W1-History of eating disorders

• HISTORY OF EATING DISORDERS
• Types of AN

  • DSM-5 AN-R
  • DSM-5 AN-BP
  • Other Specified ED: Atypical AN
• Self-starvation in history

  • Late 4th-8th Centuries
  • 700-1000 AD: St Wilgefortis, the "bearded woman" all throughout Europe
  • 1200 AD holy anorexia & holy fasting
  • 1300s-1600s – Renaissance, Age of Enlightenment
• Self-starvation in 1200 AD

  Food refusal believed to be an act of religious asceticism
• Religious ascetics

  • St. Catherine of Siena, St. Veronica
• Historical accounts of AN

  • 1689: Morton describes nervous condition
  • Mid 1700s-1800s – Industrial Revolution, increase in medical explanations
  • 1860: Marce documented form of hypochondriasis
  • 1812-1917: 40 cases of AN among 36,000 English hospital admissions
  • 1840: Imbert describes anorexie nerveuse
  • 18th and 19th Centuries: "fasting girls"
• Historical theories of AN

  • Cultural beliefs
  • Spiritual purity, asceticism
  • Self-sacrifice
  • Demonic possession
  • Miraculous maids, perfectionism and strength
  • Nervous atrophy, nervous consumption
  • Ill and morbid state of the spirits
  • Hypochondriacal delusion, psychosomatic conceptualization
  • Medical and endocrine interpretations
  • Hysteria, psychoanalytic interpretations
  • Neurotic illness, drive for thinness
  • Anorexogenic family environment
  • DSM, spectrum of eating disorders
  • Neurobiology + psychiatry
• Types of BN

  • DSM-5 BN
  • Other Specified EDs: Subthreshold BN
• First formally characterized in 1979
• Symptoms may have first been described earlier
• Early case studies of BN-like symptoms

  • 1908: Janet's case study of a 26-year-old male
  • 1921: Case of "Ellen West"
  • 1932: Wulff's case studies: 4 cases with oral symptoms
• Some described in context of obesity, & may have been subthreshold BN?
• Russell's characterization of BN (1979)


  • Powerful & intractable urges to overeat
  • Morbid fear of becoming fat
  • Avoidance of fatting effects of food by vomiting or abusing purgatives or both
• BULIMIA NERVOSA AS A DIAGNOSIS: WHY NOT UNTIL 1979?

  • Weight and shape concern were not described
  • Drive for thinness was not central feature or even present
  • Rationale shift from "fear of sexuality" to "fear of fatness"
  • Abundance of food following the Great Depression and psychologic factors seems to have contributed in the emergence of the bulimia nervosa syndrome.
• THE MINNESOTA STARVATION STUDY

  • November 1944: Conscientious objectors enrolled in study
  • Primary goal : what happens to the body when starved to better understand how malnutrition would impact people of Europe during WW2

  Effects of extreme dietary restriction

  • Biological effects
  • Psychological effects
• "EATING DISORDER-LIKE BEHAVIORS" DURING AND AFTER STARVATION

  • Food preoccupation (obsession w/ food and recipes)
  • Even after 12 weeks of refeeding, the men frequently complained of increased hunger immediately following a large meal.
  • Binge eating and compensatory purging, leading to weight gain.
• Lessons from history

  • Core behavioral features have existed for centuries
  • Biological impact of those behaviors
  • Treatment implications