Marcus Valerius Martial AD 103
It would be easy to assume that the origins of medical understandings come from our modern obsession with our bodies and how we are educated to look and feel. However, the history of food and our relationship with it, particularly when it becomes unhealthy conditions goes all the way back to the 12th century.
Fortunately our understanding of the signs, symptoms and solutions has grown and is being continually redefined.
A prime example of cultural shifts is found in the earliest recordings of disordered eating: religious starvation. During the 12th and 13th centuries, self-starvation was considered an act of piety and great faith. Disregarding one’s basic need for sustenance was the ultimate statement of devout religious commitment.
In this period medicine began expanding as a science and the focus on eating disordered behaviors shifted over to a medical model.
As a medical condition, anorexia started to receive recognition as an illness. Richard Morton was a distinguished English physician. He was the first to label anorexia as a medical condition which he noted as a condition of “nervous consumption.”
In the early 1900s, the medical profession began exploring eating conditions stemming from problems within the endocrine system with prescriptive pituitary hormones as a treatment.
In the late 1900s, removing a child from their parents, a Parentectomy, was considered a useful treatment option for minors with eating conditions. There was a belief that an adolescent’s eating condition was caused by their parents. Fortunately this became widely discounted.
In 1903 Pierre Janet published perhaps the first detailed descriptions of patients with bulimia. Janet's observations, although anecdotal, are consistent with modern studies suggesting an association between bulimia and major affective disorder and between bulimia and anxiety disorders. Janet's writings also support the belief that bulimia is more prevalent today than a century ago.
The shift from the purely medical model over to a psychological focus began in the 1930s and 1940s. As eating disorders became recognized as mental health conditions, the focus of treatment shifted to a behavioral and psychological framework.
Before 1959, eating conditions were thought to be primarily related to behaviors such as anorexia (abstaining from food) and bulimia (vomiting or using laxatives to rid oneself of food). The concept of binge eating as a condition was recognized at this time though it was considered a symptom associated with bulimia. It would be another thirty years before being classified as its own condition in the Diagnostic and Statistical Manual of Mental Disorders.
Bruch's research was published collectively in 1973 with the title Eating Disorders: Obesity, Anorexia Nervosa, and the Person Within. Although it's now somewhat outdated, her 1979 text about the causes and treatments of anorexia, The Golden Cage: The Enigma of Anorexia Nervosa, is still referenced today.
Eating Conditions became a diagnosable mental health condition in 1980 when they was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Recognition legitimized eating eating disorders as a serious mental health challenge that warranted treatment and care.
In 1987, the addition of bulimia in the DSM was an important distinction due to the differences between bulimia and other types of eating conditions, such as anorexia.
The recognized differences in these conditions prompted separate diagnoses as well as an individual treatment approach with better options for the care and treatment.
In 2013, with the inclusion of Binge Eating in the DSM truly broadened our understanding and approach in a significant way. Diagnostic criteria for other types of eating disorders include restriction or purging, but the inclusion of binge eating disorder in the DSM allows for more behaviors.
As more information is obtained about eating conditions today, better treatment options become available. Currrent treatments use a combined psychotherapy, CBT, educational, nutritional and physical health approaches.
The expansion of diagnoses criteria continues to offer us greater cultural insight these conditions. As a result, we aim to decrease stigma and offer needed support to those who struggle with these conditions.