History of anorexia nervosa

Some claim that the history of anorexia nervosa begins with descriptions of religious fasting dating from the Hellenistic era[1] and continuing into the medieval period.

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 published her popular work The Golden Cage: the Enigma of Anorexia Nervosa in 1978.

A further important event was the death of the popular singer Karen Carpenter in 1983, which prompted widespread ongoing media coverage of eating disorders.

She also had an unnamed illness as a teenager that some now believe to have been anorexia nervosa/chlorosis[4] Her condition is described as involving weight loss, uneven appetite, vomiting and diarrhoea, pallor, fainting fits and breathing difficulties.

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”[8] 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” (a street in the City of London).

He writes of her thus: .. and the Eighteenth year of her Age, in the month of July, fell into a total suppression of her Monthly Courses from a multitude of Cares and Passions of her Mind, but without any of the symptoms of the Green-Sickness following upon it… her appetite began to abate, and her Digestion to be bad; her Flesh also began to be flaccid and loose, and her looks pale, with other symptoms usual in a Universal Consumption of the Habit of the Body.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.

He began to reduce his intake to twelve mouthfuls at each meal; after six months of this experiment, he upped the ante, cutting out all meat and eating only vegetables--primarily potatoes.

But under doctor's orders to avoid all study and to drink a bottle of Madeira per day, Dwight slowly regained his health over the next few months.

He wrote: The duration of this young gentleman's fast is, I believe, longer than any recorded in the annals of Physic.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.

In 1860, Marcé wrote: I would venture to say that the first physicians who attended the patients misunderstood the true significance of this obstinate refusal of food and The hypochondriacal delirium, then, cannot be advantageously encountered so long as the subjects remain in the midst of their own family and their habitual circle.… It is therefore, indispensable to change the habitation and surrounding circumstances, and to entrust the patients to the care of strangers.In 1868, William Gull was a leading British physician living in London.

The Lancet (the BMA's in-house journal) published the following extract from Gull's address: At present our diagnosis is mostly one of inference, from our knowledge of the liability of the several organs to particular lesions; thus we avoid the error of supposing the presence of mesenteric disease in young women emaciated to the last degree through hysteric apepsia, by our knowledge of the latter affection, and by the absence of tubercular disease elsewhere.By 1873, Sir William Gull had been made a Baronet and was one of four Physicians-in-Ordinary to Queen Victoria.

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".

Lasègue began the article by noting the importance of recognizing hysterical anorexia as a diagnostic entity, and then described the progression of the illness.

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.

[16] And stage 3 including a physical deterioration in which a sufferer has a decision to make: "she either is so yielding as to become obedient without restriction, which is rare; or she submits with a semi-docility... which... vastly complicates the situation.

[18] Lasègue also identified "emotional causes"[17] that were often connected to "some real or imaginary marriage proposal,"[17] further highlighting the link between anorexia and the frustrations one goes through in the female transition to adulthood.

[22] More recently, with progress in the field of neuroscience researchers have increasingly looked at anorexia as a biologically-based mental disorder, like schizophrenia.

Hilde Bruch (March 11, 1904 – December 15, 1984) was a German-born American psychoanalyst, who practised at Baylor College of Medicine, Houston in the United States.