosa, as many lacked the defining psychopathology required for diagnosis under contemporary criteria (Brumberg, 1988).[4]
By the late twentieth century, anorexia nervosa became widely recognized in the medical literature, particularly during the 1970s and 1980s, coinciding with advances in psychiatric classification and growing public awareness in Western countries.[4][5]
Early Diagnosis and Treatment of Anorexia Nervosa
Early medical approaches to anorexia nervosa in the nineteenth and early twentieth centuries often emphasized strict supervision, isolation from family, and enforced feeding, reflecting limited understanding of the disorder’s psychological underpinnings.[4] These practices were influenced by contemporaneous beliefs regarding hysteria, moral weakness, and excessive maternal influence.
Throughout the mid-twentieth century, treatment strategies varied widely and included psychoanalysis, behavioral modification, pharmacologic experimentation, and institutional care, often with inconsistent outcomes.[4] Forced feeding was historically employed in life-threatening cases, though it was associated with significant physical and psychological distress.
Modern treatment paradigms have shifted away from isolationist and punitive models toward multidisciplinary, evidence-based approaches emphasizing nutritional rehabilitation, medical stabilization, and structured psychotherapy, with particular attention to developmental stage and family involvement.[1]
Changing Attitudes About Body and Diet
Historical attitudes toward body weight and shape have varied substantially across time and cultures. During the Victorian era, thinness was not universally idealized, and anorexia nervosa was often conceptualized as a manifestation of hysteria rather than a distinct psychiatric disorder.[4]
In contrast, the late twentieth century saw increasing cultural emphasis on thinness, particularly in Western societies, coinciding with expanded media representation of narrow body ideals. While sociocultural pressures are recognized as risk modifiers, contemporary research emphasizes that anorexia nervosa cannot be attributed solely to cultural ideals, but instead arises from the interaction of genetic, neurobiological, psychological, and environmental factors.[6]
Anorexia Nervosa in Contemporary Culture
Public awareness of anorexia nervosa increased markedly in the late twentieth century, particularly following high-profile cases and media coverage. Since that time, specialized eating disorder treatment programs have expanded, and anorexia nervosa is now recognized as a severe, chronic psychiatric illness rather than a lifestyle choice or cultural phenomenon.[1]
In contemporary clinical practice, there is growing recognition that anorexia nervosa affects individuals of all genders, ages, and socioeconomic backgrounds, and that many cases remain undiagnosed due to stigma, limited access to care, or misperceptions about who is at risk.[7] (Udo & Grilo, 2018).
References
- ↑ 1.0 1.1 1.2 1.3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing; 2022.
- ↑ 2.0 2.1 Gull, W. W. (1997). V.-anorexia nervosa (apepsia hysterica, anorexia hysterica). Obesity Research, 5(5), 498–502. https://doi.org/10.1002/j.1550-8528.1997.tb00677.x
- ↑ Mills R, Hyam L, Schmidt U. A narrative review of early intervention for eating disorders: barriers and facilitators. Adolesc Health Med Ther. 2023;14: 217-235. doi:10.2147/AHMT.S415698
- ↑ 4.0 4.1 4.2 4.3 4.4 Banner, L. W. (1988). Fasting Girls. The Emergence of Anorexia Nervosa as a Modern Disease. Joan Jacobs Brumberg. Harvard University Press, Cambridge, MA, 1988. x, 366 pp., illus. $25. Science (New York, N.Y.), 240(4855), 1061. https://doi.org/10.1126/science.240.4855.1061
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing. doi.org/10.1176/appi.books.9780890425596
- ↑ Yilmaz Z, Hardaway JA, Bulik CM. Genetics and epigenetics of eating disorders. Adv Genomics Genet. 2015;5:131-150. doi:10.2147/AGG.S55776
- ↑ Udo T, Grilo CM. Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biol Psychiatry. 2018;84(5):345-354. doi:10.1016/j.biopsych.2018.03. 014