History of Eating Disorders: Anorexia, Bulimia, and Binge Eating Disorder through the Ages (2025 Insights)

Tracing the Origins of Eating Disorders: Anorexia, Bulimia, and Binge Eating

While today's society often highlights thinness, suggesting eating disorders are a modern issue, historical records reveal these conditions have existed for centuries, though their manifestations and interpretations have shifted over time.

This article delves into the history of eating disorders, outlining their earliest appearances, diagnostic evolution, and cultural significance. We focus on three primary disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder, providing a detailed timeline and context for each.

Early Historical Accounts of Eating Disorders

Descriptions resembling modern eating disorders date back to the Hellenistic period (323 BC–31 BC) and the Middle Ages (5th–15th centuries AD). During these times, extreme fasting was often linked to religious devotion, with food deprivation seen as a form of spiritual purification.

For example, an upper-class Roman woman reportedly starved herself to death seeking holiness, a phenomenon some scholars refer to as "holy anorexia." Women were particularly affected by such extreme fasting practices, which frequently resulted in premature death. Notable figures like St. Catherine of Siena, who died at 33 after severe food abstinence, exemplify this historical trend.

Though the motivations then centered on spirituality rather than body image, many experts believe these behaviors represent early forms of eating disorders influenced by the sociocultural environment of their times.

The Evolution of Anorexia Nervosa

In 1689, English physician Richard Morton documented what are considered the earliest modern cases of anorexia nervosa in both a male and female patient, describing a mysterious loss of appetite without physical cause, labeling it a "nervous consumption."

Two centuries later, in 1873, Sir William Gull coined the term "anorexia nervosa," while French physician Ernest Charles Lasegue described similar cases as "anorexie hysterique." The disorder gained broader recognition in 1982 through Dr. Hilde Bruch's influential lecture, which shaped modern understanding.

Contemporary research has refined earlier psychoanalytic theories, emphasizing genetic and biological factors over family dynamics. In 2003, researchers Keel and Klump suggested cultural variations influence the motivations behind food refusal, framing anorexia nervosa as a complex disorder shaped by both biology and culture.

The Emergence of Bulimia Nervosa

Unlike anorexia, bulimia nervosa is a relatively recent diagnosis. British psychiatrist Gerald Russell first identified bulimia nervosa as a distinct condition in 1979, describing patients who engaged in binge eating followed by purging to control weight.

Historical records show that purging practices existed in ancient civilizations such as Egypt, Greece, Rome, and Arabia, often used for medicinal purposes rather than weight control. Some scholars argue these behaviors may represent early forms of bulimia without the modern emphasis on thinness.

Early 20th-century cases resembling bulimia include Nadia, documented by Pierre Janet in 1903, and a patient described by Mosche Wulff in 1932 who alternated between fasting and binge-purge cycles. By the 1960s and 1970s, psychiatric case studies increasingly detailed bingeing and purging behaviors, culminating in Russell's 1979 seminal paper establishing bulimia nervosa as a distinct eating disorder.

Christopher Fairburn’s work in the late 1970s further advanced treatment approaches, marking the rise of bulimia nervosa's recognition in clinical practice.

The Discovery of Binge Eating Disorder

Binge eating disorder (BED) was identified later than anorexia and bulimia. Psychiatrist Albert Stunkard introduced the concept of "night eating syndrome" in 1959, later expanding to recognize binge eating without nocturnal patterns.

Initial research focused on weight loss populations, and in 1993, a cognitive-behavioral therapy manual by Fairburn, Marcus, and Wilson became the foundational guide for treating both bulimia nervosa and BED, solidifying evidence-based approaches.

Diagnostic Milestones in Eating Disorders

The major eating disorders were incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM) in stages:

Anorexia Nervosa

Recognized as a psychological disorder by the late 19th century, anorexia nervosa was included in the DSM-I (1952) under psychophysiologic gastrointestinal reactions, a category linking emotional factors to physical symptoms. In DSM-II (1968), it was classified among special feeding disturbances.

Bulimia Nervosa

Bulimia first appeared in DSM-III (1980) within disorders of infancy, childhood, or adolescence, without the "nervosa" suffix. DSM-IV (1994) refined bulimia nervosa’s criteria, emphasizing concerns about shape and weight.

Binge Eating Disorder

Binge eating disorder was listed in DSM-IV (1994) as a condition warranting further study and gained full diagnostic status in DSM-5 (2013), which also introduced avoidant restrictive food intake disorder (ARFID) and reorganized eating disorders under a unified category.

Summary and Modern Understanding

Anorexia nervosa has deep historical roots, shaped by cultural and spiritual contexts, while bulimia nervosa emerged more recently, influenced by modern societal ideals of thinness and food availability. Binge eating disorder depends on access to abundant food, highlighting environmental factors.

Current research recognizes eating disorders as multifaceted illnesses involving genetic, biological, and environmental interactions, affecting diverse populations across gender, age, ethnicity, and socioeconomic status.

Early intervention remains critical to prevent severe outcomes and fatalities associated with these complex conditions.

For further reading, visit our Conditions A-Z and Eating Disorders sections.

About the Author: Lauren Muhlheim, PsyD, CEDS, is a certified eating disorders expert and clinical psychologist specializing in cognitive behavioral therapy.

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