Today we have been around campus at UCSD, putting up several posters about Eating Disorders (ED) to raise awareness of this disease on campus. The poster contains some myths about ED, and information about UCSD's health center for eating disorders - for treatment and research. We hope this will help raise awareness, and give people more knowledge about the great offer this school provides.
Source: All pictures are personal, and we would like for it not to be reused by anyone else.
There has been a lot of discussion around eating disorders (ED) and why some individuals seem more predisposed than others for developing this disease. There are many people in today’s society that diets and live a healthy lifestyle, but few develop an ED. Twin studies show approximately 50-80% heritable risk, which indicates a really powerful neurobiology and genetic contribution. This means that it is not just a choice people take when developing an ED, your genes and the environment will work together.
Studies show that some traits seem to correlate with ED more than others – perfectionism, achievement, anxiety and obsessive/impulsive to mention some. Temperament and personality factors are related to neural circuit functions, and are important in developing the disorder. Their specific neurochemistry is what's causing and maintaining the disorder.
ED reflects a discrepancy between one’s physical need to eat and ones drive to eat – this is the difference between homeostatic and hedonic hunger. Humans are driven by a physiological necessity to eat. Our hunger hormones ghrelin and leptin increases or decreases the dopamine release in our brain, the first one increases, and the last decreases. Studies have yielded some utterly exciting results when it comes to RAN patients. They failed to show associations between ghrelin and bold responses to visual food cues in limbic regions. Patients with AN actually showed decreased response to sweet tastes, while individuals with BN showed increased response to sweet tastes.
Brain imaging studies have showed us that RAN patients altered reward sensitivity and increased behavioral inhibition are related to underachieve limbic (reward) circuitry and overactive executive (inhibition) neural circuity. Food is interpreted as something aversive, and threatening - and by not eating you will actually remove the negative emotions associated with food. RBN patients on the other hand showed an "exaggerated" reward drive to eat, suggesting a neural mechanism for emotional eating. This has some major clinical complications, because rewards is often used to reinforce improved dietary intake in ED, but these findings show us that this is not very successful because AN patients failed to accurately encode rewards.
These findings also contravenes the beliefs many people have about eating disorders being mainly a choice done by the person - neurobiology has a major impact on developing eating disorders, and there is always a correlation between a persons genes, and the environment. The fact that genes has such a big impact can help lessen the stigmatization towards eating disorders.
Source: Neurobiology of eating disorders by Christina E. Wierenga, Ph.D ( Date oflecture: 10.19.2016)
Every system in the human body is affected by eating disorders. There are numerous complications following malnutrition, where some of them are reversible while others are not. And considering Anorexia Nervosa has the highest mortality rate of any psychiatric disorder, we should learn more about the medical complications that follow an eating disorder. Malnutrition is defined by a low BMI and significant weight loss, weight loss is a more important determinant of malnutrition because you can be malnourished even though you have a normal or high BMI, it depends on your start point.
When you become malnourished your body starts shutting down the least important functions first, your heart rate will slow down, your body temperature will decrease (which is why malnourished people are constantly freezing), women will lose their menses etc. We will in this blog post look at some of the medical complications as a result of eating disorders.
Systems affected by eating disorders include:
- Cardiovascular system
- Fluids and electrolytes
- Head and Neck
- Dermatologic (skin and hair)
When you become malnourished the cardiac output will decrease due to decreased ventricular wall mass and thickness, which means that your heart will pump less blood. This could lead to dizziness and consequently fainting. If your heart beat is less than 45 beats per minute, you’re in the risk of getting cardiac arrest which is the number 1 cause of death. Malnourishment can also result in poor peripheral perfusion or in other words getting cold and blue hands and feet.
Fluids and electrolytes:
Some people will drink a lot of water when they’re suffering from an eating disorder, just to feel full, while others will barely drink at all. Poor oral intake of fluids, vomiting and laxative use are all causes of dehydration and/or electrolyte abnormalities. An electrolyte is a substance that has to be dissolved in a polar solvent (water for instance), so when people vomit for example and become dehydrated, electrolytes will not be dissolved. Water loading (drinking large amounts of water) can cause dilution of electrolytes, especially sodium, which is crucial for the cell’s functioning in our bodies. People who suffer from AN and BN need careful electrolyte monitoring when they’re being treated. Consequences of dehydration include low blood pressure, dizziness, constipation, confusion, organ injury etc. The consequences of electrolyte abnormalities can be lethal if not monitored.
We see cognitive impairments in memory, learning, organization, concentration and judgement. If you are malnourished it is for example extremely hard to process information. Really bright young people who developeating disorders may start forgetting things they once knew and have difficulties doing the tasks they before did without any problems. Impairments like these can occur because of their eating disorder and go away once they get enough nutrition and become healthy again. Some structural changes might not be reversible, especially if you’re young and your brain is developing.
Other psychiatric disorders as a result of eating disorders include; anxiety, depression and psychosis. Suicide is the second largest cause of death in people with eating disorders.
Malnutrition effect the gastrointestinal system in many ways. Constipation for example is not uncommon, due to malnutrition’s effect on the metabolism. If you don’t eat, your metabolism slows down and the food you eat will stay in your body for a longer time, this can cause constipation. Another example is pancreatitis, inflammation of the pancreas, which is something you can get as a result of being very dehydrated, or even vomiting can cause inflammation of the pancreas.
Malnutrition can affect the hypothalamus, so that the brain stops producing hormones such as estrogen in girls and testosterone in boys. These hormones affect your pubertal development and low levels can eventually lead to pubertal arrest depending on a person’s stage of development (eg. not developing breasts) which can be extremely devastating to one’s body image.
You have until you are 25 years old to develop the bone density that you will have for the rest of your life. If you are malnourished/suffer from an eating disorder before the age of 25 you may get decreased bone density. Estrogen and testosterone are hormones inhibiting the breaking down of bones, and cortisol inhibit bone density. Decreased sex steroid production and increased cortisol levels are related to low weight, which means that the only way you can restore the levels of hormones crucial to having healthy bones, is by regaining a healthy weight.
Dermatologic and immunologic effects:
Some people will get lanugo, which is thin, soft hair that grows on small babies when they’re born, but also anorexics when they have very little body fat left to keep them warm. Other dermatological effects include poor wound healing, dry skin, hair loss, russell sign (sore knuckles due to purging) and skin breakdown and ulcers. If you follow a vegan diet you may get a lack of iron, b12, omega 3 and other nutrients in your body and this may suppress your immune system and make you more susceptible to diseases and poor wound healing. If you get an ulcer that gets infected and you don’t have an immune system to fight it, you can actually die. Some people who have low body weight will struggle with nose bleeds or bleeding in general because the blood doesn’t cloth due to low platelet count.
https://en.wikipedia.org/wiki/Electrolyte (Date: 11.07.16)
Lecture 5, Medical complications, by Dr. Maya Kumar, MD
Source: Medical complications, by Dr. Maya Kumar, MD (Dateof lecture: 10.26.16)
What type of eating disorder (ED) do you have? How old were you when you got your ED and for how long did it/has it lasted?
I was 22 years old when I was diagnosed with Anorexia Nervosa. I believe I had struggled with this for quite a long time, but I was not aware of if myself until later.
How was your body image before you got an ED?
My self-esteem has been very low from around age 14-15. It is hard to tell exactly how I felt about my body before I got an eating disorder, because this has dominated my life for such a long time. I don’t think I had a strained relationship to my body during elementary school though.
What was your view of eating disorders before you got it?
Before I was diagnosed with AN I didn’t have any knowledge about ED's. Sure, I knew about anorexia nevrosa and binge eating, but that was as far as my knowledge went.
Do you feel that it was your own choice to get an ED?
I have always had a complicated and hard relationship towards food. I never told myself that I should go ahead and get an eating disorder, but this was a choice I made – I choose not to eat.
What factors do you think contributed to getting an ED?
This is perhaps the hardest question you could ask me about this disease. I have been through so many rounds with myself, asking the same questions over and over again. My childhood was extremely good, and there was no bullying during school, so it is hard for me to point to a particular event in my life that contributed or triggered my ED. My relationship to food and body image have been strained and complicated though, but it was not before I was diagnosed with AN that I consciously decided I would take control over my eating. At this period in my life I was extremely depressed, because I went through a though break-up and my self-esteem was very low. At this point in my life I felt like food was the only thing I could control – and my goal was never to lose weight, just feel that “rush” of being in charge and controlling something in my life.
Has your ED given you any physiological consequences?
I got osteoporosis from AN. This is something that can get better over time with the right nutrition, but my skeleton will never be as strong as if I had lived a “normal” and healthy life. My underweight has also made me develop cold hands, chills and bad teeth.
Have you had any friends with ED, did they affect you in any way?
I don’t have any good friends that suffers from any eating disorders.
What is your view on food?
Food was my worst enemy, if I lost against the food I was weak. Food was the only thing that occupied my thoughts, and the only thing my friends and family was nagging about. I hated it.
Have you ever gotten any treatment for your ED, if so, what kind of treatment?
Yes, I have. In different ways actually. My first time was a hospital in Norway - outpatient treatment - center for Eating Disorders, Vestfold Hospital). I went here for a couple of weeks to see a doctor and a shrink once a week. After this I was hospitalized as a day-time patient, this was a treatment where I Monday-Friday was at the hospital to eat and got different treatments. This was a 26 week long treatment so I could gain normal weight again, but I quit after 20 weeks. I lacked motivation and felt that I was in the wrong place. After this I started to work again while I was seeing a shrink for one year, before she again referred me back to treatment at the hospital. After two weeks I quit again, because I knew this was not working for me.
Do you use any methods to regulate your ED?
My way to cope and regulate my ED is to be honest and open with myself and my closest circle. After my last treatment I knew this was something I had to handle by myself, because in the end – it is only me who can regulate my own eating. I have lost too much because of this disease, myself, my job, my driver license and freedom. I got my job back, now I only miss my license to drive – and the only way to get this back is to gain weight.
Can you think of any direct consequences your ED has had in relation to how you perceive food, diets, workouts and social events (such as eating out with friends)?
After I was diagnosed with AN and went through different treatment programs I really changed how I looked at eating disorders. I didn’t really care about training or healthy dieting, even when I was sick. When I was in treatment though, I watched other people and I saw how easy it was to get a restrained relationship towards training and dieting – and this made me scared about starting working out. I also got a lot more knowledge about calories after my treatment, and this was also one of the reasons I quit the program. I felt that the treatment made me be even more strict with my food intake, always counting and controlling the intake of food. I don’t think food will be a “normal” thing for me again. I know my body needs nutrition, but I believe there is a long way to go before I can enjoy a good meal with family and friends again. This is something I have to live with, and that is the hardest part.
Have you ever experienced any stigma related to having ED and has that affected your openness about it?
At the time when I was diagnosed with AN I was in denial, I didn’t believe it and was utterly concerned about this – it couldn’t be true. The fact that I said yes to treatment the first time was to prove everyone wrong, because I did not suffer from a disease. The fact that I got a mental illness will always be hard on me, this has and still is taboo for many people. It was extremely hard for me at first, to tell my job, my friends and family – I was sick, and hospitalized, but had no visible injuries. After years struggling with this sickness I have gained more knowledge though, and my goal is to be more open and honest about this disease, so people can try to understand me, and gain more knowledge.
What is your body image like today?
I still struggle with low self-esteem, and how I look at my body is quite bad. But I have gained so much strength the last year, and I believe in myself now more than ever – so I believe it is better than ever, and that I at the end maybe can gain more control over this disease.
This interview is personal and we would like for it to not be reused or quoted by anyone else.
This study was conducted at the university of Minnesota during November 19, 1944 through December 20, 1945, which was a time of war and famine in the world. This experiment was not primarily conducted to study eating disorders, but offered great insights on the psychological and biological effects of starvation. The 36 participants were all male and had to have a good physical and mental health. The men were expected to lose 25 percent of their normal body weight during the study.
During the first three months of the study the participants kept a normal diet where they consumed about 3200 calories a day. During the semi-starvation period, which lasted for six months, the participants ate about 1560 calories per day, and their diet consisted of mostly potatoes, root vegetables, macaroni and bread, which was the most common food in Europe during the war. The following three months was a restricted rehabilitation period, where the men were divided into groups where they received one out of four different caloric energy levels and different protein and vitamin levels. The goal was to see how much was required to re-nourishthe participants after being subjected to conditions of famine. In the last two months, which was the unrestricted rehabilitation period, participants could consume how many calories they wanted, but their food intake was carefully monitored and recorded.
The results from this study showed for instance significant decreases in sex drive, heart rate, strength and body temperature and the participants showed signs of social withdrawal and isolation. Besides that, the men reported being depressed, tired and irritable. Participants also exhibited a preoccupation with food, not just during the starvation period but during rehabilitation as well. These findings are interesting because after the starvation period, many (however, not all) participants exhibited behaviors that resembled having an eating disorder. As a result of this study we can assume that eating disorders are not just caused by sociocultural effects, but also biological effects.
If you want to learn more about the study, you can watch the youtube video below.
https://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment (Date: 11.05.16)
https://www.youtube.com/watch?v=iOesvjNiK-Y (Date: 11.05.16)
http://www.apa.org/monitor/2013/10/hunger.aspx (Date: 11.05.16)
It is a fact that the role of media and cultural norms concerning expansion of the “thin ideal” is massive in today’s society. Being a young adult in 2016 means that you each day get exposed to a great deal of media that screams “being thin is what’s make you happy and successful”. Among social medias, it is especially blogs and Instagram accounts that yields these messages. The objectification theory states that this messages leads girls and women to see themselves as objects that gets assessed by the way they look. To make people, especially young girls aware of the massive impact these messages have on their own self- image, and educate them regarding the cause and consequences of ED, we therefore made an Instagram account. Check it out and of course follow us: toeatornot2eat
Before digging deeper into the influence of culture and media, we should make one thing clear. It is not culture and media that CAUSES the occurrence of an eating disorder. If that was true, then everyone would have one. Rather it is factors that can TRIGGER an eating disorder when you are already predisposed by genetic factors. This means that certain people may be more sensitive to media and norms, a trigger that can lead to the development of ED. When that is said, there are no escaping the facts that culture is a huge source of influence.
The profound influence of culture, eg. the western “thinness” image, can be explained by the sociocultural theory. This theory states that messages reflecting the cultures ideology are sent out by “socialization agents” and in turn impact an individual’s behavior. Norms that are socially constructed, e.g. the pressure to be thin, is internalized and consequently increase the risk of dieting, negative affect and eating pathology. The theory has given evidence by highlighting the gender differences existing between girls and boys, secular trends (decrease in body size show correlation with increased rates of ED) and crosscultural differences.
A myth that exist among people is that the main source of influence affecting ED is media. Throughout the lecture provided by Jessie Menzel in our eatingdisorder course we learned that peers work as “socialization agents”, and are a source of culture messages that affects us the most – surprisingly more than media and parents. A reason for this may be the known “fat talk” phenomenon. Haven`t you and your girlfriends, or you and your buddies talked negatively about your body or how much you gained and how much better your friends look? Research have yielded that approximately 93% of adolescences girls engage in this body-denigrated talk that is considered socially acceptable, and expected. This lead to a cultural norm, sending out messages that one SHOULD be dissatisfied with one’sbody. Studies supporting this massive peers influence reviles that physical attractiveness is related to more positive peer evaluation, that groups tend to have similar dieting behavior and that teasing correlates with body dissatisfaction and bulimic behavior.
The tripartite model offers an explanation of the influence of peers but also parents and media on the development of ED. The model provided byThompson, Altabe, Heinberg & Tantleff- Dunn illustrates that the internalization of the thin ideal and appearance comparison is mediators that affects the impact peers, media and parents have on body dissatisfaction – which in turn influence restricting and binging& purging- behaviors common in ED. High Internalization of the thin ideal, which means how a person incorporate the desire to be thin, is shown from experimental research to increase the body dissatisfaction. Some evidence yields that specific personality traits may increase the ability to internalize, including perfectionism. When talking about appearance comparison, it is the upward comparison (comparison with someone “better” than yourself”) that is strongly associated with body dissatisfaction and ED behaviors. Conclusively, peers, media and parents can be triggers for the development of ED, but how it affects depends strongly on how they internalize these messages and how and with whom they compare themselves with.
Source: Culture and eating disorders -” Its in the jeans” by Jessie Menzel, Ph. D.(Date of lecture: 10.12. 2016)
BINGE EATING DISORDER (BED)
Binge eating is an eating disorder characterized by recurrent episodes of eating large qualities of food, often very quickly and to the point of discomfort. It also includes feeling loss of control during the binge, which means that the person is unable to stop how much one is eating, and eat's rapidly. People with this disorder think a lot about food, eat alone, eat despite not being very hungry and until feeling uncomfortably full. It is also characterized by feeling anxiety, depressed, or guilty afterwards.
To be diagnosed with this disorder, the binge eating has to occur at least once a week for 3 months. Statistics show that 20% of collage-aged women have engage in this behavior, and this is the most common eating disorders in the United States, affecting 3.5 women, 2% of men, and up to 1.6% of adolescents. The people who meet the criteria for binge eating are more likely to be overweight, and often report struggling with weight as children.
AVOIDANT/RESTRICTIVEFOOD INTAKE DISORDER (ARFID)
ARFID is an eating disorder characterized by persistent failure to meet appropriate nutritional and energy needs, because the person isn´t able to take in the adequate amount of calories/nutrition through their diet. It is often associated with losing weight, significant nutritional deficiency, requiring enteral feeding or nutritional supplements and interference with psychosocial functioning. People suffering from ARFID may avoid eating out with friends or other social events if food is present.
The food disturbance cannot be better explained by not having food present and does not exclusively occur during the course of AN or BN, and is not better explained by another mental disorder.
People can develop ARFID if they once have eaten something aversive, for example a bad egg, and then they stop eating eggs or anything that resembles an egg or contains eggs. Eventually your diet will be very limited because you gradually cut out things from your diet. You might get an ARFID diagnosis if you have difficulties digesting some types of food, you avoid colors or a certain texture, if you’ve had an aversive experience (as described) or frightening episode of choking for example.
Pica is an eating disorder characterized by persistent eating/appetite for non nutritive, non food substances such as paper, hair, stones, glass etc, over a period of at least 1 month. DSM points out that for someone to get the diagnosis the consumption of non nutritive/non food substances have to appear at an age where the person understands that the objects they are consuming are inappropriate to eat, which means that a baby can´t be diagnosed with this disorder if he/she eats paper, but an adult can get the disorder because of the knowledge among (most) adults that eating paper is unusual.
It is also important to take the culture into account. The eating behavior should be something outside a culturally supported or normative practice. Pica is often linked to other mental and emotional disorders such as deprivation, family issues, pregnancy, trauma etc. It also often occur together with other mental disorders like intellectual disability, autism spectrum disorder etc. If the disease occurs early in life it may have consequences for both physical and mental development.
This type of eating disorder is characterized by repeated regurgitation of food over a period of at least 1 month. The disorder was during a period seen as exclusive to an infant or child, but later the DSM-5 classified this disorder as a legitimate eating disorder. People with this disease regurgitate the food in their mouth without any retching nausea or disgust. They often report that they like the food and are hungry, but nevertheless regurgitate the food, often within 30 minutes of eating. The disorder is not attributed to an associated gastrointestinal or other medical condition, and do not occur together with any other type of eating disorder.
OTHER SPECIFIED FEEDING OR EATING DISORDER
Other specified feeding or eating disorder is a type of disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder. This category of eating disorders consists of more than 50% of all the diagnosed eating disorders.
A typical Anorexia Nervosa is an example, and these people meet all the criteria for Anorexia Nervosa except the significant weight loss, so the weight is not below the normal. Purging disorder is another example, which is when a person participates in purging behavior, but does not binge eat. This behavior influence both weight and shape. A third example is night eating syndrome, which is characterized by excessive night time food consumption. All these conditions causes serious emotional and psychological suffering, and can also lead to serious problems in areas of school, work or interpersonal relationships.
UNSPECIFIED FEEDING OR EATING DISORDER
This category of eating disorders are used for patients that experience clinically significant distress or impairment, but the symptoms are not characteristic of one of the other diagnostic classes of eating disorders - or do not meet the full criteria for them. The diagnosis is used when the clinician chooses not to specify the reason for why the criteria don't meet the specific disorder. This can be the case if a person is diagnosed in an urgent care setting or in a emergency room.
Source: Assessment and Diagnosis , by AnneCusack, date of lecture: (10/05/16)
A common myth and a common belief among many people is that eating disorders are mainly about Anorexia Nervosa and Bulimia Nervosa. This myth is not true. There are several types of eating disorders that exists, which takes different shapes and forms.
Another myth is that you can tell just by looking at people if they suffer from an eating disorder. That´s wrong as well, no matter how a person looks like, one can suffer from having an eating disorder.
The number of eating disorders have increased over the past years and results in serious health consequences. We think that it is important for people to know about the large spectrum of eating disorders, and which symptoms must be present to be diagnosed with an eating disorder, because of the narrow knowledge about it.
The DSM-V is a diagnostic and statistical manual, which describes the diagnostic criteria of many different mental disorders, and describes eight types of eating disorders:
-Avoidant/Restrictivefood intake disorder (AFRID)
-Binge eating disorder
-Other Specified Feeding or Eating Disorder
-Unspecified Feeding or Eating Disorder
-Orthorexia (Not an official diagnosis in the DSM-V)
Anorexia Nervosa (AN) may be the most common or known type of eating disorder, and when talking about ED this is what always pops up. Maybe that is the reason for the everyday myth? A scaring facts is that AN actually has the highest mortality rate of any psychiatric disorder! If you are between 15 to 24-years old and have AN, the mortality rate is 12 times higher than any other cause of death. DSM-5 lists out numerous criteria’s for getting diagnosed with AN. First of all, a criterion is that restrictive energy intake leads to less than what is seen as normal body weight compared to people at the same age, sex, developmental course and physical health. Persons also have to have an intense fear of gaining weight or becoming fat AND engage in behaviors that is keeping them from gaining weight. The fear and the behavior can exist even if the person is highly underweight. To get diagnosed with AN, the person need to have a distortion in the way he/she experience his/her own body weight and have a problem understanding the seriousness of their low body weight.
There are two subtypes of AN, restricting AN and binge/purge AN. When having restricting AN you simply just don’t eat or get enough calories when eating. This type may be most associated with AN in general. On the other hand, binge and purging AN is more related to bulimia nervosa, but have slightly differences. A person having binge and purging AN eat as normal, but engage in compensatory behaviors after eating, varying from taking laxatives, exercise or vomiting. What differentiate binge- purge AN from bulimia is that the latter ED keeps a steady and normal weight while the first ED is associated with underweight. Despite the differences, binge- purging AN often leads to bulimia nervosa later.
There are several behaviors that are linked to AN which can function as warning signs. This includes making up “eating rules”, for example when to eat and amount of calories, a quick shift in the types of food to consume-suddenly turn vegan, reduce quantity of food or listing up good food vs. bad food. If you see these changes in a friends eating behavior, this MAY be anorexia nervosa.
Bulimia Nervosa is one of the most common eating disorder, and about 1 in every 100 women binges and purges to loose weight, because of their focus and self-evaluation based on body image and weight. This disorder is consisting of episodes of binging and purging, at least once a week for at least three months.
The binge episodes consist of eating an amount of food that is much larger than most people would eat during a similar period of time and under similar circumstances, and lack of control over food consumption during these episodes. They also often eat rapidly and in secret. The purging episodes include fasting, self-induced vomiting, excessive exercise, misuse of laxatives, enemas or other medications, and the individual do this to compensate for his/her binge eating episodes. Other compensations for eating are excessive or secretive exercise routines, and they often prioritize compensatory behaviors over other activities, like hanging out with friends or going to school.
Source: Assessment and Diagnosis , by AnneCusack, date of lecture: (10/05/16)
For many people, having an eating disorder is a relatively new phenomenon. But even though early history of Anorexia Nervosa (AN) and Bulimia Nervosa (BN) is somewhat unclear, there has been found evidence of people who struggled with these disorders centuries ago. It was Charles Lasegue (1873) and William W. Gull (1874) who gave the first full medical accounts of anorexia nervosa, they also both found that it occurs in males and females. However, Morton gave already in 1689 a description of a girl who one can assume had anorexia nervosa, and he reported “nervous consumption of food caused by sadness and anxious cares” in a 16-year old boy, but descriptions found in historical sources differ remarkably from how we today diagnose people with eating disorders. For example, people in the late 4th century, and 5th -8th centuries, starved themselves due to their belief that they were possessed by a demon. This is not a common explanation for why people with anorexia nervosa today, don’t consume food.
Another example is that many post-medieval women became famous for being able to stay alive even though they didn’t eat, but this resulted in having to spend many years in bed, saving as much energy as possible. 21st century anorexics tend to deny the fact that they are starving and are emaciated, and they try to keep up a normal or above normal level of activity. One of the main differences between modern anorexics and fasting women before the mid-19th century is the diagnostic criteria of having a fear of being or becoming too fat despite a state of emaciation. No descriptions of anorexic-like cases before 1875 stated that fasting was driven by a weight concern. Perhaps it is not very likely that these fasters would fulfill today’s diagnostic criteria.
Another historical example comes from English hospital admissions between 1812 and 1917, where 40 cases of anorexia nervosa were reported among 36,000 people (Parry-Jones, 1985), but even though we have seen many historical examples we have to consider how valid and reliable all these historical records are.
Bulimia Nervosa (BN) was first formally described in 1979 by Gerald Russel, but symptoms may have first been described many centuries ago. Signs of having what we today call bulimia nervosa has been seen and recorded in several ancient cultures. In ancient texts for instance, vomiting has been described as a form of “self-cleansing”. Seemingly, ancient Egyptians emptied their stomachs monthly, as did ancient Romans whenever they overate. Symptoms of bulimia were first recorded in people with AN. In today’s society, the majority of women with restricting AN willl eventually develop bulimic behaviors, and some will get the diagnosis of bulimia nervosa.
Sources: Tilman Habermas (1989), Dr. Phil., Dipl.psych: the psychiatric Historyof Anorexia Nervosa and Bulimia Nervosa: Weight Concerns and Bulimic symptoms in Early case reports