The early history of eating disorders
The history of eating disorders stretches back centuries and continues to evolve today. We thank Emmett Bishop, Jr., MD, FAED, CEDS, recipient of multiple lifetime achievement awards in the field of eating disorders, for shedding light on these milestones.
Long ago, the refusal of food was considered a spiritual practice. Fasting was commonly associated with religious beliefs, purity and self-control.[1]
It wasn’t until the last 150 years that eating disorders were given formal names. 1874 was a major turning point. That year, British physician Sir William Withey Gull and French physician Charles Lasègue independently described patients who were intentionally and severely restricting their food intake, viewing it as a disorder of the “nervous” system.[2]
At the dawn of the 20th century, eating disorders were believed to be physical illnesses caused by hormone imbalances or endocrine problems. Some physicians even viewed what we now know as anorexia as a form of tuberculosis[3]
Over time, the medical community began to recognize that eating disorders also had psychological and emotional causes, not just physical ones.
History of anorexia nervosa
1689 – English physician Richard Morton described two patients who were severely emaciated. He called their condition “nervous consumption,” attributing their weight loss to emotional rather than physical causes. These cases may represent some of the earliest descriptions of what we now recognize as anorexia nervosa.[2]
1868 – Sir William Withey Gull coined the term “apepsia hysterica” to describe extreme emaciation caused by intentional food restriction.[4] Gull later changed the term to “anorexia nervosa," distinguishing the condition from hysteria, a diagnosis frequently assigned to women at the time.[5]
1880s – Throughout the late 1800s, social pressures to avoid weight gain intensified. In France, reports described school-aged girls drinking vinegar and restricting food as they competed to lose weight [5].
1980 – Anorexia nervosa was recognized as a distinct psychiatric disorder, paving the way for standardized approaches to diagnosis and treatment.[2]
History of bulimia nervosa
Late 1800s – French psychologist Pierre Janet observed binge eating and purging behaviors in his patients, along with food restriction and self-induced vomiting. He described one female patient who was determined to be very thin. Her disordered eating behaviors began in early adolescence when she was described as being “slightly overweight” and teased by her peers.[5]
Early 1900s – Medical reports described women who ate very little and induced vomiting.[5]
1970 – British psychiatrist Gerald Russell formally named “bulimia nervosa.” He described it as an irresistible urge to overeat combined with a morbid fear of becoming fat. Self-induced vomiting or other purging behaviors were used to avoid weight gain. Russell noted that these behaviors could result in medical complications, including a high risk of suicide.[6]
1980 – Bulimia was added to the DSM-3 as a distinct diagnosis, defined primarily by the presence of binge eating behaviors.[7]
1987 – In the DSM-3-R bulimia was renamed “bulimia nervosa” and the diagnostic criteria were expanded to include compensatory behaviors such as purging.[8]
History of binge eating disorder
1955 – Binge eating first appeared in the medical literature when psychiatrist Albert Stunkard introduced “night eating syndrome (NES)," which included the following core symptoms:
Nocturnal hyperphagia (binge eating at night)
Insomnia
Morning anorexia (low appetite upon waking)[9]
Stunkard later specified that binge eating could occur at any time of day.[9] Before the 1990s, binge eating was often discussed as:
Emotional overeating
Compulsive overeating
Food addiction
1994 – Binge eating disorder (BED) was first recognized in the DSM-4 under the category “eating disorder not otherwise specified”.[10]
2013 – Binge eating disorder was included in the DSM-5 as a distinct diagnosis.[11]
2015 – The Food and Drug Administration approved lisdexamfetamine (Vyvanse) to treat BED in adults.
History of ARFID
1992 – Case reports described three young boys hospitalized for significant weight loss and malnutrition related to their refusal to eat solid food. One of the boys began avoiding food after choking on a hot dog and displayed numerous phobic behaviors. Another had an intense fear of food and described a perceived “food-fear monster” during meals. A third boy experienced severe anxiety and repeated vomiting episodes while eating.[12]
2013 – Avoidant/restrictive food intake disorder (ARFID) was added to the DSM-5,[11] replacing “feeding disorder of infancy or early childhood.” The updated diagnosis recognized that ARFID could affect people of all ages, not just young children. Establishing ARFID as a distinct diagnosis helped the field develop standardized treatment approaches and a deeper understanding of the condition.
2000s – ARFID is increasingly associated with other conditions, including autism spectrum disorder, attention -deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and anxiety disorders.
Important dates in eating disorder history
Pre-20th century
Ninth century – More than a thousand years ago, a Bavarian woman named Friderada reportedly refused to eat. A monk named Wolfhard later wrote that it was a miracle he was able to “cure” her and restore her ability to eat again.[5]
1200s-1500s – During the late medieval period, “ascetic-mystic extreme fasting” was often rooted in religious devotion, and religious fasting is still common today. Historical accounts describe many women engaging in self-starvation as an expression of faith.[5]
1300s – Saint Catherine of Siena (1347-1380) was known to restrict her food for weeks or even months at a time. For her, yielding to hunger was a sin, and fasting was a way to deepen her faith and devotion.[13]
1800s – Some males were developing a fear of being overweight, and medical clinics offered them “fasting-cures”.[5]
1860 – Queen Elizabeth of Austria was noted to have a strong fear of “becoming overweight.” She drastically reduced her food intake and became emaciated.[5]
Late 1800s – After Sir William Withey Gull established the term “anorexia,” eating disorders began shifting from the realms of folklore and theology (where women’s self-starvation was framed as religious devotion) to the fields of medicine and psychiatry.
20th century
Early 1900s – At the start of the 20th century, eating disorders were treated by endocrinologists. Doctors commonly misdiagnosed anorexia as a pituitary disorder called Simmonds’ disease.[5]
1900s – “Parentectomy” — the practice of separating people with eating disorders from their parents — was considered an appropriate treatment for anorexia nervosa.[14]
Dr. Bishop: A receptionist who worked at my medical school had an eating disorder and was removed from her parents’ home when she was young. Her physician later hired her and reported that she was cured. Early case studies suggested that separating people with anorexia from their families was effective. Today, we do the opposite — we educate and actively involve parents in recovery.
1914-1945 – What we now know as anorexia nervosa was treated exclusively as an “internal disease,” such as Simmonds’ disease in Germany.[5]
1973 – Psychoanalyst Dr. Hilde Bruch released her highly influential book, “Eating Disorders: Obesity, Anorexia Nervosa and the Person Within”.[15]
Dr. Bishop: I completed my medical residency in the 1970s. In 1974, I saw my first patient with anorexia nervosa. At this time, eating disorders were considered so rare that my supervisor told me, “You’ll never see a case like this again.”
1979 – Gerard Russell published an influential article noting the differences in symptoms and health risks between patients who have anorexia nervosa and patients who have bulimia.[6]
Dr. Bishop: In 1979, a medical student proposed a research elective on bulimia, which was not well understood at the time. After reviewing a large patient database, the student identified eight cases with the symptoms of bulimia. Around this time, medical interest and knowledge of eating disorders began to grow.
1980 – The DSM-3 added a dedicated section on eating disorders, including anorexia nervosa and bulimia (renamed bulimia nervosa in 1987).[16]
1980s – Eating disorder diagnoses increased dramatically in the 1980s. In response, college counseling centers expanded their services for students with eating disorders. During this time, treatment approaches that are still used today, such as refeeding and talk therapy, became common in clinical care.
Dr. Bishop: By 1980, we saw a sharp increase of patients with eating disorders. A nurse, recovering from anorexia, reached out to me, saying, “These individuals need our help.” At the time, patients with anorexia nervosa were being locked into Geri chairs where we fed them their meals. I wanted to, and knew that we could, do better.
1981 – The “International Journal of Eating Disorders” was created.
1983 – On February 4, Karen Carpenter died of heart failure linked to anorexia nervosa.
1990s – Public awareness of eating disorders grew as celebrities, including Diana, Princess of Wales, spoke openly about their struggles.
1994 – The American Psychiatric Association included binge eating in the DSM-4 as a feature of “eating disorder not otherwise specified” (EDNOS).
Dr. Bishop: By this time, eating disorder treatment programs were incorporating group therapy, exposure therapy, intensive outpatient treatment, nutrition therapy and cognitive behavioral therapy (CBT). Dialectical behavior therapy (DBT) was particularly transformative. DBT helped patients regulate their emotions, reduce impulsive behavior and align their actions with long-term goals.
21st century: How far we’ve come
2003 – Drs. Ken Weiner and Emmett Bishop implemented DBT in a Denver partial hospitalization program (PHP) for eating disorders, observing meaningful improvements in patients’ recoveries.
Dr. Bishop: Eating disorders can numb emotions and reduce emotional awareness. For example, someone struggling with anxiety can use food restriction to temporarily ease distress. This short-term relief can make it harder to recover. When eating disorder behaviors stop, emotions return — both pleasant and painful. This can feel overwhelming in the short term and become a significant hurdle to overcome.
2004 – Drs. Weiner and Bishop piloted acceptance and commitment therapy (ACT) in their eating disorder treatment programs and saw outcomes improve further.
2008 – Eating Recovery Center opened in Denver, Colorado, founded by Drs. Weiner and Bishop. From the start, the clinical team brought deep expertise in treating severe eating disorders. ACT became central to the adult treatment model. Family-based treatment (FBT) and emotion-focused family therapy (EFFT) strengthened care by positioning caregivers and support systems as active agents of change and healing.
Dr. Bishop: One element missing from eating disorder treatment was helping patients identify what they truly valued. Rather than focusing solely on problems, care now emphasized meaningful goals. This shift noticeably improved outcomes. Individuals who had struggled the most often made progress once they identified what mattered most in their lives.
2013 – BED and ARFID were recognized as distinct eating disorders in the DSM-5.[11] As a result, individuals could now access care for a wider range of eating disorders, often with insurance coverage.
How are eating disorders treated today?
At Eating Recovery Center, treatment consists of a multidisciplinary approach including medical stabilization, nutritional rehabilitation, evidence-based psychotherapies, education and family therapy. Eating disorder treatment addresses co-occurring mental health disorders and is available in multiple levels of care, including:
Two-week “recharge” relapse prevention programs
Transcranial magnetic stimulation (TMS), ketamine therapy and other novel treatments are being studied for their potential role in helping individuals with eating disorders and related mental health concerns. Innovations in refeeding and medical stabilization are making care safer and more effective for all patients.
Frequently Asked Questions
What is the meaning of “anorexia nervosa”?
The term “anorexia” comes from Ancient Greek words meaning “without appetite.” The term “nervosa” is Latin-derived, meaning “of nervous origin,” speaking to its psychological and emotional influence. Some experts criticize this etymology because those with the condition typically experience hunger.[17]
What is the meaning of “bulimia nervosa”?
The word “bulimia” stems from Greek, Latin and French roots and means “extreme or ravenous hunger.” The word “nervosa” comes from Latin and means “of nervous origin,” related to the psychiatric nature of eating disorders. The word “bulimia” may have first appeared in Middle English between 1150 and 1400, with documented use by a translator in 1398. At first the eating disorder bulimia included binge eating behaviors only. Nowadays the diagnostic criteria for bulimia nervosa includes both binge eating and compensatory (purging) behaviors.[8]
About Dr. Emmett Bishop
Emmett Bishop, Jr., MD, FAED, CEDS, founding partner of Eating Recovery Center, received the Certified Eating Disorder Specialist (CEDS) Lifetime Achievement Award in March 2014 to recognize his outstanding achievements in the field of eating disorder treatment and his leadership and contributions to the International Association of Eating Disorder Professional Foundation (iaedp). He was also honored by the Eating Disorders Foundation for lifetime achievement in 2020 and received the iaedp Foundation Lifetime Achievement Award in 2026. You can learn more about Dr. Bishop and his significant contributions to the field of eating disorder treatment here and here.
To learn more about eating disorder treatment at Eating Recovery Center, please contact us by filling out this form or calling 1-866-622-5914.