Anorexia Nervosa (AN) is a serious and complex eating disorder defined by an abnormal restriction of food intake, an intense fear of gaining weight, and a distorted perception of body shape or size. The history of AN is not marked by a single discovery date, but by a gradual process of recognition, evolving from documented behaviors of extreme self-starvation to a formal medical diagnosis. Understanding this history requires tracing the complex timeline across centuries, moving from spiritual practice to clinical pathology. This journey reveals how cultural context has continually shaped the perception and classification of this debilitating illness.
Early Accounts of Self-Starvation
Long before self-starvation was medicalized, historical records document individuals, primarily women, engaging in extreme fasting for spiritual reasons. During the medieval period, particularly in the 13th and 14th centuries, such severe abstinence was often interpreted as an act of piety, a phenomenon sometimes labeled anorexia mirabilis, or “holy anorexia.” Figures like Saint Catherine of Siena, who died in 1380, famously survived on minimal sustenance as a perceived route to divine connection, viewing food refusal as a spiritual discipline. This behavior was celebrated through a religious lens, establishing a powerful cultural context where physical wasting was seen as evidence of spiritual purity and devotion, contrasting sharply with the later medical view of pathology.
Initial Clinical Observations in the 17th Century
The first documented shift from a spiritual to a clinical understanding of severe self-starvation occurred in the late 17th century. English physician Richard Morton provided the earliest medical description of the symptoms in 1689 in his treatise, Phthisiologia. Morton described two case histories of extreme wasting in an adolescent boy and a young woman, naming the condition “nervous consumption,” or phthisis nervosa, and attributing the physical decline to an emotional or nervous origin. Morton noted the absence of fever or cough, distinguishing it from other consumptive illnesses, and established the foundational idea that the severe restriction was rooted in the nervous system.
Establishing the Name Anorexia Nervosa
The formal recognition of the condition as a distinct disorder happened simultaneously in the 1870s through the independent work of two physicians. In England, Sir William Gull, physician to Queen Victoria, coined the term “Anorexia Nervosa” in 1873, translating to “nervous absence of appetite.” Concurrently in France, Charles Lasègue published a paper describing the same condition, calling it “anorexie hystérique” and framing it in the context of hysteria. Gull preferred nervosa because he observed the condition in both male and female patients, believing it was a broader disorder of the nervous system, and his nomenclature ultimately prevailed.
From Physical Wasting to Psychological Disorder
Following its formal naming, the understanding of Anorexia Nervosa evolved, moving away from purely physical or hysterical interpretations. Early 20th-century psychoanalytic thought suggested the underlying causes were psychological, viewing food refusal as a defense mechanism or a manifestation of emotional conflict, emphasizing the patient’s internal experience. The condition was officially included in the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952, classified as a psychophysiological reaction. Later editions, particularly the DSM-III in 1980, solidified the modern definition by adding specific psychological criteria, such as the intense fear of gaining weight and body image distortion, and recent revisions removed the requirement of amenorrhea.