Psychiatric
circa 1373 CE, documented accounts of Catherine of Siena's fasting behaviors, Medieval Italy; formal medical description 1873 CE, William Gull, England
Anorexia nervosa, characterized by severe self-imposed food restriction, was interpreted through radically different frameworks across centuries, ranging from divine miracle to moral failing to nervous system disorder before emerging as a recognized psychiatric condition in the Victorian era. The condition's history reflects broader cultural and medical attitudes toward the body, gender, femininity, and the relationship between mind and physical health.
Historical Narrative
Historical accounts of voluntary severe fasting appear across many centuries and cultures, though the meanings assigned to such behavior shifted dramatically over time. In medieval Christian Europe, extreme fasting was frequently interpreted as a form of holy asceticism rather than illness. Women such as Catherine of Siena in the fourteenth century became celebrated for their alleged ability to survive on minimal nourishment, a phenomenon termed inedia prodigiosa by church authorities and credulous observers. These so-called holy anorexics were sometimes venerated as mystics, their emaciation read as spiritual transcendence rather than physical disease.
By the early modern period, skepticism began replacing reverence in some learned circles. Physicians occasionally investigated cases of girls and young women who refused food, debating whether such feats were miraculous, fraudulent, or pathological. The case of the Welsh Fasting Girl, Sarah Jacob, in 1869 — who claimed to have survived without food for years and died when physicians attempted a formal supervised observation — attracted considerable controversy and illustrated the tension between religious interpretation and emerging medical authority over the body.
The formal medicalization of the condition is most closely associated with two physicians working independently in the 1870s. Sir William Gull in England published his landmark description of the condition in 1873, coining the term anorexia nervosa and identifying it as a nervous disorder distinct from organic disease. He described cases of young women who had wasted to dangerous degrees without discoverable physical cause and argued for a neurological or psychological origin. Nearly simultaneously, French physician Charles Lasègue published his account of what he called l'anorexie hystérique, framing the refusal of food within the then-dominant clinical concept of hysteria.
Gull's formulation proved more durable, though both physicians situated the disorder firmly within the then-prevailing understanding of the nervous system as subject to functional derangement, particularly in women, whom Victorian medicine considered constitutionally vulnerable to nervous complaints. Treatment recommendations of the era reflected these assumptions: Gull advocated for removing patients from their home environments and ensuring regular forced feeding under medical supervision, believing family attention inadvertently reinforced the behavior.
In the early twentieth century, a significant but ultimately mistaken detour occurred when the German physician Morris Simmonds described pituitary gland atrophy in an emaciated patient in 1914. For several decades, severe emaciation of the type seen in anorexia nervosa cases was sometimes attributed to Simmonds' disease — a pituitary-origin hormonal disorder — leading to misclassification and ineffective hormonal treatments for many patients.
The psychoanalytic movement of the early and mid twentieth century reclaimed anorexia nervosa as a psychiatric phenomenon, with theorists such as Hilde Bruch making particularly influential contributions in the 1960s and 1970s. Bruch challenged earlier psychoanalytic frameworks that reduced the condition to symbolic oral conflicts and instead argued that disturbances in body image perception and a fundamental deficit in self-concept were central features. Her clinical work helped reorient the field's understanding away from purely symbolic interpretations toward the cognitive and developmental dimensions that would shape subsequent psychiatric research.
Key Historical Figures
Historical narrative only — this page describes how Anorexia nervosa was understood historically. It is not medical advice and does not describe current diagnosis or treatment. Sourced from verified medical history references (NIH, Encyclopaedia Britannica, and standard medical history texts). See our medical disclaimer.