descriptive era prior to 1914, followed by the pituitary (1914-1940), rediscovery (1930-1961), psychoanalytic (1940-1967), psychosocial and neuroendocrine (1961-1981), and the biopsychosocial (1981-present) eras.
Anorexia nervosa is the best known of the eating disorders. It is found with greatest frequency among middle-to-upper-class white female adolescents. The disorder carries a 19 female-to-male ratio with a prevalence estimated at one percent among adolescent girls; it is believed that the disorder is becoming more prevalent. Anorexia nervosa is defined as a psychoneurotic disorder characterized by prolonged refusal to eat, resulting in emaciation, amenorrhea, emotional disturbance concerning body image, and an abnormal fear of becoming obese. The disorder was uncommon until recent years, but it was so striking that its clinical features were described quite early.
In describing the disorder in 1897, Weir Mitchell wrote:
To call it loss of appetite--anorexia--but feebly characterizes the symptom. It is rather an annihilation of appetite, so complete that it seems in some cases impossible ever to eat again
The patient begins to diet, sometimes after an emotional upset and sometimes without a clear precipitant. In time, the dieting becomes driven by a fear of losing control of the appetite. Many sufferers go no further and hover for years on the brink of a more serious disorder, while others have a severe dieting metamorphosis into an implacable pursuit of thinness and an abhorrence of body fat. Denial is common, and the sufferer typically does not perceive herself as emaciated and exaggerates her body proportions. She will jog and exercise relentlessly in order to expend calories. Physical changes accompany weight loss: menstrual periods stop and ovulation ceases; the skin dries out; cheeks and forearms become covered with downy hair; the heart rate and blood pressure drop; and the manufacture of blood ...