Disturbances in eating have been noted in literature dating back to the 12th century. “The first descriptions of anorexia nervosa in the western world date from the12th and 13th centuries, most famously Saint Catherine of Siena, who denied herself food as part of a spiritual denial of self” (Deans, 2011).
It was not until the 17th century that problems with appetite or eating were tied to some emotional or psychological problem. “At the end of the late seventeenth century, the English physician Richard Morton described the phenomenon of ‘nervous consumption’—a wasting different from tuberculosis due to emotional turmoil” (Vandereycken, 2002 p 152). According to the same author, the loss of appetite and emaciation were common symptoms of well-known diseases such as hysteria, mania, melancholy, as well as all kinds of psychotic disorders.”
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Descriptions of food purposely restricted were written in 1873 by Earnest-Charles Laseque and Sir William Withey. The symptoms included extreme weight loss, amenorrhea, constipation, and restlessness without a relation to a psychiatric problem.
for women to emulate (Chistoper G. Fairburn, 2002).In the 1960s, here was recognition that eating disorders were related to emotional disturbances. Conversely, the prevailing representation of women considered attractive were usually slender. At that time, Twiggy a popular model, who was remarkably slender was perceived to be the ideal body type
It was not until the 20th century that anorexia nervosa was a common psychological problem recognized by certain populations in western countries. In the 1960’s an American psychiatrist Hilde Bruch, wrote more about anorexia nervosa and added the issues of low self-esteem and distorted body image as well as other aspects of this disorder (Garfinkel, 2002).
The eating disorder diagnoses were not legitimately categorized as psychiatric problems until the 1970s. Anorexia Nervosa was the first eating disorder to be classified with symptoms. It was not until 1983, when popular singer Karen Carpenter died from heart failure as a result of anorexia nervosa, that the general population realized the severity and consequences of Anorexia Nervosa.
Gerald Russell was the leading professional to propose a detailed description of symptoms that made up diagnostic criteria. He divided indications into three areas; a behavioral disturbance, a characteristic psychopathology. and an eating disorder. “The behavioral disturbance leads to a marked loss of body fat; the psychopathology is characterized by a morbid fear of getting fat, and the endocrine disorder manifests itself clinically amenorrhea in females and loss of sexual potency and loss of sexual interest in males. These criteria have evolved into the current DSM-IV and IDC-9 criteria …” (Garfinkle, 2002 p.155).
Anorexia is defined as a prolonged loss of appetite (Encyclopedia Britannica, 2013).Often anorexia is confused with anorexia nervosa. Anorexia Nervosa is defined as “a serious disorder in eating behavior primarily of young women in their teens and early twenties that are characterized especially by a pathological fear of weight gain leading to faulty eating patterns, malnutrition, and usually excessive weight loss” (Encyclopedia Britanica, 2013). At times even professional confuse these terms.
This distinction between Anorexia and Anorexia nervosa is significant in psychiatrically evaluating patients today. Recently, a situation arose in my practice illustrating the importance of recognizing this distinction and implications for treatment. The patient, a woman in her 90s reported being hospitalized for anorexia when she was 25. Recently, she, sought treatment as she was experiencing similar symptoms, \these included anxiety, lack of sleep and appetite. As the dialogue between she, myself and her psychiatrist evolved, it was clear that her weight loss was an indication of severe anxiety. She had never purposely restricted her food intake. Evaluation the basis of symptoms is essential in creating an appropriate treatment plan. In the 1930s when this woman, was first diagnosed with anorexia, it was unclear to her as to the reason she had lost so much weight. The symptoms were resolved easily with treatment for severe anxiety. There was no need to explore other issues related to anorexia nervosa.
As a clinician, it is hopeful that we can be more productive in treating these disorders. It is very concerning as the many in which these disorders contribute to the gloomy quality of life. Also the adverse impacts to patients bodies and of course the most devastating as those that perish and rob the world from many of their talents. Karen Carpenter comes to mind “We have only just become… to live.”
References Christopher G. Fairburn, K. D. (2002). Eating Disorders and Obesity. New York: The Guilford Press.
Deans, E. M. (2011, Dec). Evolutonay psychiatric history of eating disorders. Retrieved from Psychology Today: http://www.psychologytoday.com/blog/evolutionary-psychiatry/201112/history-eating-disorders
Encyclopedia Britannica. (2013, April 14). Merriam-Webster.com. Retrieved from Merriam-Webster.com.: http://www.merriam-webster.com/dictionary/anorexia
Farrell, E. (2010, April 14). Lost for Words: The Psychoanalysis of Anorexia and Bulimia. Retrieved from Psychoanalysis and Psychotherapy: http://www.psychoanalysis-and-therapy.com/human_nature/farrell/chap1.html
Garfinkel, P. E. (2002). Chapter 28. Classification and Diagnosis of Eating Disorders. In K. D. Christopher G. Fairburn, Eating Disorders and Obesity (pp. 153-161). New York: The Guilford Press.
Russell, G. F. (1985). The History of Bulimia Nervosa. In D. M. Garfinkle, Handbook for Treatment of Eating Disorders 2nd Edition (pp. 11-24). New York: The Guilford Press.
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