<ul><li>Before modern medicine, unexplained women's behaviors and illnesses were diagnosed as hysteria.</li><li>Symptoms of hysteria included fever and physical pain, as well as behaviors that didn't fit female stereotypes of passivity, feebleness, and fragility.</li><li>Mood swings, anxiety, and depression were all considered symptoms of hysteria.</li></ul>

Anorexia and Hysteria: A Shared History

<ul><li>Psychiatry asylums played a role in anorexia being recognized as its own medical condition separate from hysteria</li><li>At first, psychiatric institutions were places where people with mental illnesses were looked after, but not treated</li><li>This changed with a mental health reformation</li><li>People began to see mental illness as either curable or at least manageable through kindness and therapy</li><li>Psychiatric institutions began offering treatments and rehabilitation to the poor, and accountability came with it.</li></ul>

Separating Anorexia from Hysteria

<ul><li>Since the mid-1800s, we've gained a deeper understanding of why anorexia develops, but its early associations with hysteria have been difficult to escape</li><li>Anorexia and hysteria are not the same illness</li><li>In a 1982 Life Magazine article, it was claimed that "hysteria has almost disappeared, but if there is an equivalent today it is ANorexia, the psychosomatic disorder of young, middle-class women who won't eat."</li><li>A 1988 article from Harvard scientists still suggested that both illnesses were caused by female cultural stereotypes.</li></ul>

Modern Misconception

<ul><li>A psychosomatic disorder is a condition where observed physical symptoms don’t have medical explanations.</li><li>These symptoms are instead attributed to psychological things (e.g., stress, emotions, and personality).</li><li>Many times, we just haven't found medical explanations for them yet.</li><li>However, because we are beginning to find a medical explanation for why anorexia develops (particularly genetics and neurochemical dysfunction), we can't call it a purely psychosomatic condition.</li></ul>

Psychosomatic Disorder

<ul><li>Alexithymia is a personality trait that makes it difficult to identify our feelings, describe what other people are feeling, and to think imaginatively.</li><li>Illness denial is more difficult to find a medical explanation for, but emerging neurological explanations suggest that people with anorexia are not denying their illness out of stubbornness.</li></ul>

Medical Explanations for Psychosomatic Symptoms in Anorexia

<h3>Key points</h3><UL><LI>Anorexia was first considered a type of hysteria. </LI><LI>Reformation in how we care for mental illness helped define anorexia as its own disorder.</LI><LI>While many symptoms of anorexia don't have medical explanations yet, this doesn't mean they aren't real.</LI><LI>Educating the public about medical explanations for anorexia could reduce its stigma.</LI></UL><img alt="Callum Skelton/Unsplash" height="513" src="https://cdn.psychologytoday.com/sites/default/files/styles/article-inline-half-caption/public/field_blog_entry_images/2022-04/callum-skelton-lamnxplz7qc-unsplash.jpg?itok=Oy9AE9fz" title="Callum Skelton/Unsplash" width="342"><div>Source: Callum Skelton/Unsplash</div><h3>Anorexia and Hysteria: A Shared History</h3>Before modern medicine, unexplained women’s behaviors and illnesses were diagnosed as hysteria.1Symptoms of hysteria included, but weren’t limited to, fever and physical pain, as well as behaviors that didn’t fit female stereotypes of passivity, feebleness, and fragility. Mood swings, <a href="https://www.psychologytoday.com/intl/basics/anxiety" title="Psychology Today looks at anxiety" hreflang="en" dir="ltr">anxiety</a>, and <a href="https://www.psychologytoday.com/intl/basics/depression" title="Psychology Today looks at depression" hreflang="en" dir="ltr">depression</a> were all considered symptoms of hysteria.2<div dir="ltr">
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 </div>Prior to the mid-1800s, anorexia wasn’t recognized as a medical condition and, therefore, cases of self-starvation were diagnosed as hysteria.1Because hysteria symptoms were attributed to female-specific anatomy (e.g., the womb) and <a href="https://www.psychologytoday.com/intl/basics/pregnancy" title="Psychology Today looks at pregnancy" hreflang="en" dir="ltr">pregnancy</a>, only women were diagnosed with it.2 This is partially why anorexia stereotypes (i.e., it’s a female illness) developed. It's also why many still think anorexia is "all in someone's head."<h3>Separating Anorexia from Hysteria</h3><a href="https://www.psychologytoday.com/intl/basics/psychiatry" title="Psychology Today looks at Psychiatric" hreflang="en" dir="ltr">Psychiatric</a> asylums played a role in anorexia being recognized as its own medical condition separate from hysteria.1Before the 1800s, people with psychiatric conditions were cared for by family. If the family was wealthy, they could also send people to a psychiatric institution for care.3At first, psychiatric institutions were places where people with mental illnesses were looked after, but not necessarily treated. Consequently, patients staying in these institutions could suffer inhumane treatment, such as being tied to their beds.3<img alt="Hoshino Ai/Unsplash" height="456" src="https://cdn.psychologytoday.com/sites/default/files/styles/image-article_inline_full_caption/public/field_blog_entry_images/2022-04/hoshino-ai-sybo0dq8htw-unsplash.jpg?itok=syDesL99" title="Hoshino Ai/Unsplash" width="684"><div>Source: Hoshino Ai/Unsplash</div>This changed in the 1800s with a mental health reformation. People began to see mental illness as either curable or at least manageable, through kindness and <a href="https://www.psychologytoday.com/intl/basics/therapy" title="Psychology Today looks at therapy" hreflang="en" dir="ltr">therapy</a>. Consequently, psychiatric institutions began offering treatments and rehabilitation. They were also opened to the poor.3With the reformation came accountability. Psychiatric asylums were required to submit public progress reports detailing what was happening in their institutions.3This meant the public could see how many people were dying from self-starvation and it alarmed them. Why were people starving to death? It seemed like the institutions were being neglectful.1This pushed doctors to examine cases of self-starvation further, eventually making it a recognized medical condition: anorexia nervosa.1<div dir="ltr">
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 </div>Physician Sir William Withey Gull is credited with scrapping the disorder’s initial name, l’anorexie hysterique (hysterical anorexia), and replacing it with anorexia nervosa. By swapping hysteria with nervosa, Gull was acknowledging the role of the <a href="https://www.psychologytoday.com/intl/basics/neuroscience" title="Psychology Today looks at nervous system" hreflang="en" dir="ltr">nervous system</a> and mind in the illness, while clarifying that both males and females could develop it.1<h3>Modern Misconceptions about Anorexia</h3>Since the mid-1800s, we’ve gained a deeper understanding of why anorexia develops. Nonetheless, its early associations with hysteria have been difficult to escape. <img alt=" Adrienn/Pexels" height="228" src="https://cdn.psychologytoday.com/sites/default/files/styles/article-inline-half-caption/public/field_blog_entry_images/2022-04/pexels-adrienn-1523528.jpg?itok=Loh57ZtT" title=" Adrienn/Pexels" width="342"><div>Source: Adrienn/Pexels</div>For example, a quote in a 1982 Life Magazine article claimed that “hysteria has almost disappeared, but if there is an equivalent today it is anorexia, the psychosomatic disorder of young, middle-class women who won’t eat.”4While researchers in the 1980s largely agreed that anorexia and hysteria were not the same illness, a 1988 article from Harvard scientists still suggested both illnesses were caused by female cultural stereotypes.4While female cultural stereotypes play a role in anorexia development, it’s misleading to suggest they solely cause it. Anorexia is not restricted to females and its development is complex.<h3>Anorexia as a Psychosomatic Disorder?</h3>Because we still don’t know exactly why anorexia develops, some modern researchers have suggested it is a psychosomatic condition.5<div dir="ltr">
 article continues after advertisement
 </div>A psychosomatic disorder is a condition where observed physical symptoms don't have medical explanations.6 These symptoms are instead attributed to psychological things (e.g., <a href="https://www.psychologytoday.com/intl/basics/stress" title="Psychology Today looks at stress" hreflang="en" dir="ltr">stress</a>, emotions, and <a href="https://www.psychologytoday.com/intl/basics/personality" title="Psychology Today looks at personality" hreflang="en" dir="ltr">personality</a>).<img alt="Karolina Grabowska/Pexels" height="456" src="https://cdn.psychologytoday.com/sites/default/files/styles/image-article_inline_full_caption/public/field_blog_entry_images/2022-04/pexels-karolina-grabowska-6028541.jpg?itok=EzySu9g_" title="Karolina Grabowska/Pexels" width="684"><div>Source: Karolina Grabowska/Pexels</div>This doesn’t mean psychosomatic conditions are imaginary or that they're all in someone’s head. Many times, we just haven’t found medical explanations for them yet. As science advances, the number of disorders considered purely psychosomatic shrinks. Stomach ulcers, for example, were once considered psychosomatic, but now have a medical explanation.6While only a few disorders remain purely psychosomatic, many have psychosomatic contributors. Stress is an example of a psychosomatic contributor, as it can increase the likelihood of illness development. For example, we know that certain factors (e.g., <a href="https://www.psychologytoday.com/intl/basics/genetics" title="Psychology Today looks at genetics" hreflang="en" dir="ltr">genetics</a>) make a person more susceptible to developing cardiovascular disease. Stress can increase the likelihood that these people will develop it.6Certain psychosomatic contributors (e.g., emotions) can also increase the likelihood that someone will develop anorexia. However, because we are beginning to find medical explanations for why anorexia develops (particularly genetics and neurochemical dysfunction), we can’t call it a purely psychosomatic condition.<div dir="ltr">
 article continues after advertisement
 </div><h3>Medical Explanations for Psychosomatic Symptoms in Anorexia</h3>Alexithymia and illness <a href="https://www.psychologytoday.com/intl/basics/denial" title="Psychology Today looks at denial" hreflang="en" dir="ltr">denial</a> are two common psychosomatic symptoms of anorexia.5 While we haven’t established medical explanations for either symptom, we’re making progress.Alexithymia is a personality trait that makes it difficult to identify our feelings, describe what other people are feeling, and to think imaginatively.7Why alexithymia develops and how it contributes to physical symptoms in anorexia is unclear.Some studies show that dysfunction in brain areas associated with understanding facial expressions might cause alexithymia (e.g., the dorsal anterior cingulate cortex).7 Another explanation is increased activation in brain regions involved in pain perception (e.g., the insula). This could be why people with alexithymia have low pain thresholds. Low levels of the neurochemical <a href="https://www.psychologytoday.com/intl/basics/oxytocin" title="Psychology Today looks at oxytocin" hreflang="en" dir="ltr">oxytocin</a> might also cause alexythimia.8 Oxytocin helps us understand our emotions, as well as the emotions of others. This is something people with anorexia often struggle with. Consequently, it's unsurprising that people with anorexia tend to have atypical levels of oxytocin.9<img alt=" Andres Ayrton/Pexels" height="513" src="https://cdn.psychologytoday.com/sites/default/files/styles/article-inline-half-caption/public/field_blog_entry_images/2022-04/pexels-andres-ayrton-6551424_0.jpg?itok=zP8_3Q_Y" title=" Andres Ayrton/Pexels" width="342"><div>Source: Andres Ayrton/Pexels</div>Illness denial is more difficult to find a medical explanation for. Nonetheless, research has found that brain functioning might contribute to it. For example, some studies suggest that people with anorexia might have difficulty accurately determining their body size and shape.10 This would explain the denial of apparent weight loss. It’s unclear, though, if these are problems with size estimation accuracy (e.g., vision problems) or if the problem is how people with anorexia interpret what they see (e.g., emotional dysfunction).10Either way, people with anorexia are not denying their illness out of stubbornness. There are emerging neurological explanations.<h3>Conclusions</h3>Despite slowly finding medical explanations for anorexia since the 1800s, misconceptions about its legitimacy as an illness remain.Understanding why people develop anorexia is only part of the solution to changing these misconceptions. We also need to change how we discuss anorexia. We can do this by diversifying the stories we tell about it, such as including males, different genders, and adults in our conversations. Providing accessible information about medical explanations for anorexia to the public could also help reduce its stigma.References1)Jablonowski, J. (2018). From hysteria to anorexia nervosa: An evolution of medical terminology. Fugitive Leaves. Retrieved from: <a href="http://histmed.collegeofphysicians.org/from-hysteria-to-anorexia-nervosa/" dir="ltr">http://histmed.collegeofphysicians.org/from-hysteria-to-anorexia-nervos…</a> 2)Tasca, C., et al. (2012). Women and hysteria in the history of mental health. Clinical Practice &amp; Epidemiology in Mental Health, 8, 110-119.3)Science Museum. (2018). A victorian mental asylum. Science Museum. Retrieved from: <a href="https://www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian-mental-asylum" dir="ltr">https://www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian…</a>4)Bemporad, et al. (1988). Hysteria, anorexia, and the culture of self-denial. Psychiatry, 51, 96-103.5)Abbate-Daga, G., et al. (2013). Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry, 13.6)Bransfield, R., &amp; Friedman, K. (2019). Differentiating psychosomatic, somatopsychic, multisystem illnesses, and medical uncertainty. Healthcare, 7.7)Kano, M., &amp; Fukudo, S. (2013). The alexithymic brain: The neural pathways linking alexithymia to physical disorders. Biopsychosocial Medicine, 7.8)Schmelkin, C., et al. (2017). Lox oxytocin levels are related to alexithymia in anorexia nervosa. International Journal of Eating Disorders, 50, 1332-1338.9)Kim, Y., et al. (2014). The impact of intranasal oxytocin on attention to social emotional stimuli in patients with anorexia nervosa: A double blind within-subject cross-over experiment. PLOS One, 9.10)Madsen, S., Et al. (2013). Visual processing in anorexia nervosa and body dysmorphic disorder: Similarities, differences, and future research directions. Journal of Psychiatric Research, 47, 1483-1491.<div data-hide-large-count-items="true"><button type="button" data-show-large-count-items="true" dir="ltr">
 
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Early links to hysteria have contributed to misconceptions about anorexia.

Stashed ideas

<ul><li>Anorexia was first considered a type of hysteria. </li><li>Reformation in how we care for mental illness helped define anorexia as its own disorder. </li><li>While many symptoms of anorexia don't have medical explanations yet, this doesn't mean they aren't real. </li><li>Educating the public about medical explanations for anorexia could reduce its stigma. </li> </ul>

Before modern medicine, unexplained women’s behaviors and illnesses were diagnosed as hysteria.1

Symptoms of hysteria included, but weren’t limited to, fever and physical pain, as well as behaviors that didn’t fit female stereotypes of passivity, feebleness, and fragility. Mood swings, <a href="https://www.psychologytoday.com/intl/basics/anxiety">anxiety </a>, and <a href="https://www.psychologytoday.com/intl/basics/depression">depression </a>were all considered symptoms of hysteria.2

Prior to the mid-1800s, anorexia wasn’t recognized as a medical condition and, therefore, cases of self-starvation were diagnosed as hysteria.1

Because hysteria symptoms were attributed to female-specific anatomy (e.g., the womb) and <a href="https://www.psychologytoday.com/intl/basics/pregnancy">pregnancy </a>, only women were diagnosed with it.2 This is partially why anorexia stereotypes (i.e., it’s a female illness) developed. It's also why many still think anorexia is "all in someone's head."

<a href="https://www.psychologytoday.com/intl/basics/psychiatry">Psychiatric </a>asylums played a role in anorexia being recognized as its own medical condition separate from hysteria.1

Before the 1800s, people with psychiatric conditions were cared for by family. If the family was wealthy, they could also send people to a psychiatric institution for care.3

At first, psychiatric institutions were places where people with mental illnesses were looked after, but not necessarily treated. Consequently, patients staying in these institutions could suffer inhumane treatment, such as being tied to their beds.3

This changed in the 1800s with a mental health reformation. People began to see mental illness as either curable or at least manageable, through kindness and <a href="https://www.psychologytoday.com/intl/basics/therapy">therapy </a>. Consequently, psychiatric institutions began offering treatments and rehabilitation. They were also opened to the poor.3

With the reformation came accountability. Psychiatric asylums were required to submit public progress reports detailing what was happening in their institutions.3

This meant the public could see how many people were dying from self-starvation and it alarmed them. Why were people starving to death? It seemed like the institutions were being neglectful.1

This pushed doctors to examine cases of self-starvation further, eventually making it a recognized medical condition: anorexia nervosa.1

Physician Sir William Withey Gull is credited with scrapping the disorder’s initial name, l’anorexie hysterique (hysterical anorexia), and replacing it with anorexia nervosa. By swapping hysteria with nervosa, Gull was acknowledging the role of the <a href="https://www.psychologytoday.com/intl/basics/neuroscience">nervous system </a>and mind in the illness, while clarifying that both males and females could develop it.1

Since the mid-1800s, we’ve gained a deeper understanding of why anorexia develops. Nonetheless, its early associations with hysteria have been difficult to escape.

For example, a quote in a 1982 Life Magazine article claimed that “hysteria has almost disappeared, but if there is an equivalent today it is anorexia, the psychosomatic disorder of young, middle-class women who won’t eat.”4

While researchers in the 1980s largely agreed that anorexia and hysteria were not the same illness, a 1988 article from Harvard scientists still suggested both illnesses were caused by female cultural stereotypes.4

While female cultural stereotypes play a role in anorexia development, it’s misleading to suggest they solely cause it. Anorexia is not restricted to females and its development is complex.

Because we still don’t know exactly why anorexia develops, some modern researchers have suggested it is a psychosomatic condition.5

A psychosomatic disorder is a condition where observed physical symptoms don't have medical explanations.6 These symptoms are instead attributed to psychological things (e.g., <a href="https://www.psychologytoday.com/intl/basics/stress">stress </a>, emotions, and <a href="https://www.psychologytoday.com/intl/basics/personality">personality </a>).

This doesn’t mean psychosomatic conditions are imaginary or that they're all in someone’s head. Many times, we just haven’t found medical explanations for them yet. As science advances, the number of disorders considered purely psychosomatic shrinks. Stomach ulcers, for example, were once considered psychosomatic, but now have a medical explanation.6

While only a few disorders remain purely psychosomatic, many have psychosomatic contributors. Stress is an example of a psychosomatic contributor, as it can increase the likelihood of illness development. For example, we know that certain factors (e.g., <a href="https://www.psychologytoday.com/intl/basics/genetics">genetics </a>) make a person more susceptible to developing cardiovascular disease. Stress can increase the likelihood that these people will develop it.6

Certain psychosomatic contributors (e.g., emotions) can also increase the likelihood that someone will develop anorexia. However, because we are beginning to find medical explanations for why anorexia develops (particularly genetics and neurochemical dysfunction), we can’t call it a purely psychosomatic condition.

Alexithymia and illness <a href="https://www.psychologytoday.com/intl/basics/denial">denial </a>are two common psychosomatic symptoms of anorexia.5 While we haven’t established medical explanations for either symptom, we’re making progress.

Alexithymia is a personality trait that makes it difficult to identify our feelings, describe what other people are feeling, and to think imaginatively.7

Why alexithymia develops and how it contributes to physical symptoms in anorexia is unclear.

Some studies show that dysfunction in brain areas associated with understanding facial expressions might cause alexithymia (e.g., the dorsal anterior cingulate cortex).7 Another explanation is increased activation in brain regions involved in pain perception (e.g., the insula). This could be why people with alexithymia have low pain thresholds. Low levels of the neurochemical <a href="https://www.psychologytoday.com/intl/basics/oxytocin">oxytocin </a>might also cause alexythimia.8 Oxytocin helps us understand our emotions, as well as the emotions of others. This is something people with anorexia often struggle with. Consequently, it's unsurprising that people with anorexia tend to have atypical levels of oxytocin.9

Illness denial is more difficult to find a medical explanation for. Nonetheless, research has found that brain functioning might contribute to it. For example, some studies suggest that people with anorexia might have difficulty accurately determining their body size and shape.10 This would explain the denial of apparent weight loss. It’s unclear, though, if these are problems with size estimation accuracy (e.g., vision problems) or if the problem is how people with anorexia interpret what they see (e.g., emotional dysfunction).10

Either way, people with anorexia are not denying their illness out of stubbornness. There are emerging neurological explanations.

Despite slowly finding medical explanations for anorexia since the 1800s, misconceptions about its legitimacy as an illness remain.

Understanding why people develop anorexia is only part of the solution to changing these misconceptions. We also need to change how we discuss anorexia. We can do this by diversifying the stories we tell about it, such as including males, different genders, and adults in our conversations. Providing accessible information about medical explanations for anorexia to the public could also help reduce its stigma.

1)Jablonowski, J. (2018). From hysteria to anorexia nervosa: An evolution of medical terminology. Fugitive Leaves. Retrieved from: <a href="http://histmed.collegeofphysicians.org/from-hysteria-to-anorexia-nervosa/">http://histmed.collegeofphysicians.org/from-hysteria-to-anorexia-nervos… </a>

2)Tasca, C., et al. (2012). Women and hysteria in the history of mental health. Clinical Practice & Epidemiology in Mental Health, 8 , 110-119.

3)Science Museum. (2018). A victorian mental asylum. Science Museum. Retrieved from: <a href="https://www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian-mental-asylum">https://www.sciencemuseum.org.uk/objects-and-stories/medicine/victorian… </a>

4)Bemporad, et al. (1988). Hysteria, anorexia, and the culture of self-denial. Psychiatry, 51 , 96-103.

5)Abbate-Daga, G., et al. (2013). Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry, 13 .

6)Bransfield, R., & Friedman, K. (2019). Differentiating psychosomatic, somatopsychic, multisystem illnesses, and medical uncertainty. Healthcare, 7 .

7)Kano, M., & Fukudo, S. (2013). The alexithymic brain: The neural pathways linking alexithymia to physical disorders. Biopsychosocial Medicine, 7 .

8)Schmelkin, C., et al. (2017). Lox oxytocin levels are related to alexithymia in anorexia nervosa. International Journal of Eating Disorders, 50 , 1332-1338.

9)Kim, Y., et al. (2014). The impact of intranasal oxytocin on attention to social emotional stimuli in patients with anorexia nervosa: A double blind within-subject cross-over experiment. PLOS One, 9 .

10)Madsen, S., Et al. (2013). Visual processing in anorexia nervosa and body dysmorphic disorder: Similarities, differences, and future research directions. Journal of Psychiatric Research, 47 , 1483-1491.

Bite-sized knowledge
to upgrade
your career

Where Did Anorexia Stereotypes Come From?

Anorexia and Hysteria: A Shared History

Separating Anorexia from Hysteria

Modern Misconception

Psychosomatic Disorder

Medical Explanations for Psychosomatic Symptoms in Anorexia

IDEAS ABOUT

MORE LIKE THIS

History of Psychotherapy

Here's What People With High-Functioning Depression Want You to Know

Major Depressive Disorder (MDD) - The Human Condition

It's time to

READ

LIKE

A PRO!

Bite-sized knowledgeto upgradeyour career

Where Did Anorexia Stereotypes Come From?

Anorexia and Hysteria: A Shared History

Separating Anorexia from Hysteria

Modern Misconception

Psychosomatic Disorder

Medical Explanations for Psychosomatic Symptoms in Anorexia

IDEAS ABOUT

MORE LIKE THIS

History of Psychotherapy

Here's What People With High-Functioning Depression Want You to Know

Major Depressive Disorder (MDD) - The Human Condition

It's time to

READ

LIKE

A PRO!

Bite-sized knowledge
to upgrade
your career