The history of
anorexia nervosa
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gr ...
begins with descriptions of religious fasting dating from the
Hellenistic era
In Classical antiquity, the Hellenistic period covers the time in Mediterranean history after Classical Greece, between the death of Alexander the Great in 323 BC and the emergence of the Roman Empire, as signified by the Battle of Actium in 3 ...
and continuing into the medieval period. A number of well known historical figures, including
Catherine of Siena
Catherine of Siena (Italian: ''Caterina da Siena''; 25 March 1347 – 29 April 1380), a member of the Third Order of Saint Dominic, was a mystic, activist, and author who had a great influence on Italian literature and on the Catholic Church. ...
and
Mary, Queen of Scots
Mary, Queen of Scots (8 December 1542 – 8 February 1587), also known as Mary Stuart or Mary I of Scotland, was Queen of Scotland from 14 December 1542 until her forced abdication in 1567.
The only surviving legitimate child of James V of Scot ...
are believed to have suffered from the condition.
["Was Mary Queen of Scots anorexic?" Dr. James A McSherry, Scottish Medical Journal, 30 (1985), 243-5. ]
The earliest medical descriptions of anorexic illnesses are generally credited to English physician
Richard Morton, in 1689.
However it was not until the late 19th century that anorexia nervosa was to be widely accepted by the medical profession as a recognized condition. In 1873,
Sir William Gull, one of Queen Victoria's personal physicians, published a seminal paper which established the term ''anorexia nervosa'' and provided a number of detailed case descriptions and treatments. In the same year, French physician
Ernest-Charles Lasègue similarly published details of a number of cases in a paper entitled ''De l’Anorexie Hystérique''.
Awareness of the condition was largely limited to the medical profession until the latter part of the 20th century, when German-American psychoanalyst
Hilde Bruch
Hilde Bruch (March 11, 1904 December 15, 1984) was a German-born American psychiatrist and psychoanalyst, known foremost for her work on eating disorders and obesity.
Bruch emigrated to the United States in 1934. She worked and studied at v ...
published her popular work ''The Golden Cage: the Enigma of Anorexia Nervosa'' in 1978. This book created a wider awareness of anorexia nervosa among lay readers. A further important event was the death of the popular singer
Karen Carpenter
Karen Anne Carpenter (March 2, 1950 – February 4, 1983) was an American singer and drummer, who formed half of the sibling duo the Carpenters alongside her older brother Richard. With a distinctive three-octave contralto range, she was praise ...
in 1983, which prompted widespread ongoing media coverage of eating disorders.
Etymology
The term ''anorexia nervosa'' was established in 1873 by
Queen Victoria
Victoria (Alexandrina Victoria; 24 May 1819 – 22 January 1901) was Queen of the United Kingdom of Great Britain and Ireland from 20 June 1837 until Death and state funeral of Queen Victoria, her death in 1901. Her reign of 63 years and 21 ...
’s personal physician,
Sir William Gull. The term ''anorexia'' is of Greek origin: ''an''- (ἀν-, prefix denoting negation) and ''orexis'' (ὄρεξις, "appetite"), thus translating to "nervous absence of appetite".
In an earlier address, in 1868, Gull referred to the condition as ''Apepsia hysterica'', but subsequently amended this to ''Anorexia hysterica'' and then to ''Anorexia nervosa''. In a paper published in 1873, French physician Ernest-Charles Lasègue published a paper entitled ''De l’Anorexie Hystérique''. The use, and subsequent abandonment, of the term ''hysterica'' is of interest, since in the Victorian era the term was interpreted as applying to female behaviour. In 1873, Gull wrote:
Early descriptions
13th and 14th Centuries: Saint Catherine of Siena & Saint Hedwig of Andechs or Silesia
Of interest in terms of anorexia nervosa is the medieval practice of self-starvation by women, including some young women, in the name of religious piety and purity. This is sometimes referred to as
anorexia mirabilis
Anorexia mirabilis, also known as holy anorexia or inedia prodigiosa or colloquially as fasting girls, is an eating disorder, similar to that of anorexia nervosa, that was common in, but not restricted to, the Middle Ages in Europe, largely affect ...
. By the thirteenth century, it was increasingly common for women to participate in religious life and to even be named as saints by the Catholic Church. Many women who ultimately became saints engaged in self-starvation, including
Saint Hedwig of Andechs in the thirteenth century and
Catherine of Siena
Catherine of Siena (Italian: ''Caterina da Siena''; 25 March 1347 – 29 April 1380), a member of the Third Order of Saint Dominic, was a mystic, activist, and author who had a great influence on Italian literature and on the Catholic Church. ...
in the fourteenth century. By the time of Catherine of Siena, however, the Church became concerned about extreme fasting as an indicator of spirituality and as a criterion for sainthood. Indeed, Catherine of Siena was told by Church authorities to pray that she would be able to eat again, but was unable to give up fasting.
Historical cases of men's abstention from eating for religious or (other) spiritual reasons tends to be regarded as 'asceticism'.
1556: Mary, Queen of Scots
![Mary Stuart Queen](https://upload.wikimedia.org/wikipedia/commons/1/1f/Mary_Stuart_Queen.jpg)
Mary Stuart, known as
Mary, Queen of Scots
Mary, Queen of Scots (8 December 1542 – 8 February 1587), also known as Mary Stuart or Mary I of Scotland, was Queen of Scotland from 14 December 1542 until her forced abdication in 1567.
The only surviving legitimate child of James V of Scot ...
, was brought up as a child in the court of
Henry II of France
Henry II (french: Henri II; 31 March 1519 – 10 July 1559) was King of France from 31 March 1547 until his death in 1559. The second son of Francis I and Duchess Claude of Brittany, he became Dauphin of France upon the death of his elder bro ...
. Her medical history is documented in some detail thanks to the accounts of various ambassadors who sent reports back to their respective sovereigns. It is known, for example, that she had measles when she was five, rubella when she was seven, dysentery and malaria when she was 14 and smallpox when she was 15.
She also had an unnamed illness as a teenager that some now believe to have been anorexia nervosa/chlorosis
Her condition is described as involving weight loss, uneven appetite, vomiting and diarrhoea, pallor, fainting fits and breathing difficulties. She was, however, physically active throughout the illness; she continued to ride on horseback and dance in the evenings at the same time as these symptoms were observed.
1613: Jane Balan – the “French fasting girl of Confolens”
The case of Jane Balans, the “French Fasting Girl of
Confolens
Confolens ( ; oc, Cofolents, ) is a commune in southwestern France. It is one of the two sub-prefectures of the Charente department. Confolens is the administrative center of a largely rural district, which has seen the development of tourism ...
,” was described in 1613 by Pedro Mexico. He noted that she “lived without receiving meat or drink for at least three years.” The condition began on 15 February 1599, when Jane Balans was around 10 years old. After suffering a fever and vomiting, she became withdrawn and weakened, refusing all food.
Contemporary superstition blamed the wicked power of an apple given her by an old woman some months prior to the start of the condition; Mexio diagnosed the case as a “drying up of the liver and of all the parts serving to nourishment due to hurtful humours”
1689: Richard Morton’s case descriptions
![Richard Morton physician](https://upload.wikimedia.org/wikipedia/commons/f/f2/Richard_Morton_physician.jpg)
Two early medical descriptions of a syndrome involving loss of appetite and extreme fasting without any evidence of known disease are provided by the English physician
Richard Morton in 1689. He provided two case descriptions in his ''“Phthisiologia: Or, a Treatise of Consumptions,”'' a 1694 translation of his 1689 work ''“Phthisiologica, seu exercitationes de phthisi libris comprehensae. Totumque opus variis histories illustratum.”'' Morton described these cases as “Nervous Atrophy, or Consumption.” The first, in 1684, involved a “Mr Duke’s daughter in
St Mary Axe
St Mary Axe was a medieval parish in the City of London whose name survives as that of the street which formerly occupied it. The Church of St Mary Axe was demolished in 1561 and its parish united with that of St Andrew Undershaft, which is ...
” (a street in the
City of London
The City of London is a city, ceremonial county and local government district that contains the historic centre and constitutes, alongside Canary Wharf, the primary central business district (CBD) of London. It constituted most of London fr ...
). He writes of her thus:
The girl consulted Dr Morton only after she had been ill for two years, and then only because she experienced frequent fainting fits. Morton described her as a “Skeleton only clad in skin.” He noted her “continual poring upon Books” despite her condition and that she was indifferent to the extreme cold of an unusually severe winter. She refused any treatment (which consisted of the likes of cloves bruised in wine, and stomach plasters). She died three months later.
The other patient was described as “The Son of the Reverend Minister Steele.” He began to fast at the age of 16. Morton attributed his “want of appetite” to “studying too hard” as well as the “passions of his mind.” Morton was more successful with this patient, who followed the doctor's advice to abandon his studies and move to the country, take up riding and drink plenty of milk, whereupon he “recovered his health in great measure.”
1770s: Timothy Dwight
In a biography of
Noah Webster
Noah ''Nukh''; am, ኖህ, ''Noḥ''; ar, نُوح '; grc, Νῶε ''Nôe'' () is the tenth and last of the pre-Flood patriarchs in the traditions of Abrahamic religions. His story appears in the Hebrew Bible (Book of Genesis, chapters 5– ...
, a near-fatal case of anorexia was described of an instructor at
Yale College
Yale College is the undergraduate college of Yale University. Founded in 1701, it is the original school of the university. Although other Yale schools were founded as early as 1810, all of Yale was officially known as Yale College until 1887, ...
:
1790: Robert Willan’s case description
Robert Willan
__NOTOC__
Robert Willan (12 November 1757, near Sedbergh, Yorkshire – 7 April 1812, in Madeira) was an English physician and the founder of dermatology as a medical specialty.
Life
Willan was educated at Sedbergh School, and received his M ...
was an English physician in London who is credited with founding dermatology as a medical speciality. He is one of the first to describe the symptoms of extreme weight loss in males, in his paper “A Remarkable Case of Abstinence,” published in Medical Communications in 1790. This describes the case of a young Englishman who died in 1786 after fasting for 78 days. He wrote:
19th Century descriptions
1859: Louis-Victor Marcé’s case descriptions
Louis-Victor Marcé (1828–1864), a French physician in Paris, published a number of case studies describing psychiatric disorders of women during and following pregnancy. His case descriptions included that of a patient displaying the symptoms of anorexia nervosa in 1859. In 1860, Marcé wrote:
1868: William Gull (address to the British Medical Association)
![Sir William Gull signed](https://upload.wikimedia.org/wikipedia/commons/3/39/Sir_William_Gull_signed.jpg)
In 1868, William Gull was a leading British physician living in London. That year, he described his observations of an emaciated condition in young women in an address to the
British Medical Association
The British Medical Association (BMA) is a registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquar ...
(BMA) in Oxford. He observed that the causes of the condition were unknown, but that the subjects affected were "mostly of the female sex, and chiefly between the ages of sixteen and twenty three" although he also qualified this statement by adding that he had occasionally seen it in males of the same age.
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
(the BMA's in-house journal) published the following extract from Gull's address:
1873: Sir William Gull’s "Anorexia Nervosa" paper
By 1873, Sir William Gull had been made a
Baronet
A baronet ( or ; abbreviated Bart or Bt) or the female equivalent, a baronetess (, , or ; abbreviation Btss), is the holder of a baronetcy, a hereditary title awarded by the British Crown. The title of baronet is mentioned as early as the 14th ...
and was one of four Physicians-in-Ordinary to
Queen Victoria
Victoria (Alexandrina Victoria; 24 May 1819 – 22 January 1901) was Queen of the United Kingdom of Great Britain and Ireland from 20 June 1837 until Death and state funeral of Queen Victoria, her death in 1901. Her reign of 63 years and 21 ...
. In that year, he published his seminal work ''“Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica)"'', in which he describes the three cases of Miss A, Miss B, and a third unnamed case. In 1887, he also recorded the case of Miss K, in what was to be the last of his medical papers to be published.
[Medical Papers, Sir William Withey Gull, edited by T D Acland (1894) p311-314]
Sir William Gull writes that Miss A was referred to him on 17 January 1866. She was aged 17 and was greatly emaciated, having lost 33 pounds. Her weight at this time was 5 stone 12 pounds (82 pounds/37kgs); her height was 5 ft 5 inches /167 cm (
body mass index
Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
of 13.5). Gull records that most of her physical condition was normal, with healthy respiration, heart sounds and pulse; no vomiting nor diarrhoea; clean tongue and normal urine. The condition was that of simple starvation, with total refusal of animal food and almost total refusal of everything else.
![Gull - Anorexia Miss A](https://upload.wikimedia.org/wikipedia/commons/9/9c/Gull_-_Anorexia_Miss_A.jpg)
Gull prescribed various remedies (including preparations of cinchona, biochloride of mercury, syrup of iodide of iron, syrup of phosphate of iron, citrate of quinine) and variations in diet without noticeable success. He noted occasional voracious appetite for very brief periods, but states that these were very rare and exceptional. He also records that she was frequently restless and active and notes that this was a "striking expression of the nervous state, for it seemed hardly possible that a body so wasted could undergo the exercise which seemed agreeable".
In Gull's published medical papers, images of Miss A are shown that depict her appearance before and after treatment (right). Gull notes her aged appearance at age 17:
Miss A remained under Gull's observation from January 1866 to March 1868, by which time she seemed to have made a full recovery, having gained in weight from 82 lbs/37 kg to 128 lbs/58 kg.
Miss B was referred to Gull on 8 October 1868, aged 18, as a case of suspected
tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
. Gull noted that her emaciated appearance was more extreme than normally occurs in tubercular cases. His physical examination of her chest and abdomen discovered nothing abnormal, but he recorded a "peculiar restlessness" that was difficult to control. The mother advised that "She is never tired". Gull was struck by the similarity of the case to that of Miss A, even to the detail of the pulse and respiration observations.
Miss B was treated by Gull until 1872, by which time a noticeable recovery was underway and eventually complete. Gull admits in his medical papers that the medical treatment probably did not contribute much to the recovery, consisting, as in the former case, of various tonics and a nourishing diet.
Although the cases of Miss A and Miss B resulted in recovery, Gull states that he observed at least one fatality as a result of anorexia nervosa. He states that the post mortem revealed no physical abnormalities other than
thrombosis
Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thro ...
of the femoral veins. Death appeared to have resulted from starvation alone.
1873: Ernest-Charles Lasègue
Ernest-Charles Lasègue was a French physician who practised at the
Salpêtrière, Pitié and Necker hospitals. From 1869, he was a professor of clinical medicine at Hôpital Necker.
In 1873, Lasègue published a paper entitled ''"De l’Anorexie Histerique"'' in the ''Archives générales de Médecin.'' Later that year, a translated version of the paper was published in the British ''Medical Times''.
![Charles Lasegue](https://upload.wikimedia.org/wikipedia/commons/9/97/Charles_Lasegue.jpg)
Lasègue began the article by noting the importance of recognizing hysterical anorexia as a diagnostic entity, and then described the progression of the illness. He proposed the hypothesis that at the onset of the disease, lack of appetite originates from a wish to avoid pain. After this, a passage was deleted from the translation which described 'the paradoxical liveliness' of the anorexic. Lasègue contrasted anorexic behaviour to the behaviour of people forced into starvation during the great famine in Paris. Lasegue then described the downward spiral of the anorexic, characterized by indifference, disgust, aversion, and eventually starvation, ill health and possible death.
Lasègue's paper contrasts with Gull's work by its focus on the psychological symptoms and examination of the role of parental influences and family interactions. He wrote about some of the family dynamics inherent in anorexic families, and provided a detailed description of a scene in which relatives try to persuade an anorexic to eat.
In an addendum to his ''Anorexia Nervosa'' paper, Sir William Gull provides the following comment on Lasègue's work:
Recent history
Although the medical facts of anorexia nervosa have been documented since the 1870s, public awareness of the condition was limited until the second half of the 20th century. The concept of obsession with body image as a motivating factor for excessive fasting did not emerge until the mid-1960s,
and it was not until 1980 that body image disturbance was formally included as a diagnostic criterion in the
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
published by the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
. More recently, with progress in the field of
neuroscience
Neuroscience is the scientific study of the nervous system (the brain, spinal cord, and peripheral nervous system), its functions and disorders. It is a multidisciplinary science that combines physiology, anatomy, molecular biology, development ...
researchers have increasingly looked at anorexia as a biologically-based mental disorder, like
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
.
According to Disorders in Social Relationships published by the Sciences Po University press anorexia nervosa affects young girls in the middle and upper social class. The symptoms of anorexia nervosa is closely entwined with "social relations". Between the ages of 15-24 with the disorder are at a 10% greater risk of dying than others at the same age. In a 2020 review it was found that AN runs in families and is often fatal.
It was also found that "The National Eating Disorders Association (NEDA) estimates that between 0.3 and 0.4 percent of all young women and 0.1 percent of young men suffer from AN on this or any day. They estimate that approximately 1 percent of women and 0.3 percent of men reported Anorexia during their lifetimes" in the 2020 Breakthrough Research in Anorexia Nervosa by Drs. Cynthia Bulik and Walter Kaye.
Recent Found Insights and Treatments
In the 2020 Breakthrough article it was also found that "Medications, psychedelic medicine, and deep brain stimulation may offer hope and help us to understand which diseases are the most like Anorexia Nervosa, major depression, OCD, or SUDs."
There has been progress with studying AN and it is commonly linked to important genetic and neurobiological causes.
Hilde Bruch research and publications
Hilde Bruch
Hilde Bruch (March 11, 1904 December 15, 1984) was a German-born American psychiatrist and psychoanalyst, known foremost for her work on eating disorders and obesity.
Bruch emigrated to the United States in 1934. She worked and studied at v ...
(March 11, 1904 – December 15, 1984) was a
German-born American psychoanalyst
PsychoanalysisFrom Greek language, Greek: + . is a set of Theory, theories and Therapy, therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a bo ...
, who practised at
Baylor College of Medicine
Baylor College of Medicine (BCM) is a medical school and research center in Houston, Texas, within the Texas Medical Center, the world's largest medical center. BCM is composed of four academic components: the School of Medicine, the Graduate Sc ...
,
Houston
Houston (; ) is the most populous city in Texas, the most populous city in the Southern United States, the fourth-most populous city in the United States, and the sixth-most populous city in North America, with a population of 2,304,580 in ...
in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
. Her early career focussed on obesity; but from the early 1960s she increasingly turned her attention to anorexia nervosa and its underlying causes. Bruch's 1973 work ''Eating Disorders'': ''Obesity, Anorexia Nervosa, and the Person Within'' is considered a seminal work on the subject and was the first of several works that documented her work with anorexic subjects.
Her best known work is ''The Golden Cage: the Enigma of Anorexia Nervosa'', published in 1978. This book drew on material in ''Eating Disorders'' in a publication aimed at a lay readership. It sold 150,000 copies and is recognized as one of the earliest publications that created a wider awareness of anorexia nervosa beyond the medical profession.
Death of Karen Carpenter
Karen Carpenter
Karen Anne Carpenter (March 2, 1950 – February 4, 1983) was an American singer and drummer, who formed half of the sibling duo the Carpenters alongside her older brother Richard. With a distinctive three-octave contralto range, she was praise ...
was a popular American vocal and drummer musician. Her death on February 4, 1983, was attributed to heart failure as a consequence of anorexia nervosa.
Public awareness of anorexia nervosa and other eating disorders was transformed by Karen Carpenter's death. Her young age (32) coupled with her fame as an entertainer captured public attention and received extensive media coverage. The sympathetic reporting of her illness prompted other celebrities, such as
Jane Fonda
Jane Seymour Fonda (born December 21, 1937) is an American actress, activist, and former fashion model. Recognized as a film icon, Fonda is the recipient of various accolades including two Academy Awards, two British Academy Film Awards, sev ...
and
Lynn Redgrave
Lynn Rachel Redgrave (8 March 1943 – 2 May 2010) was an English actress. She won two Golden Globe Awards throughout her career.
A member of the Redgrave family of actors, Lynn trained in London before making her theatrical debut in 1962. By ...
, to come forward and share their experiences.
Karen Carpenter's brother and singing partner,
Richard Carpenter, established a fund dedicated to his sister's memory for research into anorexia nervosa.
Notes
References
* Brumberg, Joan Jacobs; ''Fasting Girls: The History of Anorexia Nervosa''. Vintage Books, 2000. {{ISBN, 0-375-72448-6
* Carol Lawson; ''Anorexia: It's Not a New Disease'', Published: December 8, 1985
*''Palm Beach Post'', December 26, 1985.
See also
*
List of deaths from anorexia nervosa
This is a list of notable people who have died from anorexia nervosa, in chronological order.
*1380: Catherine of Siena – Italian Saint, aged 33
*1387: Pierre de Luxembourg – French Catholic bishop, aged 17
*1882: Sophie Gray – Scottish mo ...
*
Anorexia mirabilis
Anorexia mirabilis, also known as holy anorexia or inedia prodigiosa or colloquially as fasting girls, is an eating disorder, similar to that of anorexia nervosa, that was common in, but not restricted to, the Middle Ages in Europe, largely affect ...
*
Fasting girl
A fasting girl was one of a number of young Victorian era girls, usually pre-adolescent, who claimed to be able to survive over indefinitely long periods of time without consuming any food or other nourishment. In addition to refusing food, fasti ...
Anorexia nervosa
Anorexia
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gre ...