Massimiliano Aragona

 

Purpose To show the contribution of different psychopathological stances in shaping the concept of anorexia nervosa through history.

Methods Description of the most relevant observations of clinical cases, from XVIII to early XX century.

Results The clinical descriptions were shaped by the clinical questions the physicians wanted to investigate. We found medical and psychopathological questions. The former focused on somatic differential diagnosis, measurement of bodily signs and symptoms, organic etiologic explanations, and medical (also behavioral) remedies. The latter studied the psychic phenomena in detail, tried to understand the link between symptoms, settled explanatory hypotheses about

the individual, familial, experiential and situational factors leading to eating disturbances, and illustrated various strategies of “moral”, behavioral, and psychological treatment. Within the psychopathological approach there were at least three stances, based on the main nosographical constructs operating as “psychopathological attractors”: Hysteria (Mid XIX Century), Psychasthenia (End of XIX Century), and Schizophrenia (First half of XX Century).

Conclusion There was an interplay between the different presentation of symptoms in patients and the different theoretical/nosological views of the clinicians. At one side, the different views of the observer entailed different attention to this or that phenomenon (consequently over or under detected), different interpretations of the same phenomenon, etc. At the other side, the patients’ phenomena were partly different, and the symptoms of Anorexia as we currently conceive it emerged slowly. In every new description a detail emerged, while other phenomena previously noted were no more reported, so while something was unveiled, something was concealed.

 

History of Psychiatry, Psychopathology, Anorexia, Bulimia, Eating Disorders