An eating disorder is a serious mental and physical illness, yet the recognition of these conditions as medical problems developed over centuries. The behaviors associated with eating disorders have existed throughout history, but their interpretation has dramatically shifted from spiritual devotion to psychological and biological illness. The “discovery” of eating disorders was not a single event but a gradual process across different centuries and diagnostic categories. Understanding this timeline clarifies when self-starvation and other disordered behaviors moved from being seen as moral or religious phenomena to being classified as conditions requiring medical intervention.
Early Descriptions of Self-Starvation
Long before the medical community recognized eating disorders, instances of extreme food restriction were documented, often interpreted through a religious or moral lens. In the Middle Ages, particularly among women, severe self-starvation was sometimes viewed as an act of piety, a phenomenon now retrospectively referred to as anorexia mirabilis or “miraculous loss of appetite.” These behaviors were considered a way to imitate the suffering of Christ and elevate the spirit above the needs of the body.
A prominent example is Saint Catherine of Siena, who lived in the 14th century and is recorded to have subsisted almost entirely on water and herbs, ultimately dying from self-starvation at age 33. Her refusal to eat was framed by her biographers as a sign of profound spiritual devotion and a successful rejection of earthly pleasures. While her extreme fasting resembles modern anorexia nervosa, the cultural context saw the behavior not as a sickness but as a path to sainthood. This highlights that the behaviors have always been present, but the medical diagnosis of a disorder is a much more recent development.
The Formal Medical Recognition of Anorexia Nervosa
The formal medical recognition of an eating disorder occurred in the 19th century, when self-starvation began to be classified as a distinct syndrome rather than a religious or moral issue. This shift marks the beginning of eating disorders being viewed as medical conditions. The year 1873 is frequently cited as the moment of formal recognition, with two physicians independently describing the condition on separate sides of the English Channel.
In England, Sir William Gull, a physician to Queen Victoria, published a paper establishing the term “Anorexia Nervosa.” He had previously referred to the condition as Apepsia hysterica in 1868 but changed the name to “nervosa” because he realized the condition was a disorder of the nervous system, not just the digestive system, and was not limited to women. Gull provided detailed clinical descriptions, noting extreme emaciation without apparent physical disease, alongside a persistent refusal to eat.
Simultaneously in France, Ernest-Charles Lasègue published “De l’Anorexie Hystérique,” offering a comprehensive account of similar self-starvation. Lasègue focused on the psychological trajectory of the illness, detailing the resistance of patients and the family dynamics involved. Although Gull is often credited with coining the lasting term, the near-simultaneous descriptions by both men cemented self-starvation as a recognized medical and psychiatric concern in the Western world. This 1873 recognition of “Anorexia Nervosa” represents the first formal classification of an eating disorder.
The Identification of Bulimia Nervosa and Binge Eating Disorder
The recognition of eating disorders as a spectrum of conditions continued long after the 19th-century identification of Anorexia Nervosa. The full scope of disordered eating was not understood until the 1970s, with the formal identification of Bulimia Nervosa. This condition involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors like self-induced vomiting or excessive exercise.
The British psychiatrist Gerald Russell formally described this distinct pattern in 1979 in a paper titled “Bulimia Nervosa: an ominous variant of anorexia nervosa.” Russell noted that the patients he studied shared the intense fear of becoming fat seen in Anorexia Nervosa but were often of normal weight and engaged in uncontrollable overeating episodes followed by purging. This work distinguished Bulimia Nervosa as a separate diagnostic entity, even though it was initially viewed as a variant of the established anorexia diagnosis. The formal definition of Bulimia Nervosa demonstrated that eating disorders were characterized by cycles of binging and compensatory behaviors, not solely self-starvation.
The discovery process extended into the 21st century with the formal recognition of Binge Eating Disorder (BED). BED is characterized by recurrent episodes of eating an unusually large amount of food in a short period with a feeling of lack of control, but without the regular compensatory behaviors seen in Bulimia Nervosa. While the behavior had been observed and studied for decades, it was the last of the major eating disorders to be officially classified. This shows that the medical understanding of eating disorders is an evolving process, with new patterns of behavior continually being identified and formalized.
Standardizing Diagnosis in the Modern Era
The final stage in the discovery process involved standardizing the diagnostic criteria for eating disorders to ensure consistent identification and treatment across the global medical community. This standardization relies on official psychiatric manuals, such as the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases (ICD). The inclusion of a condition in these manuals signifies its acceptance as a formal, distinct illness.
Anorexia Nervosa and Bulimia Nervosa were first formally included in the third edition of the DSM, known as DSM-III, which was published in 1980. This inclusion provided clinicians with uniform criteria for diagnosis, moving the conditions from specialized medical literature into mainstream psychiatric practice. The criteria for these conditions have been refined across subsequent editions, but the 1980 DSM-III marked their official entry into the modern diagnostic system.
Binge Eating Disorder (BED) achieved standardized status much later, first appearing in the appendix of the DSM-IV for further study. It was not until the publication of the DSM-5 in 2013 that BED was officially added as a stand-alone diagnostic category. This step provided clear criteria for a disorder previously categorized under the residual “Eating Disorder Not Otherwise Specified” (EDNOS) diagnosis, completing the standardization of the three most prevalent eating disorders.