Anorexia comes from the Greek for "without hunger." Bulimia literally means "ox-like hunger." Those definitions are remnants of a time when the disorders were misunderstood. Early researchers were told by subjects that the reason they didn't eat was that they "weren't hungry," while people with bulimia seemed to eat a lot, but were throwing up nearly everything they ate. In reality, people with anorexia nervosa do possess an appetite, while people with bulimia do not possess unusual hunger. The word nervosa indicates what earlier researchers were beginning to realize: that there was a psychological aspect to the disorders. It was recognized that while they seem to be about "eating or not eating food," such food-related behavior is connected to some deeper emotional and psychological matters.
Diagnosis is a lot more accurate today, and despite the pattern of secrecy, the good news is that most people and many researchers are so familiar with these painful illnesses that people do know their names and something about them. Until fairly recently this kind of attention was rare, so people suffered without help, but this does not mean that eating disorders are new to humankind.
It's not just modern-day celebrities who make news by being too thin. The hieroglyphics of ancient Egypt and early manuscripts from ancient Persia, as well as writings from the earliest Chinese dynasties, describe activities related to what we call anorexia and bulimia. Those couches that we see in scenes from ancient Roman banquets were used so that the parties could more easily overeat - and then go to special rooms called vomitoria where they could throw up and make more room for feasting.
Other stories, from Africa, tell of mothers who refused food during famines to save the little bit of food for their children. This became such an admired habit that some of them continued to refuse food. Historians say that in Europe, the first formal description of anorexia nervosa in medical literature was made in London in 1689 by a doctor who first described an anorexic patient as "a skeleton clad only with skin." The first medical articles about anorexia were not written until 1874, and it was not until the 1930s that researchers began to believe that the causes of self-starvation included psychological problems. Today it is seen as a combination of emotional distress with physiological imbalance, caused in part by social factors.
All eating disorders are similar in that they are physical, psychological, and social disturbances, though the specific patterns differ for each type. For example, the physical side of anorexia involves self-starvation, while a physical aspect of bulimia results in damage to teeth and stomach from purging. When physicians examine someone with an eating disorder, they often find malnutrition, dehydration, ruptured stomach or esophagus, and serious heart, kidney, and liver damage. Psychologically, most sufferers employ denial - they refuse to believe or to admit the facts that a doctor can show them. Other psychological symptoms that professionals observe in those with eating disorders include depression, guilt and shame, mood swings, perfectionism, and "all or nothing" thinking.
Socially, eating disorders involve increasing isolation from others. Some of this is by choice - to protect the disorder's ritualistic patterns. But also, the sufferers' feelings and obsessions damage family and social relationships. You may observe some of these symptoms and behaviors in people you care about. You may feel hurt when shut out of someone's life, so it's especially important to understand that people with eating disorders are suffering, and that their withdrawal isn't meant to be personal.
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