1.2. The enduring nature of anorexia nervosa

There is a popular notion that anorexia nervosa is a\uddisorder of recent origin; that it is importantly driven\udby ‘fashion’ and that its form and content are\udchangeable. But the fashion trade more often sees\uditself as a barometer of social change, rather than a\udprime mover. Others believe that anorexia nervosa\udis more likely to be as old as mankind and that,\udessentially, it does not change, having always been\ud‘a profound biological solution to existential problems’\ud(Crisp, 1980). The first author also recently\udresorted to publishing a fabricated illustrative case\udin a stone-age female, in an effort to highlight such\uda possibility (Crisp, 2000).Whenattention to its often\udhidden psychopathological aspects has waned periodically\udthen, collusively, it has flourished in the\udmedical literature as a variety of gastroenterological,\udfluid balance, central nervous system and other disorders.\udBut physicians were also the first medical\udprofessionals to recognise the disorder as importantly\udpsychologically driven and labelled it accordingly.\udThe ‘psychiatric’ literature was quick to follow\udthis lead. It became replete with case reports that\udclearly identified the condition (e.g. see Kaufman\ud& Heiman, 1964). Subsequently researchers have\udfound case material in the historical literature suggestive\udof anorexia nervosa over many centuries\ud(e.g. see Bell, 1985; Bliss & Branch, 1960; King,\ud2003; Mantel, 2004; Vandereyken & van Deth,\ud1994). Thus van Deth and Vandereyken (1997) also\udreported on three exhaustive studies of such literature\udon self-starvation. Throughout the last millenium,\udsustained asceticism, with fasting and\udstarvation at its heart, is reported as vastly more\udcommon in females than males and usually arising\udin the mid to late teens.\udThere is lively debate as to whether the condition\udhas always been or must exclusively be driven by a\udphobic avoidance mechanism in relation to ‘fatness’\ud(see Section 2, this issue). Purgation, both vomiting\udand massive laxative useage, seem always to have\udbeen a feature in some cases e.g. see Baron’s 1997\udreport on Lord Byron’s severe eating disorder, 200\udyears ago. Such behaviour sometimes explicitly\udreflected the personal need to maintain a low anorectic\udlike weight, faced with the threat of weight gain\udif food restriction had given way to bulimia.\u