1.2. The enduring nature of anorexia nervosa
2006
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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