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A Brief History of Treatment for Eating Disorders

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT

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If you have an eating disorder or witnessed the effect an eating disorder has on a friend or loved one, you know how difficult it can be to manage. Anorexia nervosa, bulimia nervosa, binge eating disorder, orthorexia, and others can cause lasting damage to the body. These disorders can also have a devastating effect on mental health.

Eating disorders are often both treatment-resistant and deadly. Estimated mortality rates hover in the four to five percent range for people diagnosed with an eating disorder. That rate increases when including associated physical problems, co-occurring mental health disorders, and death by suicide.

With all factors combined, some experts estimate that the true mortality rate for anorexia climbs closer to ten percent. That makes it arguably one of the most dangerous mental health disorders we know about. Other eating disorders such as bulimia nervosa, orthorexia, and binge eating disorder have similarly adverse health effects. All these conditions present significant treatment challenges.

It’s clear, then, that for people diagnosed with an eating disorder, as well as for their friends and loved ones, intervention and treatment are critical. Yet historically, experts have struggled to find the best way to treat these conditions.

Anorexia Throughout History

In the Middle Ages, inanition, or avoiding food for weeks and even months, became associated with saintliness, cleanliness, and virtue. In some religious traditions, they were perceived as a sign of holiness. Self-starvation had a high-profile female role model in Saint Catherine of Siena, who starved herself to death. Her contemporaries saw this as saintly discipline and obedience to her vows. In many Judeo-Christian narratives, voluntary starvation was also viewed as a punishment or compensation for humanity’s many sins.

In the latter half of the nineteenth century, the association of thinness with an ideal standard of beauty emerged. Languid and wan beauties proliferate throughout the history of art. From ancient Greek mythical iconography to various traditions of portraiture and sculpture, down to the fashion magazines of today, thinness is idealized. Romanticizing and idealizing a thin body type, like the virtuous ideal of Saint Catherine, prompts young women to embrace thinness as aspirational. Social media contributes, as well. Images of models and influencers enhanced by filters and lenses perpetuate thinness as desirable to attain. Taken altogether, the history of the association of thinness with beauty – and current trends – can have a negative impact on the mental and physical health of young women and men alike.

Diagnosis and Early Treatment

Clinicians first defined anorexia nervosa (the clinical term for self-starvation) as a formal diagnosis in the 1970s. Bulimia, orthorexia, and binge eating disorder emerged as formally recognized conditions soon after, in the 1980s.

While identifying these disordered eating habits as clinically diagnosable medical conditions was an important step, early on, clinicians struggled to find adequate treatments.  Parentectomy, an often-cited early prescription, was shorthand for the idea that the parents were the root of the problem. Many thought that removing the parental influence or cutting off contact altogether could have beneficial results. Now, though, mental health experts understand that families need to work together to help a family member with an eating disorder heal.

Triggers in the home environment may contribute to the complex disordered-eating behaviors that endanger patient health and well-being. However, in recent years, many promising new treatments have emerged, as researchers make progress on the study of each disorder and its associated implications for mental and physical health. And, as research paints a more detailed picture, clinicians can now tailor a targeted approach for each person’s individual needs.

New Research, New Treatments

Pharmaceuticals, when combined with cognitive behavioral therapy (CBT) and other therapeutic interventions, offer a promising avenue. In 2015, the FDA approved a new drug to treat moderate to severe binge eating disorder in adults. For anorexia and bulimia, anti-depressants and anti-emetics have shown results in some studies. Best results, though, usually occur when combined with therapy.

New avenues of research are ongoing. At the University of Toronto, a promising study found that patients with anorexia, as well as those diagnosed with bulimia, benefited from deep-brain stimulation. Benefits included changes in neural circuitry, improved mood and anxiety regulation, and improved body mass index. Researchers at the University of Minnesota recently obtained funding to study a new therapeutic intervention that helps binge eaters identify what triggers their disordered eating behavior. If they know their triggers, researchers propose, they can understand when they’re about to binge. Then, they can use skills learned in therapy to prevent a binge-eating episode.

The bottom line is that untreated eating disorders can have severe and deadly consequences. But that’s not the whole story. People can and do fully recover from and manage eating disorders. With a comprehensive, integrated treatment model that stresses love, support, counseling, therapy, and lifestyle changes, people diagnosed with eating disorders can redefine their relationship with food. They can embrace a new way of living and thriving, free from the cycles of disordered eating.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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