On the uses of history in psychiatry: diagnostic implications for anorexia nervosa

OBJECTIVE: The current study demonstrates that recent attempts to equate anorexia nervosa with any form of voluntary self-starvation are not justified. METHOD: Three arguments are critically reconsidered: That weight phobia was not part of early case reports on anorexia nervosa, that weight phobia should be eliminated from the diagnosis of anorexia nervosa, and that there is a continuity of forms of extreme fasting since the late Middle Ages. RESULTS: A critical approach to the history of eating disorders by interpreting historical sources makes the emergence of anorexia with weight phobia in the middle of the 19th century probable. The criteria for establishing psychiatric diagnoses and the differences between historical types of extreme fasting also support the historical novelty of anorexia nervosa. DISCUSSION: The etiologic implications of the historical specificity of anorexia nervosa are limited. Research should be directed to better understand self-starvation without weight phobia.