History of Anorexia Nervosa
and Bulimia Nervosa
Throughout history we can recognize the heterogeneous manifestation of disturbed eating behavior. Whereas the terms “bulimia” and “anorexia” have been employed for ages, their nosological status has continuously been challenged. Traditionally, in medicine, both food avoidance and overeating were almost invariably looked upon as symptoms of a diversity of illnesses, predominantly gastrointestinal disorders. Preoccupations with body weight and shape, and the application of weight-control strategies such as dieting and purging have acquired popular and medical attention only in the last part of the 20th century (and only in Western or westernized countries). Hence, the specific syndromes anorexia nervosa and bulimia nervosa appear to be relatively “modern” clinical entities.
Until the 19th century, “anorexia” (the medical term for loss of appetite) was considered a symptom of several physical and emotional disorders. But for centuries, voluntary abstention from food was not primarily a pathological phenomenon; extreme fasting was part of the penitential or ascetic practice of many pious Christians. Later on, forms of long-lasting food refusal, not accompanied by symptoms of well-known diseases such as tuberculosis, were more likely to stir up speculations about supernatural powers or demonic influences. Ultimately, extreme or unusual forms of food abstinence were looked upon as signs of a mental disorder. Food avoidance and emaciation were common symptoms of well-known diseases such as hysteria, mania, melancholy, chlorosis, and all kinds of psychotic disorders. At the end of the 17th century, the English physician Richard Morton described the occurrence of “nervous consumption”—a wasting different from tuberculosis and due to emotional turmoil. This is often quoted as the first medical report of anorexia nervosa, but Morton’s interesting case studies (of both a girl and a boy) did not attract any attention and fell into oblivion, until rediscovered three centuries later.