In the United States alone, over 30 million people suffer from one form of eating disorder or the other. These statistics are not to be taken lightly, especially in light of the fact that there is one death every hour attributed to these eating disorders. As far as psychological disorders go, eating disorders have the highest mortality rate of them all.
While eating disorders are often misrepresented as cultural after effects of body image issues manifested by the pressures of the post-modern era, in reality the unhealthy eating patterns like extreme fasting, purging and bingeing date back to Roman and Christian times. The two most recognized eating disorders are anorexia nervosa and bulimia nervosa.
Anorexia Nervosa involves extreme restriction in caloric intake to achieve weight loss, while bulimia nervosa involves purging or throwing up after periodic binge eating. While more prevalent in teens struggling with body image issues, teen eating disorder treatment is vital or else these disorders can carry on to adulthood and cause fatalistically serious physical and mental health problems.
The Medicalization of Eating Disorders
Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder were categorized as psychiatric disorders in the 19th and 20th Centuries. Anorexia Nervosa was first diagnosed and so named in 1873 by English physician William Gull. Bulimia Nervosa was identified and characterized as an ominous variant of anorexia nervosa, over a hundred years later in 1979 by British psychiatrist Gerald Russell.
Originally, doctors thought that both anorexia and bulimia were physical diseases that were caused by underlying medical issues like hormone imbalances and endocrine deficiencies.
Some doctors even thought that anorexia was a variation of tuberculosis. However, over time physicians began to recognize that the foundations of eating disorders lay in deep rooted psychological and emotional issues rather than physical ones. These disordered eating habits often form a behavior pattern, a vicious cycle of self-induced starvation, followed by bingeing, and consequently purging, a pattern which has been witnessed constantly over medical history.
This gives rise to the belief that these are unchanging diseases that had reared their ugly heads long before they were linked to body image and beauty standards of being skinny in modern times
Even today, there is no consensus about what the best approach for treatment of these disorders may be. This is because eating disorders are complicated and multi-faceted illnesses that can be brought about by a myriad of triggering elements and hence each case requires targeted and unique treatment.
Recently there has been evidence put forwards that looks at the contribution of neurobiological factors and the role of genetic variations in the development of eating disorders. Both these factors hold significant implications for how patients with such disorders should be treated.
Historical Timeline of Eating Disorder History and Research
While it is an easy assumption to make that eating disorders are rooted in society’s obsession with body image in the current times, the first occurrence of eating disorders in recorded history can be traced back to the 12th century, way before being skinny was all the rage.
12th and 13th Centuries: Self-starvation was seen as a religious act, religious starvation was thought to be an act of piety and great faith. Men and women would starve themselves for weeks, believing that giving in to the temptation of food was a sin, and disregarding their need for sustenance was a statement of their devout commitment to God.
1689: English physician Richard Morton provided the first medical description of anorexia symptoms was the first to label it as a medical condition. He called anorexia a condition of “nervous consumption” and that it was a “wasting disease.”
1873: Sir William Gull coined the term “anorexia” and pointed out that it may occur in all humans, males and females. This was the time when the larger medical community recognized anorexia as something other than just traditions of theology (women starving themselves to show their devotion to God).
1888: Doctors noted symptoms and conditions in both male and female patients which we can now identify as eating disorders.
Early 1900s: Doctors would “treat” anorexia patients by separating them from their parents. This treatment was called “Parentectomy” and was thought to be an appropriate treatment well into the 20th century.
1900s: Eating disorders were considered to be endocrine disorders and physicians of the time would prescribe pituitary hormones to treat these disorders.
1903: Dr. Pierre Janet and other doctors observed bulimic behavior in patients. The various signs of what we now know as bulimia included bingeing, purging and abusing laxatives to maintain low body weight.
1930s and 1940s: Eating disorders began to be recognized as psychological conditions. The focus of treatment also shifted to a more behavioral and psychological framework. Psychoanalysis influenced professionals to think anorexia nervosa as being linked to sexual origins. Patients showing symptoms of eating disorders were increasingly referred to Psychiatrists.
1959: Dr. Albert Stunkard made the first mention of binge eating disorder (BED). At the time, binge eating disorder was classified as a symptom associated with bulimia and linked to night eating.
1970s: Cases of anorexia and bulimia became more common, numbers of such reported cases increased.
1973: Psychoanalyst Hilde Bruch published a book with case studies on eating disorders called “Eating Disorders: Obesity, Anorexia Nervosa and the Person Within.” Another book by Hidle Bruch, “The Golden Cage,” showcased the challenges faced by people suffering from eating disorders.
1977: The number of reported cases of bulimia in the U.S., England, France and Germany rapidly rose between 1970 and 1980.
1979: An article titled “Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa,” was published by Gerard Russell which highlighted the differences in symptoms and health risks of anorexic and bulimic patients.
1980: A separate section was added to The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) for eating disorders like anorexia. This recognition recognized and endorsed the serious mental health challenges posed by eating disorders.
1983: One Karen Carpenter, who suffered from anorexia, died of heart failure. This increased awareness of eating disorders in the public eye.
Mid 1980s: Celebrities started coming out to the public about their own eating disorders, most notable of which was Diana, Princess of Wales, who confessed to being bulimic. College counseling centers started offering counseling services for eating disorders.
1987: The Diagnostic and Statistical Manual of Mental Disorders (DSM-III) recognized bulimia as a separate eating disorder.
2013: Binge eating disorder was recognized as its own disorder in the The Diagnostic and Statistical Manual of Mental Disorders DSM-5. It was also classified as a disorder the treatment for which would be covered by insurance.
Evolution of Eating Disorder Research and Treatment
The awareness of anorexia, bulimia and binge eating disorder has increased substantially. Treatment of these disorders is done holistically, a multi-faceted approach using a combined psychotherapy, cognitive-behavioral, educational and physical health approaches. As more information comes to light about eating disorders, better treatment options have become available, and more people make full recovery from eating disorders every day.
- (Craighead et al., 2013)
- (Bemporad, 1997; Craighead, Martinz, & Klump; 2013; Lock & Kirz, 2013).
- (QIMR Berghofer Medical Research Institute, 2016).