Let’s Get Real About the History of Eating Disorders
This is the second piece of a three-part series acknowledging the serious nature of eating disorders and how little was known about how to help people with eating disorders in the past.
In the first part, we talked about anorexia as the deadliest mental illness. This time, we’ll glimpse into the history of eating disorders. While major advances have been made since the 1980’s--and people recover from eating disorders every day—by reflecting on the history of eating disorder diagnosis and treatment, we can be reminded of how far the field of eating disorders has come.
Anorexia and bulimia were originally thought to be physical diseases due to a medical condition. Some researchers attributed these disorders to hormone imbalances and endocrine deficiencies, and some physicians once thought that anorexia was a form of tuberculosis. In time, the medical community began to understand that the causes of eating disorders were in part psychological and emotional rather than wholly physical.
How Long Have Eating Disorders Been Around?
Eating disorders have existed a long time. Historical descriptions exist from the time of Caesar in 700 BC where rich ancient Romans would gorge themselves at lavish banquets, then purge so they could return to the feast. In later centuries, women would starve themselves, believing their desire for food was sinful; in 1686, an English physician described a 20-year-old patient as "a skeleton clad with skin."
While people have long experienced and displayed symptoms of eating disorders, it took hundreds of years before terms were ascribed to those conditions. Here is a brief history of three types of eating disorders that are widely recognized today.
The term anorexia has been used for over 140 years, originating from the Greek language and means “without appetite.” Initially, the title “anorexia hysterica” was used in publications about this type of eating disorder. That changed during a medical presentation in 1874 when the condition was called “anorexia nervosa," classifying it as separate from medical hysteria. Still, there has been some criticism over the etymology of anorexia because those with the condition do still experience hunger and have an appetite.
Bulimia Nervosa wasn’t named as an eating disorder until 1979 when British psychiatrist Gerald Russell coined the term–more than 20 centuries after Romans exemplified its symptoms at Caesar’s banquet table. Russell referred to bulimia nervosa as “powerful and intractable urges to overeat” in combination with “a morbid fear of becoming fat” and the “avoidance of the fattening effects of food” by using compensatory mechanisms, such as self-induced vomiting, laxatives, or prolonged periods of starvation.
Binge Eating Disorder
First called “Night Eating Syndrome" in 1959 by psychiatrist Albert Stunkard, he later specified that binge eating could occur at any time of day. It wasn’t until the 1990's that binge eating disorder (BED) was first recognized as a formal diagnosis. Prior to then, individuals with this type of behavior were labeled emotional overeaters, compulsive overeaters and food addicts, with BED first studied in weight loss populations.
A Timeline of Eating Disorder History and Research
12th to 14th Centuries – Hundreds of years ago, a number of women practiced self-starvation as a religious practice. Saint Catherine of Siena (1347-1380) was one of the most well-known of these women who would starve themselves for weeks or eat very little for months at a time. They believed that yielding to food was a sin; fasting was a way to show their devotion to God.
1689 - English physician Richard Morton described symptoms of anorexia in a condition he termed, “wasting disease.”
1873 - Sir William Gull established the term “anorexia” — pointing out that it occurs in males and in females. At this time, anorexia started to move from the traditions of folklore and theology (women starving themselves as a devotion to God) to the fields of medicine and psychiatry. It has been said that there was a transition from a pursuit of spiritual perfection to a pursuit of bodily perfection in sufferers with anorexia nervosa.
1888 - Doctors noted conditions similar to what we now know as eating disorders in both male and female patients.
Early 1900s - “Parentectomy” was considered an appropriate treatment for anorexia nervosa well into the 20th century. Essentially, a person with an eating disorder would be separated from their parents as a “cure.”
In 1903 - Dr. Pierre Janet noted bulimic behaviors in his patients. Other doctors reported patients displaying various signs of what we now know as bulimia — including binging, purging and abusing laxatives to maintain a low weight. Eating disorders were often treated as endocrine disorders at this time.
1940s - Psychoanalysis influenced how professionals thought about eating disorders. These professionals considered anorexia nervosa as being linked to possibly sexual origins. Psychiatrists started taking on more patients showing signs of eating disorders.
1959 - Dr. Albert Stunkard first described binge eating disorder (BED). Interestingly, he noted that BED seemed to be linked to night eating.
1970s - Anorexia and bulimia cases began to show increase in this decade.
1973 - Psychoanalyst Dr. Hilde Bruch released a highly influential book, “Eating Disorders: Obesity, Anorexia Nervosa and the Person Within.” This book coincided with an increase in both anorexia and bulimia.
1977 - Bulimia (binging and purging by exercise, vomiting or using laxatives) cases rapidly rose during the 1970s and 1980s in the U.S., England, France and Germany.
1979 - Gerard Russell published an influential article “Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa,” noting the differences in symptoms and health risks between patients who have anorexia and patients who have bulimia.
1980s - College counseling centers expanded counseling services for eating disorders. Celebrities started speaking out about their own eating disorders (Diana, Princess of Wales). Some treatment practices that are still used today (refeeding, talk therapy) were used with patients.
1980 - The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) added an eating disorders section including anorexia.
1983 - Karen Carpenter died of heart failure — likely linked to anorexia — increasing awareness of eating disorders in the public eye.
1987 - The DSM-III-R listed bulimia as a separate eating disorder for the first time. The American Psychiatric Association mentioned binge eating in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was listed as a feature of bulimia.
1994 - The American Psychiatric Association again mentioned binge eating in the DSM-4. It was listed as a feature of “eating disorder not otherwise specified” (EDNOS).
21st Century - In 2013, Binge eating disorder is recognized as its own disorder in the DSM-5. For the first time, people can get treatment for this disorder and have it covered by insurance.
How Eating Disorder Research and Treatment Have Evolved
In this century alone, the awareness of anorexia, bulimia and binge eating disorder has increased substantially. Eating disorder treatment now encompasses a holistic model that addresses multiple approaches: medical, psychological, nutritional, and more.
Today, Eating Recovery Center (ERC) converts their treatment model in Adult Programs to Acceptance and Commitment Therapy (ACT) in addition to established principles of medical stabilization and nutritional rehabilitation. Using skills from Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) therapeutically, ACT provides the theoretical framework to understand what processes help people get well.
ERC also focuses on caregivers and support system as the agents of change and healing through their commitment to a variety of family treatment methods (including Family Systems, Family Based Treatment, and Emotion Focused Family Therapy).
Additionally, the stigma associated with body size, as well as mental health disorders, shows promise of decreasing, thanks in larger part to the tireless work of several campaigns, such as Love Your Tree, Say it Brave and Health At Every Size. These initiatives empower individuals and their families to seek help if they experience eating disorders. More people are learning that not only do these disorders have a name, but long-lasting recovery is also possible.