When did eating disorders first appear? (2023)

Given the current sociocultural fixation on thinness, one might reasonably conclude that eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are relatively new phenomena. However, historical evidence shows that eating disorders have been around for quite some time — albeit perhaps in slightly different forms.

The historical record

The earliest historical descriptions of people with symptoms consistent with modern eating disorders come from the Hellenistic (323 BCE-31 BCE) and Medieval (5th–5th century BCE) periodsth-fifteenthcentury AD).

It was around this time that purification through the denial of bodily needs and the material world emerged as a cultural theme.

There is an account of a twenty year old upper class Roman girl starving herself to death in search of holiness. There are other reports from the Middle Ages of extreme self-induced fasting, often resulting in premature starvation - Catherine of Siena is an example.

Food deprivation was viewed as a spiritual practice and women were disproportionately affected. Some contemporary writers have referred to these fasting habits as "sacred anorexia."

The motivation for this fast appears to be different from the urge to be thin that has dominated contemporary discussions of eating disorders. Despite this, many believe that it is the same disorder that takes on different cultural meanings simply because of the sociocultural climate.

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history of anorexia

In 1689, the English doctor Richard Morton described two cases of "nervous consumption" - one in a boy and one in a girl. These are believed to be the earliest modern cases of the disease that we know of todayanorexia. He described the lack of a physical explanation for the loss of appetite and wasting, and therefore classified "this consumption as jittery".

The next reported cases were about 200 years later. In 1873, Sir William Gull, another English physician, coined the term "anorexia nervosa" in published case reports. Also, in 1873, a French doctor, Ernest Charles Lasegue, published descriptions of people with "anorexia hysterique".

The American doctor Hilde Bruch significantly influenced the understanding of modern anorexia nervosa. She has published numerous articles and books. It was around this time that anorexia became more well-known.

Recent research has expanded our knowledge, and some of Dr. Bruch's ideas - such as those implying early family dynamics as the cause of the disorder - are now considered obsolete. Previous psychoanalytic explanations of the disease were superseded as our understanding of genetic and biological processes increased.

Researchers Keel and Klump (2003) suggest that the differing motivations for food refusal across historical time periods may represent culturally significant ways to understand a disorder that leaves people - disproportionately women - feeling unable and unable to eat to be ready.

History of Bulimia Nervosa

Unlike anorexia nervosa - which seems to have been identified throughout history -Bulimiaseems to be a more modern development. Bulimia nervosa was first described in 1979 by British psychiatrist Gerald Russell as a variant of anorexia.

Russell himself believed that bulimia nervosa was a culture-bound condition and did not believe that extrapolation to historical cases of overeating and vomiting was relevant to our modern understanding of the disorder. Nonetheless, cleaning was a practice in ancient Egypt, Greece, Rome, and Arabia, cultures where it was used to prevent diseases thought to originate from food. Doctors have also prescribed it. Some early Roman emperors were observed to overeat and then vomit. Some authors disagree with Russell and suggest that this behavior was an early historical variant of bulimia nervosa which—as in the case of the early reports of anorexia nervosa—lacked the modern urge to be thin.

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Searches for descriptions of bulimia nervosa in the early medical literature were less successful than searches for anorexia nervosa.

Among the earliest cases to bear a marked resemblance to modern bulimia nervosa is the case of Nadia, described by Pierre Janet in 1903. She displayed a restricted diet, fears of obesity and binge eating.

Another early description, the case of patient D, was given by Mosche Wulffin in 1932. This patient had periods of fasting alternating with periods of overeating and vomiting.

In 1960, US psychiatrists Bliss and Branch published case histories containing a number of cases of binge eating and vomiting. The German psychiatrist Ziolko published articles in the 1970s describing patients suffering from compulsive eating and vomiting and increasing weight problems.

The 1970s produced case reports of patients with what more closely resembles modern bulimia nervosa. Gerald Russell published his case series of 30 patients between 1972 and 1978 reporting self-induced vomiting in an attempt to mitigate the effects of binge eating. These were found to present a syndrome distinct from anorexia nervosa but shared the same fear of obesity.

His famous article, published in 1979, called bulimia nervosa "an ominous variant of anorexia nervosa." In 1976, Christopher Fairburn also saw an early case of bulimia nervosa and began studying it and developing a treatment for it. The disorder was little known before the second half of the 20th centurythCentury; since then it has become relatively common.

History of Binge Eating Disorder

binge eating disorderwas later on the scene. Binge eating disorder was first described in 1959 by psychiatrist Albert Stunkard, who coined the term "Night-Eating-Syndrom“. He later specified that binge eating could occur without the nocturnal component of this disorder. Binge eating disorder was first studied in populations experiencing weight loss.

In 1993, a manual of cognitive-behavioral therapy for binge eating and bulimia nervosa was published by Fairburn, Marcus, and Wilson. This guide has described howcognitive behavioral therapycould effectively treat bulimia nervosa and binge eating disorder. It has become the most-studied manual on treating eating disorders

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diagnostic history

The three main disturbances occurredDiagnostic and Statistics Guidein the same order.

Anorexia nervosa was recognized as a mental disorder in the late 1700s, following the early reports mentioned above. In 1952 it received a place in the first edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-I), the first eating disorder to do so. However, it was officially categorized: "006-580 Psychophysiological Gastrointestinal Reaction" in a broad category that included gastrointestinal disorders such as peptic ulcer disease, chronic gastritis, and ulcerative colitis. What they had in common was that emotional factors were assigned a causal role.

ThatDSMsecond edition (DSM-II) was released in 1968. Anorexia has been categorized under Particular Symptoms (306). “This category is intended for occasional patients whose psychopathology is manifested by discrete, specific symptoms. An example could be anorexia nervosa under feeding disorder as listed below. However, it does not apply if the symptom is the result of an organic disease or defect or another mental disorder. For example, anorexia nervosa due to schizophrenia would not be included here.”

Other diagnoses in this category in the DSM-II were:

306.0 speech disorder

306.1 Specific learning disorder

306.2 Tick

306.3 Other psychomotor disorder

306.4 Sleep disorders

306.5 Feeding disorder

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306.6 Enuresis

306.7 Encopresis

306.8 Headache

306.9 Other special symptom

ImDSM-III(1980) debuted eating disorders as a diagnostic category under the rubric of disorders of infancy, childhood, or adolescence. Bulimia - not yet called bulimia nervosa - appeared for the first time in this issue. The other eating disorders that are included inDSM-IIIWaren Anorexia nervosa, pica,rumination disorder, and atypical eating disorder.

With the publication ofDSM-IVIn 1994, bulimia nervosa appeared in its current form, with the required shape and weight characteristics. Binge Eating Disorder (BED) was also mentioned for the first time. At this point, BED was not yet recognized as a distinct disorder, but was included in an appendix as a proposed diagnosis for future studies.

In this edition, anorexia nervosa and bulimia nervosa were lifted out of the disorders of infancy, childhood, or adolescence and became their own—eating disorders—while the other disorders (pica, rumination disorder, and eating disorder of infancy or early childhood) remained in the Category feeding and eating disorders in infancy or early childhood.

The binge eating disorder eventually emerged as an independent diagnosis in theDSM-5 in 2013. The categories "Eating Disorders" and "Nutrition and Eating Disorders in Infants and Toddlers" were reunited in the new umbrella category,Nutrition and Eating Disorders. ThatDSM-5also includedAvoidant restrictive feeding disorder (ARFID), for the first time. It replaced the feeding disorder in infancy or early childhood.

In Summe

While anorexia nervosa appears to have existed for centuries, gaining importance depending on sociocultural context, bulimia nervosa is thought to be a more modern disorder influenced by sociocultural factors, particularly the intensified idealization of thinness and increased availability of high-density foods . Binge eating relies on large supplies of easily edible foods and is therefore confined to places and times when food is plentiful. Purging appears to be limited to a context where preventing weight gain is culturally significant.

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Our understanding of these diseases is expanding and evolving. We now know that these are complex diseases that are caused by a combination of genetic and environmental factors. We recognize that this affects people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations and socioeconomic status.

What is an eating disorder?


When was the first case of anorexia? ›

History of Anorexia Nervosa

In 1689, English physician Richard Morton described two cases of “nervous consumption” —one in a boy and one in a girl. These are considered the earliest modern cases of the illness we now know as anorexia nervosa.

What is the root of all eating disorders? ›

Interpersonal Factors

Smaller roots that make up this larger root may include certain family functioning styles, social or romantic concerns, identity concerns (e.g., LGBTQ individuals), having been teased, bullied, or abused, traumatic life events, and/or major life changes, such as moving or the death of a loved one.

How would you describe rates of eating disorders since the 1960's? ›

Rates of diagnosed eating disorders have literally doubled since the 1960s. Similarly, an increase in rates of anorexia in young women ages 15-19 has occurred in each decade since 1930. The incidence of bulimia in women between the ages of 10 and 39 has tripled between 1988 and 1993.

How was bulimia discovered? ›

Bulimia nervosa was first described in 1979 by British psychiatrist Gerald Russell as a "chronic phase of anorexia nervosa" in which patients overeat and then use compensatory mechanisms, such as self-induced vomiting, laxatives, or prolonged periods of starvation.

When did anorexia peak? ›

The incidence of anorexia nervosa remained remarkably consistent over the period studied. Overall there was an increase in the incidence of bulimia, but rates declined after a peak in 1996. This study provides further evidence for the stability of anorexia nervosa incidence rates.

What percent of girls have an eating disorder? ›

Table 2
Anorexia Nervosa (%)Binge-Eating Disorder (%)

What is most responsible for causing eating disorders? ›

What causes eating disorders? The exact cause of eating disorders is unknown. However, many doctors believe that a combination of genetic, physical, social, and psychological factors may contribute to the development of an eating disorder. For instance, research suggests that serotonin may influence eating behaviors.

What are 3 common reasons why people have eating disorders? ›

Some risk factors for developing an eating disorder are:
  • striving to be perfect in one or more areas.
  • low self-esteem.
  • poor body image.
  • social pressure to be thin.
  • problems coping and dealing with stress.
  • bullying.
  • challenges in relationships with friends and/or family.
  • abuse or trauma.

What's the most serious eating disorder? ›

Anorexia Nervosa

Experts consider anorexia nervosa to be the most deadly of all mental illnesses because it has the highest mortality rate. For this reason, we can consider it to be the most severe of the 12 types of eating disorders.

What country has the most people with eating disorders? ›

It is fair to say that the increasing rate of eating disorders, Japan has the highest rate of prevalence, followed by Hong Kong, Singapore, Taiwan, and South Korea.

Which group has the highest incidence of eating disorders? ›

Females. Women are considered to be the population most impacted by eating disorders, with studies indicating women have higher rates of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder than men (. 9%, 1.6%, and .

What age group has the highest rate of eating disorders? ›

How common are eating disorders? The eating disorders anorexia nervosa and bulimia nervosa, respectively, affect 0.5 percent and 2-3 percent of women over their lifetime. The most common age of onset is between 12-25.

What percentage of the population has an eating disorder? ›

Eating disorders affect at least 9% of the population worldwide. 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime. Less than 6% of people with eating disorders are medically diagnosed as “underweight.”

Who first discovered anorexia nervosa? ›

Abstract. Sir William Gull coined the name 'anorexia nervosa'. Examples of self-starvation appeared in the Hellenistic era. Holy anorexics abused their bodies, rejected marriage and sought religious asylum where many perished and became saints.

What are the main 2 causes of bulimia? ›

Factors that increase your risk of bulimia may include:
  • Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. ...
  • Psychological and emotional issues. ...
  • Dieting.
May 10, 2018

Does anorexia shorten your lifespan? ›

The disease has the highest mortality rate of all mental health disorders. As many as 20 percent of the people who suffer from anorexia will eventually die from it. And the longer a person suffers from anorexia, the greater their risk of dying becomes.

What is the survival rate for anorexia? ›

Regardless of age, every 1 in 5 anorexia deaths is a result of suicide. Without treatment, up to 20 percent of all eating disorder cases result in death.

Is There Life After anorexia? ›

Life after anorexia treatment is never going to be easy. However, it's worth putting in the effort. With the right attitude and the right support, you can live a long, happy and healthy life free of your eating disorder.

How many high school girls have eating disorders? ›

3.8% of female, and 1.5% of male, adolescents will struggle with an eating disorder [1]. Prevalence rates of eating disorder diagnoses increase with age [1]. .

What is the #1 eating disorder in the US today? ›

Binge-eating disorder

Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Which eating disorder is the least common? ›

Anorexia nervosa is the least common of the three eating disorders, but it is often the most serious.

What are the 2 main causes of anorexia? ›

The exact causes of anorexia nervosa are unknown. However, the condition sometimes runs in families; young women with a parent or sibling with an eating disorder are likelier to develop one themselves. Then there are psychological, environmental, and social factors that may contribute to the development of anorexia.

What part of the brain has to do with eating disorders? ›

The brain region known as the right insula also seems to be altered in people with anorexia. That bit of brain helps to process taste sensations, but it's also involved in interoception, the ability to sense one's own bodily signals. Those skewed body signals are the subjects of Zucker's research at Duke.

How does the brain develop an eating disorder? ›

NIH-funded study finds changes can affect food intake control circuitry and cause disorders to progress. Researchers have found that eating disorder behaviors, such as binge-eating, alter the brain's reward response process and food intake control circuitry, which can reinforce these behaviors.

What is it called when you don't like eating? ›

Anorexia is a general loss of appetite or a loss of interest in food. When some people hear the word “anorexia,” they think of the eating disorder anorexia nervosa.

What is Diabulimia? ›

What is diabulimia? Type 1 diabetes with disordered eating (T1DE) or diabulimia is an eating disorder that only affects people with type 1 diabetes. It's when someone reduces or stops taking their insulin to lose weight.

What is Orthorexia? ›

Individuals living with orthorexia are extremely focused – and often obsessive – over the quality and purity of their food. Individuals with this condition often limit “go foods” to those that are organic, farm fresh, whole, raw and/or vegan. The quantity of food is typically less important than that quality.

Has everyone had AN eating disorder? ›

When it comes down to it, no— not everyone has an eating disorder. Not everyone spends their days trying to find ways to be in control of their diet and their life. Not everyone has the perpetual anxiety of how they will get out of the next meal.

Can you not be skinny and have AN eating disorder? ›

People with eating disorders can be underweight, can be overweight, and anywhere between. Regardless what someone may weigh, eating disorder behaviors can have serious—sometimes fatal—health consequences.

Can everyone get AN eating disorder? ›

Eating disorders can affect people of any age, race, gender or sexual orientation. They are often diagnosed in teenagers and young adults, but many people are first diagnosed with an eating disorder in later adulthood. Sometimes the first signs and symptoms develop at a much younger age.

What is the start of anorexia? ›

Warning Signs of Anorexia

Constant worry about dieting, food, calories, and weight. You complain a lot about being “fat” You refuse to eat whole groups of food, like carbohydrates. You pretend you're not hungry when really you are.

What is the background of anorexia? ›

Origins of Anorexia Nervosa

Anorexia has origins in religious practice, and is believed to have developed out of early European fasting practices. Fasting was a common practice in ancient Christianity, and was typically just a few days in duration and was associated with purity.

Can you get anorexia at 12? ›

While this is shocking, and while actual eating disorders in children this young are still relatively uncommon, anorexia nervosa has been identified in children as young as seven years old. Importantly, eating disorders in children and tweens look different than eating disorders in teens and adults.

What is the most common eating disorder in the world? ›

Eva Schoen, PhD, assistant professor of psychiatry and clinical director of eating disorders services at University of Iowa Hospitals & Clinics, says binge eating disorder, or BED, is the most common eating disorder, even though it's not talked about as much as other eating disorders, such as anorexia or bulimia.


1. Wednesday Webinar: Understanding Eating Disorders and How to Intervene
(NJ Center for Tourette Syndrome)
2. Eating disorders through developmental, not mental, lens | Richard Kreipe | TEDxBinghamtonUniversity
(TEDx Talks)
3. What Defines an Eating Disorder
4. How do I tell if I have an eating disorder?
(Children's Hospital Colorado)
5. Treatment for Eating Disorders
(Psych Hub)
6. Five signs your child may have an eating disorder
(Joe DiMaggio Children's Hospital)


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