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Anorexia Nervosa

Writer's picture: dr.ssa Elizabeth Mooredr.ssa Elizabeth Moore

Vista di una finestra in primo piano che incornicia un paesaggio di montagna con un lago, una barca e montagne innevate e verdi sullo sfondo, simboleggiando introspezione e riflessione legate all'anoressia mentale

From the Greek "an" meaning deprivation, lack, and "orexis" meaning appetite, anorexia nervosa, also known simply as anorexia, is one of the most widespread mental health disorders in our socio-cultural context. It manifests as an obsessive and relentless pursuit of excessive thinness.

Although the term "anorexia" might cause confusion (from the Greek "an" for deprivation and "orexis" for appetite), we know today that in the disorder, food intake is drastically reduced, but this is not due to the subject’s lack of appetite. Despite being preoccupied with thoughts of food and eating, individuals with anorexia impose self-restriction and consider any transgression of this rule a shameful weakness, which leads to overwhelming feelings of guilt.


The individual feels insecure, inadequate, and incapable of handling life. Unable to experience themselves in interpersonal relationships, they attempt to exercise control over their body, using it as a way to translate their inner turmoil into something definable. The rejection of food, therefore, represents only a symptom of a deeper issue.


Particularly prevalent among adolescents in Western countries, anorexia is now appearing at increasingly younger ages, with signs emerging as early as late latency or pre-adolescence. It predominantly affects the female population (90% to 97% of cases).


Among the most common physical symptoms are: a weight loss exceeding 25%, amenorrhea, hyperactivity, and hypothermia. The disease has a fatality rate ranging from 10% to 20%.

In the pathogenesis of anorexia, there are predisposing factors and predictive risk indicators, which can be grouped into three main areas:

  • Individual factors, which, in the complicated relationship with the body, express an overall difficulty in personal growth.

  • Socio-cultural factors, which relate to the profound changes in the role of women (in a society that displays eternally young and efficient bodies).

  • Family-related factors—you may also read: "Family and Boundaries."


Until the 1960s, the nuclear family, including extended family with grandparents, was considered the epitome of family life in Western culture. Today, new family structures are constantly emerging (e.g., families formed after the dissolution of previous marriages, often with children from earlier unions; single mothers; cohabiting couples). Our culture often views these families as "problematic," "deviant," and tends to overlook the difficulties faced by even the "traditional" family. However, it is precisely in families considered socially "ideal" that this pathology most frequently develops.


Anorexia Nervosa Historical Background

It is possible, and even somewhat intuitive from the history of psychiatry, that cases of anorexia nervosa have occurred throughout history. The few remaining descriptions refer to anorexia (as a loss of appetite), attributing some importance to nervous factors.

It must be acknowledged that the priority contribution to the subject, and the first recorded case in medical literature, belongs to the Englishman Richard Morton. This 17th-century physician was the first to describe concretely many of the typical symptoms of anorexia nervosa and to distinguish them clearly from the vague diagnosis of death by wasting or the specific symptoms of tuberculosis.


In his 1689 treatise, Morton called the condition "atrophia sen phtysis nervosa," describing a wasting of the body without fever, cough, or altered respiration, but accompanied by loss of appetite and poor digestion. He described the condition of a 21-year-old woman, ill for two years, who came to him for treatment in 1689. Morton highlighted a near-total rejection of food, extreme weight loss, constipation, amenorrhea, and refusal of any form of treatment. The English doctor concluded that the cause of this wasting should be sought in the central nervous system, specifically in "moral suffering and worries." After only three months, the girl’s condition worsened and she died.


However, it wasn't until the second half of the 19th century that anorexia was described as a pathologically determined disorder. This was first done by the Parisian clinician Charles E. Lasègue and the Englishman William W. Gull.

Lasègue published a comprehensive report, based on eight cases he followed, describing what he called "anorexie hysterique." According to Lasègue, the main cause of the disease was an intellectual perversion caused by an emotion that the patient was unwilling to confess or that was kept hidden.


It wasn't until the 1930s that anorexia nervosa was recognized as having a psychological foundation. Once this was established, there was a significant increase in publications on the topic, although this did not reduce the confusion surrounding the disorder.


Sigmund Freud, while not specifically addressing anorexia, likened it to melancholia, describing it as "melancholia in an undeveloped sexuality." He viewed the impairment of the nutritional drive as a rejection of sexuality because the body had failed to master sexual arousal.


A few years later, the Italian Mara Selvini Palazzoli identified in anorexics a dominant idea of bodily nullification through the rejection of oral needs, seeing it as an attempt by the ego to gain power and value.


Hilde Bruch, one of the leading authorities in this field, emphasized themes of identity, autonomy, and perfection. For Bruch, the distinguishing feature that sets primary anorexia apart from any other atypical form is the "relentless pursuit of thinness," which also serves as the patient’s main goal. This pursuit represents a desperate struggle to achieve autonomy and identity. In her developmental theory, normal education allows a child to "condition" themselves to distinguish hunger from other needs, something that unfortunately does not exist in anorexic relationships.


Conclusion

In conclusion, anorexia nervosa remains a complex challenge in contemporary mental health. Through history and culture, we have come to understand its psychological and social roots more clearly. However, its prevalence among adolescents and its severity require ongoing commitment in research and clinical practice. It is essential to adopt a holistic and multidisciplinary approach to effectively address this disorder, ensuring targeted support and treatments for those affected.




 Written by

Dr Elizabeth Moore, Psychologist

(consultation only in Italian)

 

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Bibliography

 

  • Bell Rudolph, La santa anoressia, Laterza, Roma, 1987

  • Bruch Hilde, Patologia del comportamento alimentare, Feltrinelli, Milano, 1982

  • Bruch Hilde, Anoressia, Raffaello Cortina, Milano, 1988

  • Montecchi Francesco, Anoressia mentale dell'adolescenza, Franci Angeli, Milano, 1994



External resources

If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resour


  1. National Eating Disorders Association (NEDA)Link: NEDA


  2. Associazione Italiana Disturbi dell'Alimentazione e del Peso (AIDAP)Link: AIDAP


  3. World Health Organization (WHO)LLink: WHO


  4. Academy for Eating Disorders (AED)LLink: Academy for Eating Disorders


  5. Centro per la Cura dei Disturbi Alimentari "Palazzo FrancisciLink: https://etabtodi.it/contenuti/252779/centro-disturbi-comportamento-alimentare-palazzo

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