Anorexia Nervosa: An Eating Disorder
In order to counsel someone with Anorexia Nervosa, one must first understand that it is not a disease that can be transmitted from one person to another. It is a disorder that is not easily recognizable and often times is confused with another eating disorder, Bulimia Nervosa. The question of whether Anorexia Nervosa is a new disorder or has historical roots will be explored in this paper. The question of whether the current form of Anorexia Nervosa is socially driven, is familial or manifests as a mental disorder will also be explored in this paper. Although Anorexia Nervosa may be acceptable in today’s society, if untreated, can be detrimental not only to the individual’s body weight, but can be psychologically symptomatic and ultimately can cause death. In conclusion, a course of treatment will be reviewed and how a relative or caregiver can do to support a person with an eating disorder
Anorexia Nervosa is not a disease. It cannot be transmitted from one individual to another. It is described according to the Diagnostic and Statistical Manual of Mental Disorders as an eating disorder and is “characterized by a refusal to maintain a minimally normal body weight” (American Psychiatric Association, 2000, p. 583). McShane defined anorexia as:
[T]he pathological pursuit of thinness, primarily through starvation, secondarily through exercising…An eating disorder is a dependency, a way of dealing with stress, a way of managing feelings or conflicts, a way of easing pain or a compensation for lack of control in times of emotional turmoil (McShane, 1996, p. 1).
It was Louis-Victor Marce in 1859 who described a patient with anorexia nervosa (Pearce, 2005). Sheppird and Emery (2018) indicate that Sir Richard Morton, a British physician described anorexia nervosa in 1689. The description that Morton assigned to it was “nervous consumption,” which was wasting due to emotional turmoil. It was in 1874 that:
[A]norexia nervosa was introduced as a clinical diagnosis by two different physicians, Sir William Withey Gull of Britain and Charles Laségue of France. Each emphasized varying aspects of the condition in their clinical reports, yet they both describe anorexia as a “nervous” disease characterized by self-starvation. They were the first to recognize the illness as a distinct clinical diagnosis. When Gull reported about his work to the Clinical Society of London, he used the term anorexia nervosa, which literally means “nervous loss of appetite,” to describe the condition. He was the first to do so. Gull’s reports were published by the society the following year, and the term later gained broad acceptance (Sheppird & Emery, 2018).
Gull wrote six years after he published his first account in 1868, the following:
In…1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…The subjects…are…chiefly between the ages of sixteen and twenty-three…My experience supplies at least one instance of a fatal termination…Death apparently followed form the starvation alone…The want of appetite is, I believe, due to a morbid mental state…We might call the state hysterical (Pearce, 2005, p. 55).
A young Kelsey Osgood wrote about her own experience in becoming an anorectic:
It never occurred to me to try to lose weight in any healthy way, or to strive for a body that “looked good.” I wanted to be repulsively thin, and I knew how people got that way, and that was by being anorexic. I didn’t think of anorexia as a disease, really, but rather as the most logical progression of self-control. It was dieting perfected, and perfection was always the goal. Determination was a quality I had always considered myself particularly deficient in, discipline, too, but all that would change. If I were going to learn to make poetry, it would be by imitating Sylvia Plath. (Osgood, 2013, p. 22)
Joan Jacobs Brumberg (1988) realized that anorexia mirabilis may have been the forerunner to anorexia nervosa. She found an aesthetic significance was attached to women who made the decision to starve themselves.
One might ask if there is a distinct difference between anorexia mirabilis and anorexia nervosa. In the medieval times, women used a form of appetite control as a way to symbolize their religious values (Brumberg, 1988). Pursuant to Jules R. Bemporad (1995) voluntary self-starvation was not a recently developed but has been reported throughout history. Many may be familiar with St. Jerome, the translator of the Old Testament from Hebrew to Latin, but few may know him by his given and baptized name of Eusebius Sophronius Hieronymus. He was a known spiritual leader who attracted women who were born into wealthy families, but who wanted to live the aesthetic life of abstinence and prayer proclaimed by Hieronymus. He used many of these women in helping him in the transcription of the Hebrew Bible. It is recorded that a young protégé of Hieronymus, Eustochium had a sister. Blessila took the elder Hieronymus’ words and applied them to her life and died of malnutrition at the age of 20, perhaps the first to be recorded as dying from self-starvation (Bemporad, 1995).
Fasting was popular among holy women in the thirteenth through sixteenth centuries. These women were, for the most part, Roman Catholic and were intent on becoming saints by and through their spiritual piety and faith in God. They denied normal sustenance for nutrition for the Eucharist – spiritual communion with God through the eating of the body (bread wafer) and drinking his blood (wine). Their purpose was to serve God. Medieval women offered to help those in need. For example, Angela of Fogligno, drank pus from sores and ate scabs and lice form the bodies of sick people. It is said that she spoke of the pus as being as “sweet as the Eucharist (Brumberg, 1988).
In the dark ages, women who refused to eat or drink were thought to be possessed by the devil. Exorcism was used to cast out the demonic presence as was evidenced in two cases (Skrabanek, 1990).
In the late middle ages and early renaissance period, Rudolf Bell (1985) wrote Holy anorexia and Caroline Bynum (1987) wrote Holy feast and holy fast that call attention to self-starvation among European women. Bell’s book records 261 cases including St. Ubaldesca in 1206 to Maria Zonfrilli in 1934. St. Catherine is used as the prime example to most of these women. Catherine was born in 1347. She had a special relationship with her sister, Bonaventura who died in childbirth and then later her younger sibling Nanna died. During the time following her sisters’ deaths, her parents tried to find a suitable husband for Catherine. To make herself less attractive to suitors, she cut her hair, used meditation and flagellated in imitating the passion of Christ. Her intensity in asceticism and her devotion to Christ Jesus increased. Her parents sought to break her will but eventually relented and allowed her to become a nun. She ate and slept little yet she had an unlimited source of energy. She devoted herself to helping others. It is reported that she slept on a bed of sticks that she designed herself and bound her body with an iron chain. She died of malnutrition at age 32 (Bemporad, 1995). Some women followed Catherine’s lead by seeking to get out of arranged marriages and raising children.
The holy anorexia, according to an article published in 2016 by Dell’Osso, et al., states “that some authors named the common fasting habits reported in holy women as “holy anorexia” (also known as anorexia mirabilis)…[to] differ from AN in focusing on spiritual purity instead of a drive for thinness and overevaluation of body shape and body weight, and it is also associated with other penitential practices, as seen earlier.” The authors of this particular article believe that the change occurred during the Renaissance period when new patterns among women who deprived themselves of food started to appear. (Dell’Osso, et al., 2016) Those who were starving themselves were distancing themselves from religion and toward a more body image issue. The ideal body shape for women changes according to the time, culture and social norms.
What evolved next was a new type of anorectic — starving themselves for notoriety, fame and money. Claims from all over the world were reported to newspapers that certain young women could go days, weeks, months and even years without eating. Upon inspection of these claims it was learned either the women were suffering from some digestive disorder, stomach ailments or would sneak food to eat claiming all the time they were able to go without food or water. The women were not to be confused or associated
with having anorexia mirabilis because these young women were certainly not starving themselves for spiritual reasons. There was no medieval term derived to describe these girls, hence the term “fasting girls” (Bromberg, 1988) was used. More and more women were referred to insane asylums. Women had to be lunatics to starve themselves. Doctors in the 1920s and 1930s were referring to two terms almost interchangeably: hysterical anorexia and anorexia nervosa (Bromberg, 1988). Anorexia Nervosa then was treated in hospitals, clinics, and health farms or by private physicians in homes other than the home in which the child was reared. This treatment was used up to and including the 1970s.
The 1980s brought about a new form or anorectic. It can be explained as cultural and was popular and promoted. Ever since the introduction of Twiggy, new demands were placed on young women. Society stressed the youthful look and denounced the well-contoured look of a woman. The age of the athletic woman grew out of that timeframe. The concentration was on diets and physical fitness routines. Magazines, papers and televisions promoted messages to young girls and women to become the perfect size 5, 7 or 9. As in the case of one 17 year old anorectic:
I went to my bookcase and quickly pulled out all my old issues of Seventeen magazine. the exceedingly slender models were beautiful; they seemed to dance across the pages (Landau, 1994, p. 38).
Women with anorexia nervosa express their individualism by controlling a facet of their lives, i.e., physical appearance (Brumberg, 1988). Anorectics supplement their dieting with exercise. They begin a compulsive behavioral pattern that includes a strict exercise regimen and limited intake of food. Susan Byrne on writing about disorders in athletes, believes that both running and food disorders were part of the media frenzy and perhaps in some way responsible for the increased numbers of athletes with eating disorders and in sports (Byrne, 2006).
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