Since very early scientists did not understand that anyone can develop an eating disorder — no matter their shape, weight, race, ethnicity, sex assigned at birth, gender, or sexuality — most of the documented history of earying disorders focuses on patients who were severely underweight.
Severely underweight individuals were the most physically “obvious” sufferers of eating disorders, so they were studied first, but all types of eating disorders have existed long before anyone wrote anything down in research journals or history books. So, instead of talking about specific dates, which do not accurately reflect the entire history of eating disorders, let’s discuss how the idea of eating disorders (and eating disorder diagnoses) have varied over time.
In this article, you will learn:
- How the concept of eating disorders shifted from being a medical illness to a psychological one
- Early theories behind eating disorders
- More modern understandings of the multi-faceted nature of eating disorders
- Why professionals’ thinking about eating disorders has improved
- How we know eating disorders are real
Initial Theories in the History of Eating Disorders: From Spiritual Rigidity to Medical Illness
Most theories surrounding how eating disorders develop and progress were, again, focused on anorexia for the majority of recorded history. This means that many initial theories are focused on those who experienced weight loss as a side effect of what we now know is a psychiatric illness.
With that said, these are some early theories about why people develop disordered eating/eating disorders:
- Pre-recorded history: The ancient Egyptians and Romans prescribe purging as medicine. Purging is a way to cleanse oneself of toxins.
- 1100-1200s: Imposed starvation is a way to express religious devotion.
- 1694: Fasting is caused by an “ill and morbid state of the spirits”.
- 1689: Eating disorders are thought to be a medical disorder.
- 1858: Self-imposed food refusal caused by a fear of indigestion.
- 1900s-1950s: Eating disorders are an endocrine disorder — people with eating disorders have problems with hormonal secretion in their pituitary glands.
- 1959: Binge eating is first noted in obese individuals, and thought to simply be a behavior associated with being in a larger body. It was also associated with night eating syndrome.
Other eating disorders were not studied much, which is why there are no early theories concerning eating disorders under the category of Other Specified Eating/Feeding Disorders that was formally introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (aka the DSM-V.)
Related: Here’s a quick rundown of how eating disorder diagnostic categories have developed over the years.
The Shift to a Psychological Understanding of Eating Disorders
The field of psychology developed two approaches to the field of medicine and psychology, the empirical research method and positivism, which really started the shift from a purely medical illness to a psychological one.
The empirical research method involves doing a lot of observations and drawing conclusions based on data taken from those observations. And positivism is an approach to studying people and societies that relies on experiments and statistics — from empirical research.
Together (and along with other revolutionary concepts in the field), these two ideas turned the field of psychology into a science. Researchers could observe people who suffered from eating disturbances and find common thought patterns between them. Eventually, they were able to categorize groups of behaviors into different disorders with distinct thoughts and obsessions as diagnostic criteria.
A lot of this has to do with Dr. Pierre Janet, who in 1903 noticed what we now call bulimic symptoms in patients. These patients had some of the same thinking as individuals with anorexia (such as fear of weight gain and food rituals), but they did not have the same behaviors. As researchers noticed more and more eating disorder behaviors (with similar underlying thought patterns), they thought that eating disorders might be a cognitive problem, not just a medical one.
Early Psychological Theories About Eating Disorders:
“EATING DISORDERS” ARE ACTUALLY JUST A SIDE EFFECT OF ANOTHER MENTAL ILLNESS.
The term “anorexia nervosa” as a diagnosis was coined by Sir William Withey Gull, MD in 1873. He described the phenomenon of self-starvation as a side effect of a “morbid mental state, which destroys the individual’s appetite.” This idea carried all the way throughout the early 1900s.
The full association between restrictive and purging behaviors and negative body image was not found until the third edition of the DSM (published in 1980). This was the first time that eating disorders were formally categorized as a distinct mental illness, and not just a side effect of another mental illness.
PARENTS ARE TO BLAME FOR EATING DISORDERS (WHICH IS NOT TRUE.)
In the early 20th century, eating disorders (in adolescents) were thought to be caused by dysfunctional families or drive to become independent from the family. Treatment at the time involved “parentectomy”, or removing children from their parents to “cure” their eating disorder.
This theory has been widely disproven and now parents are encouraged to get involved in their child’s eating disorder recovery process.
Related: This is how to talk to your child about eating disorders.
EATING DISORDERS ARE A RESULT OF THE UNCONSCIOUS DREAD OF BEING “ORALLY IMPREGNATED” (ALSO WIDELY DISPUTED.)
Sigmund Freud is the father of psychoanalysis, or the psychological practice of “investigating” the relationship between the conscious and unconscious mind. Freud, after doing psychoanalysis on individuals with anorexia, claimed that those who suffer from this particular mental illness are afraid of their mature female sexuality. Specifically, he believed that refusing to eat adequately is a defense against the dreaded unconscious wish to be “orally impregnated.”
However, since restriction is not the only symptom of eating disorders, this theory, and several theories about eating disorders that are only related to starvation, are not entirely accurate.
The Modern Understanding of Eating Disorders: Complex Illnesses with Several Contributing Factors
From 1980 and onward, researchers have had:
- A greater understanding of the complex nature of eating disorders
- More scientific research capabilities than ever before.
With the two of these combined, researchers, treatment providers, and the general public are becoming a lot more aware about the many factors that contribute to eating disorders. Established theories that factor into eating disorders (and how they came about in a historical context) include:
EATING DISORDERS ARE A PERSON’S ATTEMPT TO TAKE CONTROL IN AN OTHERWISE UNCONTROLLABLE LIFE.
In 1973, psychiatrist Hilde Bruchas proposed the idea that anorexia results from patients’ inability to become an independent individual, away from the family, during their teenage years. Restricting food was a reaction to this inability to become independent — it was a way to gain control when there seemed to be no control in their lives.
At the same time, theories about how family dynamics contributed to eating disorders, and how family members could help the sufferer with recovery, were gaining traction. From these two conceptualizations of eating disorders came two important treatment approaches: family based treatment and (more loosely) cognitive behavioral therapy.
Related: This is what family based treatment is and whether the approach is the right fit for your family.
SOCIOCULTURAL INFLUENCES FACTOR INTO EATING DISORDERS.
In 1979, Professor Gerald Russell published a paper about patients who suffered from binging and purging behaviors. He coined the term “bulimia nervosa” and made the public aware of the condition. Bulimia was then included in the DSM-III in 1980.
Unfortunately, with this new information passing from researcher to researcher, and magazines doing their own spreads on the “new, mysterious binge-purge syndrome,” cases of bulimia increased rapidly. At the same time, media outlets featured thin women, making small, unattainable for the majority of people (due to biological factors), the ideal body. The pressure to be thin coupled with the idea that you could “eat whatever you wanted, and not gain any weight” created a sociocultural setting that bulimia thrive in.
Other sociocultural factors that play into eating disorders include:
- Social comparison
- Cultural perceptions of beauty and success
- Environmental eating behaviors such as what your family eats, or what you see others eating on TV
- The cultural understanding of “health” (which is becoming problematic now)
Related: Not sure how our current idea of “health” is dangerous? Read up on the relationship between fatphobia, COVID-19, and eating disorders.
RESEARCHERS FIND PERSONALITY TRAITS AND OTHER MENTAL ILLNESSES INFLUENCE THE LIKELIHOOD OF DEVELOPING AN EATING DISORDER.
From large case studies, researchers have discovered that certain personality traits, such as perfectionism, impulsivity, and rigid thinking are highly correlated with eating disorders. Certain mental illnesses, such as anxiety, depression, OCD, and OCPD, are also likely to manifest along with an eating disorder. Sometimes the eating disorder comes first, and sometimes the comorbid illness does.
Researchers have also determined that certain chemicals in the brain, such as serotonin and dopamine, play a huge role when it comes to emotion regulation and reward processing functions in the brain. And those functions have a huge impact on whether an individual develops an eating disorder.
Related: OCD, OCPD, and eating disorders — is there a correlation?
EATING DISORDERS AND GENETICS: ARE EATING DISORDERS REALLY HEREDITARY?
Starting around 1985, researchers really started investigating whether there was a genetic component that influenced eating disorders. Specifically, they wanted to know whether there were specific genes or gene mutations that caused eating disorders, and how those genes were passed down to the next generation.
Twin studies, family studies, and genetic sequencing studies have all indicated that eating disorders are about as hereditary as depression. Some studies have even found that you are 6 times more likely to develop an eating disorder if you have a relative with an eating disorder.
EATING DISORDERS MAY NOT BE DISTINCT DIAGNOSES, BUT RATHER, THEY BELONG ON A SPECTRUM OF SYMPTOMS.
There have been many accounts of diagnostic crossover when it comes to eating disorder diagnoses. For example, many individuals with anorexia will later develop bulimia. Hereditary studies have also shown that there are similar hereditary risks for anorexia, bulimia, and binge eating disorder.
This supports the idea that:
- Eating disorders have a high likelihood of diagnostic crossover.
- There is possibly a common gene that causes all types of disordered thoughts and behaviors surrounding food and body image.
EPIGENETICS: A POTENTIAL EXPLANATION FOR THE ENVIRONMENTAL ROLE OF EATING DISORDER DEVELOPMENT
A newer field of study gaining popularity right now is epigenetics, or the study of how and why certain genes express themselves while others do not. A lot of the field focuses on the role your environment may have on gene expression.
A potential example of the role epigenetics may play in eating disorder development is the fact that individuals in environments that idealize thinness are more likely to develop an eating disorder. People who live in different communities are not vastly different in their genetic makeup — but their environments are enough to change how their genes function.
This concept is also important when it comes to figuring out why some individuals who share the same genes develop eating disorders and others do not. For example, not all twins of someone with an eating disorder also develop one.
Current epigenetic studies about eating disorders are sparse, since the field is relatively new and it’s difficult to get a large enough sample of participants to really study the genes that are potentially involved in eating disorders.
Are eating disorders real? The history, and the current research, is in.
If you were questioning whether your (or someone else’s) eating disorder is real — it is.
There is a long history of eating disorders, both documented and undocumented, with mythical and scientific theories behind why they develop, and a variety of treatment approaches. The discovery of genetic and neurobiological factors that contribute to eating disorders has only solidified the fact that eating disorders are real illnesses, just like any physical illness. And eating disorders need to be treated with the same level of severity, too.
If you are struggling, or know someone who is struggling, just know that eating disorders are not cut-and-dry. They are complex and dangerous illnesses. And the faster a person starts recovery, the more likely they are to make a full recovery.
