Table 1.
Historical evolution of eating disorders spectrum
| Era | Definition or diagnosis | Conceptualization | Associated conditions |
|---|---|---|---|
| Middle Ages19 | Anorexia mirabilis | Focusing on spiritual purity instead of drive for thinness Explained by holiness |
Associated with other penitential practices; perfectionism, moral stiffness |
| 1500–180018 (Di Nicola 1990,95 Brumberg 198894) | Miraculous maids | Focusing on exhibition of extraordinary starving abilities Often explained with a mix of spiritual and material beliefs |
Perfectionism, secondary benefits |
| 169420 | Nervous atrophy | Fasting caused by an “ill and morbid state of the spirits” A psychological etiology was supposed |
|
| 185828 | Hypocondriacal delusion due to dyspepsia, characterized by food refusal | Self-imposed food-refusal, with somatic symptoms Psychological etiology |
|
| Late XIXs18,29,30 | Anorexia nervosa (Gull30) Anorexia hysterica (Lasegue29) Anorexia distinguished from the term “hysteria”, making anorexia be considered a psychological disorder |
Self-imposed food-refusal, with somatic symptoms Psychological etiology |
Romantic ideal of a pale, languid body Beginning of drive for thinness |
| Early XXc38 (Brumberg, 1988)94 |
Pituitary atrophy Hysteria (psychoanalytic interpretations) |
Hormone etiology Psychoanalytic interpretations (defense against a dreaded unconscious wish for oral impregnation) |
|
| 1950–1960s31 | Anorexia nervosa First eating disorder placed in the DSM (DSM-I) |
Food-refusal considered as a psychophysiological reaction (a neurotic illness) | – |
| 1970s32 | Anorexia nervosa Pica and rumination (DSM-II) |
Special symptoms feeding disturbances Drive for thinness, focus on weight24 |
Anorexogenic family environment40 |
| 1980s DSM-III33 DSM-III-R34 (Halmi et al, 1981)96 (Joseph et al, 1982)97 (Rosen et al, 1986)70,98 |
Bulimia nervosa diagnosis was added | ED classified under disorders of childhood or adolescence (DSM-III, DSM-III-R) | Beginning of ED spectrum concept: ED include a number of psychiatric disorders with a great variability Importance of childhood trauma in bulimia nervosa Similarities between AN and ASD, AN considered as an “empathy” disorder |
|
DSM-IV35 DSM-IV-TR36 |
Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified (DSM-5) |
All others clinically significant eating disorder symptoms absorbed by residual category of EDNOS and BED included under disorders for further research (DSM-IV) Eating disorders moved to independent section (DSM-IV-TR) |
|
| DSM-51 | Pica Rumination disorder Avoidant/restrictive food intake disorder Anorexia nervosa Bulimia nervosa Binge eating disorder Other specified eating or feeding disorder Unspecified eating or feeding disorder |
ED conceptualized as an independent DSM category (feeding and eating disorders) Inclusion of three disorders In AN, removal of the amenorrhea criterion In BN, threshold frequency of binge episodes and compensatory behaviors were decreased and two subtypes (purging type and non-purging type) were deleted BED were recognized as a formal diagnosis |
|
| 2000–201526,51–55,66,11 | Emerging trends: Orthorexia Reverse anorexia Pregorexia Diabulimia Drunkorexia |
The eating disorders spectrum underlined importance of atypical, mild, and subthreshold symptomatology Different phenotypes of patients |
OCD traits, OCPD, impulsiveness, ASD spectrum Focus on healthy food instead on gain weight |
Abbreviations: AN, anorexia nervosa; ASD, autism spectrum disorder; BN, bulimia nervosa; BED, binge eating disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ED, eating disorder; EDNOS, eating disorder not otherwise specified; OCD, obsessive–compulsive disorder; OCPD, obsessive–compulsive personality disorder; R, revised; TR, text-revised.