1 - Historical and current conceptualizations of eating disorders: a developmental perspective

Summary

There is no human society that deals rationally with food in its environment, that eats according to the availability, edibility, and nutritional values alone.

(Hilde Bruch, 1973, p. 3)

Introduction

Eating disorders are complex, multi-faceted and acutely sensitive to societal and cultural pressures. They challenge clinicians to expand their understanding beyond the individual and consider external pressures that trigger and maintain the process of disordered eating. In this chapter, we review how conceptualizations of eating disorders have evolved, and highlight the power of social context in the development and maintenance of these ‘diseases’. We shall also review current research into eating disorders, which spans numerous disciplines, including psychology, psychiatry, sociology, and more recently genetics and molecular biology. Multidisciplinary approaches are particularly helpful for conceptualizing eating disorders. As these disorders generally develop in childhood and adolescence, we pay particular attention to a developmental approach that also considers societal pressures, developmental norms, mutability of behaviours, and the individual's unique response to his or her environment.

History of anorexia nervosa

While the term ‘anorexia nervosa’ (AN) was first introduced into medical literature in 1874 by Dr William Gull, reports of self-starvation may date back to times of early Christianity (Keel & Klump, 2003). Cases of self-starvation attributed to demonic possession were documented in the fifth century (Keel & Klump, 2003). Saint Wilgefortis, thought to have lived between the eighth and twelfth centuries, reportedly engaged in self-starvation resulting in emaciation and (what has been speculated to be) lanugo – the fine downy hair that may result from anorexia and malnutrition (Keel & Klump, 2003).