Introduction history of ideas

Two different approaches may be discerned in the conceptualization of anorexia nervosa.

1. The medicoclinical approach defines the illness in terms of its clinical manifestations; the main landmarks were the descriptions by William Gull in 1874 (.!> and Charles Lasegue in 1873.(2)

2. The sociocultural approach is unlike the more empirical clinical approach and takes causation into account by viewing the illness as a response to prevailing social and cultural systems. This was best argued by the social historian Joan Jacobs Brumberg who considers anorexia nervosa simply as a control of appetite in women responding to widely differing forces which may change during historical times.(3) This approach allows flexibility in identifying anorexia nervosa in different historical and cultural settings, but it carries the risk of excessive diagnostic latitude.

There is a strong argument for accepting the original descriptions by Gull (1874) and Lasegue (1873) as containing the essence of anorexia nervosa. They both recognized a disorder associated with severe emaciation and loss of menstrual periods, inexplicable in terms of recognized physical causes of wasting. They were both extremely cautious about the nature of the mental disorder. Gull spoke of a morbid mental state or 'mental perversity', and adopted the more general term anorexia 'nervosa' which has persisted until today. Lasegue also referred to 'mental perversity' but was bold enough to call the condition 'anorexie hystérique, faute de mieux'.

It is probably best to seek a balance between the diagnostic rectitude of the medicoclinical approach and the malleability of anorexia nervosa in response to changing historical and sociocultural settings. Looking back in historical times, it may well be that the self-starvation and asceticism of St Catherine of Siena corresponded to modern anorexia nervosa.*4,5,) In more recent times the preoccupations of the patients have altered so that their disturbed experience with their own body (6,) or their 'morbid fear of fatness'(7) has earned the distinction of becoming one of the diagnostic criteria. Yet this concern with body size was not remarked upon by Gull or Lasegue. This is an argument for concluding that at least the psychological content, and perhaps also the form, of anorexia nervosa are changeable in response to historical times and sociocultural influences.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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