Is Anorexia Truly a Contemporary Disease?

Background: Anorexia nervosa (AN) is reported to be on the rise. However, instances of fasting have been noted since antiquity. Can modern diagnoses be applied to circumstances very different from our own? Is there a continuum of symptoms whose meanings have evolved over centuries, or is AN a recent development?

Subjects And Methods: A literature review was conducted. Twelve articles were found to be pertinent to the study, including several by Jacques Maître, who also published a book on the subject that was utilized.

Results: Few instances of fasting and no deaths from AN are reported in Western antiquity. With the advent of Christianity, prolonged fasting appears in the West. From the 12century onwards, food deprivation becomes significant in women's spiritual lives, reaching a peak in inedia until the Renaissance. In 1873, Lasègue and Gull published a medical description of AN. Thereafter, AN fluctuated between being a distinct pathology and a symptom of another syndrome. Long considered a hysterical symptom, Freud initiated a shift toward sexual causality. In 1914, hypophyseal atrophy was considered a cause but was later forgotten. World War II did not produce instances of AN; food refusal has meaning only when food is abundant. During times of imposed famine, women's roles in food management and corpulence are valorized. In the 1960s, attention shifted to body image and an inability to cope with pubertal changes. Today, Russell describes a change in patient profiles with increased fear of weight gain and reduced fear of sexualization.

Conclusion: Two opposing theses emerge. On one hand, it is argued that mystical fasts and AN cannot be linked and that AN is a recent disorder. Modern society subjects us to greater social pressures, forcing women to deny their biological roles in pursuit of thinness. On the other hand, AN is considered the heir to mystical fasting, as part of women's attempts to escape societal roles. Hagiographic descriptions and psychoanalytic studies that highlight the unconscious dynamics between mother-daughter relationships and pubertal difficulties support this view.