Eating Disorders Awareness: How It’s Changed Over Time

The first eating disorder is thought to have been named in 1873, but the history of disordered eating may date back as early as the Roman Empire. Since then, our understanding and awareness of eating disorders can be said to have come a long way, with the creation of National Eating Disorders Awareness Week and the growth of organizations designed to help and support those experiencing eating disorders and their families.

Here, we look at the history of eating disorders for an understanding of how far awareness has come and how people are continuing to bring awareness to eating disorders today. If you are living with disordered eating symptoms, consider reaching out to a therapist to begin your healing journey.

History of eating disorders

When considering the history of eating disorders, it can be important to note that when they were first being explored, researchers did not make connections between distorted body image and disordered eating behaviors. 

In fact, some research shows that before 1873, eating disorders were not considered disorders at all, and the idea that someone would binge, purge, or starve with the purpose of losing weight wasn’t widespread. Instead, these behaviors were associated with different cultural connotations. 

It wasn’t until between 1873 and 1980 that mental health experts and doctors began to view the most common eating disorders at that time (anorexia nervosa and bulimia nervosa) as mental illnesses. After 1980, the understanding shifted again when the Diagnostic and Statistical Manual of Mental Disorders (DSM) began linking them to a disturbed body image.

Binging and purging in Roman times

Historical accounts of binge eating and purging indicate that these behaviors were not seen as disordered but were instead associated with wealth and abundance. Historical texts indicate that Roman emperors would eat in excess and then make themselves vomit, something that only the wealthy could afford to do. In this historical context, binging and purging may have been seen as a status symbol.

Starvation and religion in the Late Middle Ages, Reformation, and the Scientific Revolution

Historical cases of starvation in the Middle Ages were often linked to religiousness and an attempt to encourage self-discipline and moderation, which some believed would bring them closer to God. 

After the Middle Ages, the first medical descriptions of anorexia began to appear. In 1694, a physician named Richard Morton first detailed cases of anorexia. He attributed reduced appetite and significant weight loss to emotional causes and viewed weight loss as a secondary symptom.

The “fasting girls” of the Victorian era

In the Victorian Era during the 19th century, “fasting girls” came into popularity. These young women claimed they could survive without food. What we now call “eating disorders” were not considered disorders during this time, and there is no indication that fasting girls were trying to lose weight or had a desire to attain a certain body image. Rather, it seemed that they wanted to appear divine in the eyes of the people around them, indicating that their reasons for not eating had more of a religious or cultural basis.

Eating disorders from 1873 to 1980

Eating disorders in the first DSM

The first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was introduced in 1952. It listed anorexia and bulimia as digestive symptoms rather than disorders. The DSM-II categorized anorexia as a feeding disturbance but did not link it to body image. 

A shift in thinking: 1980 and beyond

The DSM-III, which was released in 1980, marked the first time that anorexia nervosa was tied to body image or a person’s perception of their own beauty. In the revised edition of the DSM-III released seven years later, bulimia nervosa was also connected to body image, with one of the diagnostic criteria being “a persistent over-concern with body shape and weight.” 

This shift marked a turning point in which eating disorders were not only qualified as a specific category of mental illnesses but were also linked to a disturbed body image and a desire for thinness. 

This history indicates that there is often a societal and cultural component to eating disorders. While Roman emperors and fasting girls engaged in the same types of behavior as people with eating disorders today, the current diagnostic criteria for anorexia and bulimia include a fear of gaining weight and a desire to be thin, which were not applicable historically. Knowing this can bring awareness to our current cultural beliefs and beauty standards and how they may affect us mentally.

Eating disorders in the modern era

Eating disorders appear to be on the rise worldwide, with the prevalence more than doubling since 2000. 

In addition to anorexia nervosa and bulimia nervosa, binge eating disorder has also become more common and is reportedly the most common eating disorder in the United States.

Social media may be a significant factor in the rising prevalence of eating disorders. Many researchers believe that social media has played a significant role in society’s perceptions of body image and body weight, potentially contributing to the increase in people developing eating disorders. 

The COVID-19 pandemic may have also played a role in the worsening of eating disorders. During lockdowns, people generally had limited access to healthcare, varying access to food, financial difficulties, increased boredom, and uncertainty about their health and the future. These factors, combined with loneliness due to isolating from others, may have had drastic impacts on mental health. 

Data shows that the National Eating Disorders Association saw an approximate 75% increase in messages to their helpline during the early days of the pandemic, indicating that the pandemic may have changed how people talk about mental health. It seems that more people began to open up about their stress and anxiety and seek help for their mental health challenges during this time.

National Eating Disorders Awareness Week

National Eating Disorders Awareness Week (NEDAW) takes place every year from the end of February through the beginning of March. NEDAW generally aims to highlight the seriousness of eating disorders in the U.S. and help people understand their impacts and treatment options.

Every year, NEDAW has a different theme. For example, the 2024 theme was “Let’s Talk About It: Eating Disorders, Stigma, and Empowered Recovery,” and the 2023 theme was “It's Time for Change.” 

Multiple organizations and agencies are involved in NEDAW every year, including nonprofits and government agencies like Mental Health America, the Substance Abuse and Mental Health Services Administration, the Office on Women’s Health, and the National Institute of Mental Health.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Growing awareness and organizational support

Part of the reason for the increase in awareness of eating disorders is the number of organizations and agencies trying to draw attention to them. Here are some of the groups working hard to raise awareness about these mental illnesses: 

• The Academy for Eating Disorders
• F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders)
• National Alliance on Mental Illness (NAMI)
• National Institute of Mental Health (NIMH)
• National Association of Anorexia Nervosa and Associated Eating Disorders (ANAD)
• National Eating Disorders Association (NEDA)
• National Alliance for Eating Disorders
• Project HEAL

Facts and statistics about eating disorders

• Approximately 9% of the U.S. population will have an eating disorder in their lifetime.
• Girls and women tend to be twice as likely to have an eating disorder as those of other genders. 
• About 10,200 deaths a year directly result from eating disorders. 
• Around 30% of those with eating disorders receive adequate care.
• Eating disorders can affect people of every body type. Approximately 6% of people with an eating disorder are considered underweight.
• The most common mental health comorbidities with eating disorders tend to be substance use disorders, anxiety disorders, and mood disorders.

Mental health treatment and other interventions for eating disorders

Eating disorder treatment usually depends on the person’s symptoms, and there are a variety of interventions that can help, including the following:

• Psychotherapy: Talk therapy is often an essential part of treatment for eating disorders. Working with a therapist can help people with these conditions understand their experiences, learn problem-solving skills, find healthy ways to cope with stress, and replace unhealthy habits with more constructive ones. Multiple types of talk therapy can effectively treat eating disorders, including cognitive behavioral therapy and family therapy. 
• Education: Registered dieticians can help people with eating disorders learn how to work toward a healthy weight by teaching them how to meal plan and understand how nutrition affects the body.
• Medication: In general, medications cannot cure eating disorders, but they can address symptoms of underlying conditions that can contribute to eating disorder symptoms, like anxiety and depression. Vitamins and supplements, as suggested by a doctor or another professional, may also be necessary to correct any nutrient deficiencies resulting from malnutrition.
• Hospitalization: Hospitalization may be necessary in some cases. Hospitalization is typically short-term and aimed at stabilizing medical symptoms resulting from nutrient deficiencies. If long-term intensive treatment is needed, it may take place in a residential treatment program.

Getting help for an eating disorder in online therapy

Talk therapy can be an essential part of treatment for people with eating disorders and is usually key to long-term recovery. If psychotherapy is a part of your treatment plan, consider online treatment. With an online therapy platform like BetterHelp, you can work with a qualified mental health professional from the comfort of your home. There are more than 30,000 therapists on the platform, and you can change providers at any time until you find one with whom you are comfortable.

Research suggests that online therapy can be an effective treatment for eating disorders. A 2022 study found that internet-delivered cognitive behavioral therapy resulted in “significant symptom reductions in core ED (eating disorder) symptomatology, functional impairment as well as depressive symptoms” and that these results were maintained at a three-month follow-up.