Eating disorders have existed for centuries, though people understood and labeled them very differently depending on the era. The earliest behaviors resembling modern eating disorders appear in medieval religious records from as far back as 700 A.D., while the formal medical recognition of anorexia nervosa didn’t arrive until 1873. The full spectrum of eating disorders we recognize today only took shape over the last few decades.
Medieval Fasting and “Holy Anorexia”
The oldest well-documented cases of self-starvation come from the medieval Christian tradition. Between the 13th and 17th centuries, mostly in southern Europe, 181 cases of extreme religious fasting were recorded. These women starved themselves not to achieve thinness, but as a form of spiritual devotion. The behavior was called anorexia mirabilis, meaning “miraculous loss of appetite,” and it often accompanied other forms of self-denial like lifelong virginity and self-flagellation.
One of the earliest known cases is St. Wilgefortis, dated somewhere between 700 and 900 A.D. According to the account, her father, the King of Portugal, tried to force her into marriage. She had taken a vow of virginity and refused to eat. She lost her feminine shape, hair grew over her body, and the suitor withdrew. Her father had her crucified. She was later made a patron saint for women seeking freedom from the burdens placed on them by others.
Saint Catherine of Siena is another well-known case. She ate almost nothing, forced herself to vomit what little she consumed, and flagellated herself in imitation of Christ. She died of malnutrition at 32. For many of these women, fasting was a path to social status and even fame that marriage and motherhood would never have offered them. The church and community viewed this behavior through a religious lens, not a medical one.
The Vomitorium Myth
A common misconception places eating disorder behavior even further back, in ancient Rome, where wealthy citizens supposedly retreated to “vomitoriums” to purge between courses at lavish banquets. This is false. No ancient source uses the word “vomitorium” to describe a room for vomiting. The term, first appearing in a 5th-century text by Macrobius, actually refers to the passageways in amphitheaters through which crowds would “spew forth” into their seats.
The mix-up took hold in the 1800s. By 1871, writers were already misidentifying rooms in Roman ruins as vomiting chambers. Vomiting did occur in Rome, but primarily as a medical treatment. The physician Celsus advised that purging the stomach was acceptable for health reasons but warned against making it a daily habit, calling that a sign of luxury. Stories of emperors gorging and purging were moral critiques of excess, not descriptions of widespread cultural practice.
Anorexia Nervosa Gets a Name: 1873
The shift from religious interpretation to medical diagnosis happened in the 19th century, and it happened almost simultaneously on both sides of the English Channel. In 1873, British physician Sir William Gull presented a paper on what he called “anorexia hysterica” to the Clinical Society of London, describing a condition of extreme emaciation mostly affecting young women between ages 15 and 23. That same year, French physician Ernest-Charles Lasègue independently published his own paper, “De l’anorexie hystérique,” in a French medical journal.
Gull is generally given slight priority because he had briefly mentioned an anorexia-like condition in a paper as early as 1868. By 1874, he had settled on the term “anorexia nervosa,” which stuck. The condition was soon included in the very first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), classified as a psychophysiological reaction.
Gull’s original description focused entirely on women, tying the condition to hysteria, a diagnosis considered inherently female at the time. This framing made it nearly impossible to identify male sufferers for decades. It wasn’t until the 1930s that clinicians began seriously considering male anorexia, initially attributing cases to family dysfunction, specifically “an authoritarian father and a weak mother.” The reframing of anorexia as a psychiatric problem linked to family dynamics, rather than a uniquely female condition, gradually opened the door to recognizing it in men.
Bulimia and Binge Eating: 20th Century Discoveries
The other major eating disorders were identified much more recently. In 1959, American psychiatrist Albert Stunkard published the first clinical description of binge eating, documenting a pattern of compulsive overeating that went beyond simple overeating or emotional eating. A few years earlier, another American psychiatrist, Walter Hamburger, had laid groundwork by recognizing that obesity could have significant emotional dimensions, but Stunkard was the first to describe binge eating as a distinct behavior.
Bulimia nervosa came next. In 1979, British psychiatrist Gerald Russell described it as a “chronic phase of anorexia nervosa” in which patients overeat and then compensate through self-induced vomiting, laxatives, or prolonged starvation. Russell’s description gave the disorder its name and clinical identity. By the 1980s, bulimia nervosa was added to the DSM-III, though eating disorders were still classified under disorders of childhood or adolescence.
How the Diagnostic Picture Expanded
The formal classification of eating disorders evolved slowly through each edition of the DSM. Anorexia nervosa appeared in the first edition in 1952. Bulimia nervosa was added in the 1980s with the DSM-III. The DSM-IV, published in 1994, created a catch-all category for clinically significant eating problems that didn’t fit neatly into anorexia or bulimia, and placed binge eating disorder under “disorders for further research” rather than giving it full recognition.
That changed in 2013 with the DSM-5, which officially recognized binge eating disorder as a formal diagnosis for the first time. The same edition reclassified pica (eating non-food substances) and rumination disorder (repeatedly regurgitating food), which had previously been categorized only as childhood disorders. Moving them into the main feeding and eating disorders category acknowledged that these conditions can persist across a person’s entire life, not just in childhood.
Why Cases Seemed to Spike
It’s tempting to assume eating disorders exploded in the 20th century alongside diet culture and media images of thinness. The reality is more complicated. A review published in the American Journal of Psychiatry found that a true increase in the incidence of anorexia nervosa over time was “questionable” once the data was critically analyzed. Much of the apparent rise likely reflects better recognition, changing diagnostic criteria, and greater willingness to seek treatment rather than a genuine epidemic of new cases.
What clearly did change was context. Medieval women starved themselves for God; modern patients are far more likely to be driven by body image and a fear of weight gain. The behaviors can look strikingly similar across centuries, but the meaning people attach to them shifts with the culture around them. Eating disorders, in some form, are as old as recorded history. What’s relatively new is calling them what they are.