Crisp, Arthur, Gowers, Simon, Joughin, Neil, McClelland, Lisa, Rooney, Barbara, Nielsen, Soren, Bowyer, Carol, Halek, Chris, and Hartman, David (2006) The enduring nature of anorexia nervosa. European Eating Disorders Review, 14 (3). pp. 147-152.

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Abstract

There is a popular notion that anorexia nervosa is a disorder of recent origin; that it is importantly driven by ‘fashion’ and that its form and content are changeable. But the fashion trade more often sees itself as a barometer of social change, rather than a prime mover. Others believe that anorexia nervosa is more likely to be as old as mankind and that, essentially, it does not change, having always been ‘a profound biological solution to existential problems’ (Crisp, 1980). The first author also recently resorted to publishing a fabricated illustrative case in a stone-age female, in an effort to highlight such a possibility (Crisp, 2000).Whenattention to its often hidden psychopathological aspects has waned periodically then, collusively, it has flourished in the medical literature as a variety of gastroenterological, fluid balance, central nervous system and other disorders. But physicians were also the first medical professionals to recognise the disorder as importantly psychologically driven and labelled it accordingly. The ‘psychiatric’ literature was quick to follow this lead. It became replete with case reports that clearly identified the condition (e.g. see Kaufman & Heiman, 1964). Subsequently researchers have found case material in the historical literature suggestive of anorexia nervosa over many centuries (e.g. see Bell, 1985; Bliss & Branch, 1960; King, 2003; Mantel, 2004; Vandereyken & van Deth, 1994). Thus van Deth and Vandereyken (1997) also reported on three exhaustive studies of such literature on self-starvation. Throughout the last millenium, sustained asceticism, with fasting and starvation at its heart, is reported as vastly more common in females than males and usually arising in the mid to late teens. There is lively debate as to whether the condition has always been or must exclusively be driven by a phobic avoidance mechanism in relation to ‘fatness’ (see Section 2, this issue). Purgation, both vomiting and massive laxative useage, seem always to have been a feature in some cases e.g. see Baron’s 1997 report on Lord Byron’s severe eating disorder, 200 years ago. Such behaviour sometimes explicitly reflected the personal need to maintain a low anorectic like weight, faced with the threat of weight gain if food restriction had given way to bulimia.

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