ANGI - Anorexia Nervosa Genetics Initiative.

Identification of genetic variants associated with eating disorders is underway. The Anorexia Nervosa Genetics Initiative, an initiative of the Klarman Family Foundation, has contributed to advancing the field, yielding a large-scale genome-wide association study published in Nature Genetics. Eight genetic variants significantly associated with anorexia nervosa were identified, along with patterns of genetic correlations that suggest both psychiatric and metabolic origins of this serious and life-threatening illness. This article details the role of Professor Nick Martin in contributing to this important collaboration.

[Treatment history of eating disorders between 1984-2008 at the Department of Psychiatry and Psychotherapy, Semmelweis University].

The authors summarize their experiences collected from psychotherapeutic treatment of anorectic and bulimic patients treated at the outpatient and inpatient clinics of the Department of Psychiatry and Psychotherapy, Semmelweis University in the period of 1984-2008. The introduction provides an overview of the literature, that represents a theoretical background to their therapeutic strategies. Afterwards, insights are given about the authors own treatment strategies, that varied, although only slightly in different time periods. Therapeutic outcomes are summarized separately for groups of restrictive and purging anorexia patients, bulimia patients and bulimia patients suffering from other impulse control problems. Results are evaluated on the basis of clinical assessments, symptomatic reductions of eating disorders after treatment, and based on two years follow-up data. Finally results are analysed critically, concerning the used methods and further opportunities for relapse prevention.

Uma história sociocultural da anorexia na adolescência a partir de blogs Pró-Ana de 2006-2014 o IMC da questão: doença ou estilo de vida? / A socio-cultural history of anorexia in adolescence from blogs Pro-Ana 2006-2014 the BMI of the question: disease or lifestyle?

O trabalho investigar á a representação social da Anorexia na sociedade brasileira, especificamente nos blogs Pró-Ana de 2006 à 2014. A construção histórico - social da Anorexia Nervosa dialoga com a difusão dos ideários de beleza magra e da imagem corporal perfeita, adentrando em práticas e discursos que se inter-relacionam com o discurso das ciências, d a mídia e da sociedade. A configuração histórica da doença como um fenômeno social, constitui - se para além do constructo biológico e adentra as distintas dimensões da experiência do indivíduo com o seu corpo e com sua realidade social. Assim, operaremos com o “IMC da questão: doença ou estilo de vida” para entender as possibilidades de representação do fenômeno sociocultural na virtualidade. Isso significa dizer que os discursos, experiências e práticas representa m uma perspectiva que engloba o nível online e offline, mas também a esfera individual e coletiva. Utilizaremos à s abordagens de história das doenças, da historiografia digital e dos estudos culturais. Recorreremos à teoria da representação social para refletir a Anorexia fora de uma visão convencionada pelo campo científico, favorecendo discursos em torno de práticas e de motivações anoréxicas narradas por adolescentes nos blogs. O “IMC da questão” constituirá a representação considerando o “I da questão”, que delimitará elementos da cultura juvenil. O “M da questão” trará o ideal de magreza, apresentando recursos que reforçam a magreza - perfeição como ideal a ser atingido. O “C da questão” demonstrará como a magreza é valorizada e almejada na contemporaneidade, representando a promessa de aceitação social e de felicidade plena. Portanto, a representação da Anorexia como práticas de hedonismo, de saudísmo, de estilo de vida e de patologia denuncia um problema social na conjuntura histórica, que envolve dilemas individuais e coletivos n uma realidade idealizada para e pelo belo, magro, perfeito, sucesso, poder e consumo.(AU)

The Disjointed Historical Trajectory of Anorexia Nervosa Before 1970.

Responses in pre-modern eras to anorexia nervosa (as now understood) varied widely, from religious piety and sanctity through fear and superstition. While noting briefly the limited conceptualizations from pre-modern history this article is primarily focused from the late 19th century, commencing with helpful but tentative formulations of anorexia nervosa for early-modern medicine that were laid out, consistently between themselves, by Lesègue, Gull and Osler. Yet that promising biomedical advent was superseded for more than a half-century by deep, internal divisions and bitter rifts that festered between three medical disciplines: neurology; Freudian psychotherapy; and Kraepelinian biological psychiatry. Mid-20th century developments preceded the 1960-1980s' improved understanding of suffering and movement toward effective remediation introduced by Dr. Hilde Bruch.

Reading Disorders: Pro-Eating Disorder Rhetoric and Anorexia Life-Writing.

This article explores the relationship between eating disorders and reading behaviors, arguing that there is a meaningful difference in a minority of readers' approach to and understanding of anorexia life-writing, and of literary texts more broadly. To illuminate this distinction, this article begins by considering the reported deleterious influence of Marya Hornbacher's anorexia memoir, Wasted, elaborating the ways Hornbacher offers a positive presentation of anorexia nervosa that may, intentionally or not, induce certain readers to "try it" themselves. This is followed by an exploration of how Hornbacher's own reading praxis is implicated in a discursive feedback loop around anorexia narratives. It concludes with a discussion of disordered reading attitudes in relation to the emergence of the "pro-anorexia" phenomenon.

The Practice of Holy Fasting in the Late Middle Ages: A Psychiatric Approach.

During the Late Middle Ages, the practice of fasting among religious women in an attempt to follow a pious and ascetic life was common. In this paper, three cases of medieval religious women are described with a particular attention to the figure of St. Catherine of Siena, her life, popularity, and iconography. In the Middle Ages, holy fasting was characterized by a refusal to eat that could involve binging and purging, lack of menstruation, an interest in cooking for others, and in some cases death due to inanition. In the Medieval narratives of fasting holy women, we can see patterns that are compatible with symptoms of anorexia nervosa. From a psychiatric perspective, it is possible to elucidate and understand the practice of fasting among religious people in the Late Middle Ages.

Anorexia santa e anorexia contemporânea:o mesmo transtorno em épocas distintas? / Anorexia mirabilis and contemporary anorexia: the same disorder in different periods?

Este estudo visa a analisar até que ponto é possível relacionar algumas santas da Idade Média, tidas como as santas anoréxicas e reveladoras de práticas rigorosas de jejum, com as anoréxicas da contemporaneidade, considerando-as como possuidoras do mesmo transtorno. O recurso metodológico utilizado refere-se a um estudo teórico da biografia de três dessas santas consideradas anoréxicas, confrontando-as com estudos referentes à anorexia nervosa presente nas mulheres da contemporaneidade. Percebe--se que há pontos em comuns entre ambas, mas não é possível equipará-las, uma vez que os ideais que as mesmas almejam são bastante divergentes, além de ser distinto o contexto histórico-cultural na qual se inserem...

This study aims to assess the possible correlation between some female saints of the Middle Ages, known as anorexic saints because of their severe fasting practices, with the contemporary anorexic women, considering both as sufferers from the same disorder. The methodology consists of a theoretical study of the biography of three anorexic saintsand contrast of this information with the studies of anorexia nervosa in the contemporary world.. The results point to some characteristics in common, but not enough to consider their disorders as equal, as the ideals involved are diverging and they do not share the same historic and cultural background...

Anorexia santa e anorexia contemporânea: o mesmo transtorno em épocas distintas? / Anorexia holy and contemporary anorexia: the same disorder in different periods?

Este estudo visa a analisar até que ponto é possível relacionar algumas santas da Idade Média, tidas como as santas anoréxicas e reveladoras de práticas rigorosas de jejum, com as anoréxicas da contemporaneidade, considerando-as como possuidoras do mesmo transtorno. O recurso metodológico utilizado refere-se a um estudo teórico da biografia de três dessas santas consideradas anoréxicas, confrontando-as com estudos referentes à anorexia nervosa presente nas mulheres da contemporaneidade. Percebe-se que há pontos em comuns entre ambas, mas não é possível equipará-las, uma vez que os ideais que as mesmas almejam são bastante divergentes, além de ser distinto o contexto histórico-cultural na qual se inserem. (AU)

Perspectiva histórica de la anorexia nerviosa / Historical perspective of anorexia nervosa

Antecedentes: los trastornos de la conducta alimentaria (TCA) han existido desde la antigüedad, variando en frecuencia, manifestaciones y posibles motivaciones, de acuerdo a las influencias históricas y socioculturales. Objetivo: describir desde una perspectiva histórica la evolución del concepto de anorexia nerviosa en la Edad Media ("santa anorexia") y en la época contemporánea ("adolescentes ayunadoras" victorianas). Método: revisión exhautiva de referencias históricas en torno al ayuno, publicaciones sobre TCA y artículos que describían casos de mujeres anorécticas famosas, utilizando la base de datos Medline/PubMed. Resultados: las anorécticas medievales y las actuales muestran conductas similares; rechazan el alimento para lograr la consagración divina y la delgadez absoluta, respectivamente. Ambas son muy auto-críticas, no poseen interés en las relaciones sociales, cuidan abnegadamente del prójimo, exhiben mínimas necesidades físicas (ej. hambre) y poseen madres dominantes. Entre las contribuciones más relevantes, Morton (1689) realiza la primera descripción médica de la anorexia ("consunción nerviosa"). En 1873, simultáneamente Gull en Inglaterra (quien acuñó el término anoerexia nervosa) y Lasègue ("anorexie hystérique") en Francia, la reconocen como una entidad diagnóstica definida. Bruch (1973) describe sus características clínicas nucleares (ej. distorsión de la imagen corporal, un paralizante sentimiento de ineficacia personal e incapacidad de discriminar requerimientos nutricionales), vigentes hasta la actualidad. Conclusiones: la análoga presentación de la enfermedad, transhistórica y transculturalmente, a través de los años (rechazo alimentario, emaciación, hiperactividad, amenorrea, búsqueda de un ideal), muestra que la esencia patológica (factores patogénicos) no se modelan por la edad, personalidad o cultura (factores patoplásticos), los que tendrían un rol secundario en el desarrollo de la enfermedad.

Background: Eating disorders (ED) have existed since ancient times and their frequency, manifestations and possible motivations have been varying according to historical and sociocultural influences. Objective: To describe from a historical perspective, the evolution of the concept of anorexia nervosa from Middle Ages ("holy anorexia") to contemporary times (Victorian "fasting girls"). Method: Medline/PubMed databases were use to make and exhaustive review of historical references on fasting, eating disorders and articles describing cases of famous anorectic women. Results: Medieval and contemporary anorectic show similar behaviours; they reject food to achieve a divine consecration and an absolute thinness, respectively. Both are very self-critical, are not interested in social relationship, selflessly take care others, display minimal physical needs (ie. hunger) and have dominant mothers. Among the most relevant contributions. Morton (1689) makes the first medical description of anorexia nervosa ("nervous consumption"). Simultaneously, in 1873, both, Gull in England (who coined the term anorexia nervosa) and Lasègue ("anorexie hystérique") in France, recognize it as a definite diagnostic entity. Bruch (1973) describes its core clinical characteristics (ie. distortion of body image, a paralyzing sense of personal ineffectiveness and a disability to discriminate nutritional requirements), currently valid. Conclusions: The analogous presentation of the illness, transhistorical and transculturally, through the years (food refuse, starvation, hyperactivity, amenorrhea, search for an ideal), shows that the essence of the pathology (pathogenic factors) is not modulated by age, personality and/or culture (pathoplastic factors), which, on their turn. would have a secondary role in disease's development.

Catherine Walpole (1703-22), an 18th-century teenaged patient: a case study from the letters of the physician George Cheyne (1671 or 73-1743).

In 1720 Catherine Walpole the 16-year-old eldest daughter of Robert Walpole, later to become Prime Minister, became very ill. She was unable to eat, fainted, took fits frequently, and had a persistent pain and swelling in her side. Sir Hans Sloane, the Walpole's doctor, referred her to Dr Cheyne in Bath because he specialized in dietary problems and nervous diseases. Cheyne kept in regular touch with Sir Hans by letter and this correspondence tells the story of Catherine's treatment from her first referral to Cheyne to her death in 1722. The contents and purposes of treatments he used are identifiable in dispensatories of the period. The letters reflect Cheyne's medical skills and knowledge as well as his sympathetic personality. Catherine's family loyalties, personal concerns and personality also emerge as the correspondence progresses. The limitations of 18th-century diagnosis and treatments available are clear but Cheyne is always concerned with Catherine's quality of life, even when he becomes aware that he cannot cure her.

Do ideal ascético ao ideal estético: a evolução histórica da Anorexia Nervosa / From the ascetic ideal to the esthetic ideal: the historical evolution of anorexia nervosa / De l'idéal ascétique à l'idéal esthétique: l'évolution historique de l'anorexie mentale / Del ideal ascético al ideal estético: la evolución histórica de la anorexia nervosa

O estudo da anorexia nervosa sob uma perspectiva histórica visa contribuir para a investigação daquilo que se configura como influência cultural na gênese e manutenção do quadro, além de questionar posições segundo as quais a anorexia nervosa seria um "mal da modernidade" ou decorrente de um único fator. Uma análise da vida das santas da Idade Média, por exemplo, mostra quanto o comportamento perseverante as aproxima das anoréxicas de hoje, ainda que a motivação e os ideais (ascético nas primeiras e estético nas últimas) sejam diferentes.

This study of anorexia nervosa from a historical point of view is intended as a contribution to the research on a condition that involves the cultural influence on the origin and maintenance of a clinical reality. The article also questions opinions that consider anorexia nervosa a "modern evil" or the result of a single factor. An analysis of the lives of certain medieval Christian saints, for example, reveals how strongly their persistent behavior, based on asceticism, identifies them with modern anorexic girls, even though, in contrast, their concerns are esthetic.

L'étude de l'anorexie mentale à partir d'une perspective historique à comme but de contribuer à l'investigation de ce qui se configure comme influence culturelle sur le développement et le maintien de ce désordre, outre de mettre en question les points de vue selon lesquels l'anorexie mentale serait un "mal moderne", soit le résultat d'un seul facteur. L'analyse de la vie de saintes du Moyen Âge, par exemple, montre que leur conduite persévérante les rapproche des anorexiques modernes, bien que leur motivation et leurs idéaux (ascétisme dans le premier cas, esthétique dans le deuxième) soient entièrement opposés les uns des autres.

El estudio de la anorexia nerviosa desde una perspectiva histórica busca contribuir para la investigación de aquello que se configura como influencia cultural en la génesis y mantenimiento del cuadro, además de cuestionar posiciones según las cuales la anorexia nerviosa seria un "mal de la modernidad" o decurrente de un factor único. Un análisis de la vida de las santas de la edad media, por ejemplo, muestra cuanto el comportamiento perseverante las aproxima de las anoréxicas de hoy, a pesar de que la motivación y los ideales (ascético en las primeras y estético en las últimas) sean distintos.

Do ideal ascético ao ideal estético: a evolução histórica da Anorexia Nervosa / From the ascetic ideal to the esthetic ideal: the historical evolution of anorexia nervosa

O estudo da anorexia nervosa sob uma perspectiva histórica visa contribuir para a investigação daquilo que se configura como influencia cultural na gênese e manutenção do quadro, além de questionar posições segundo as quais a anorexia nervosa seria um “mal da modernidade” ou decorrente de um único fator. Uma análise da vida das Santas da Idade Média, por exemplo, mostra quanto o comportamento perseverante as aproxima das anoréxicas de hoje, ainda que a motivação e os ideais (ascético nas primeiras e estético nas últimas) sejam diferentes.AU

This study of anorexia nervosa from a historical point of views is intended as a contribution to the research on a condition that involves the cultural influence on the origin and maintenance of a clinical reality. The article also questions opinions that consider anorexia nervosa a “modern evil” or the result of a single factor. An analysis of the lives of certain medieval Christian saints, for example, reveals how strongly their persistent behavior, based on asceticism, identifies them with modern anorexic girls, even though, in contrast, their concerns are esthetic.AU

El estudio de la anorexia nerviosa desde una perspectiva histórica busca contribuir para la investigación de aquello que se configura como influencia cultural en la génesis y mantenimiento del cuadro, además de cuestionar posiciones según las cuales la anorexia nerviosa seria un “mal de la modernidad” o decurrente de un factor único. Un análisis de la vida de las santas de la edad media, por ejemplo, muestra cuanto el comportamiento perseverante las aproxima de las anoréxicas de hoy, a pesar de que la motivación y los ideales (ascético en las primeras y estético en las últimas) sena distintos.AU

Bruch revisited and revised.

The aim of this text is to remind the clinical and scientific field of eating disorders of the seminal figure Hilde Bruch. Her work is highly original, but is it sinking into the mists of oblivion? The contemporary overemphasis on cognitive behavioural therapy may indicate that. Hilde Bruch's contribution was a descriptive and theoretical model defining anorexia nervosa and severe eating disorders as self-disorders, with emphasis on developmental deficits in the organisation of the psychological self. A limited focus on cognitions may undermine both the awareness of central aspects of the psychopathology of eating disorders, as well as the relevance of sensitively regulating the psychotherapeutic stance.

[Richard Morton (1637-1698)--the distinguished physician of the 17th century].

Richard Morton was a distinguished physician of the 17th century. He was born in Suffolk, England, on July 30th 1637. Morton published three works but his landmark paper was "Phthisiologia, seu exercitationes de phthisi, tribus libris comprehensae" published in 1689, dedicated to William III. The book established his reputation at home and abroad lasting for over a century. Pulmonary tuberculosis was very frequent in the 17th century in England. He was the first physician ever to state that tubercles were always present in its pulmonary form. When we add to these momentous observations and their rational explanation the facts that he was the first physician to state categorically that tubercles are always present in phthisis, we must agree that Morton richly deserves his honoured place in the long list of those who have contributed to the solution of the problem of tuberculosis. Morton first described and gave conclusions of numerous today well known and already examined illnesses. In 1694 he gave first notes about the psychiatric illness which we today call "anorexia nervosa", calling it "nervous consumption". His chapters on treatment are long and contain a sound basis of common sense as indicated by his instructions on general management. He stresses the need for an adequate diet, an environment free from fog and smoke, and the desirability of ensuring a moderate amount of exercise. All Morton's therapeutic dicta are in their humanity and thoughtful care in striking contrast to the regimen of copious bleeding and semi-starvation inflicted by the later generation of physicians. Confirmation of his achievements and his teaching can be found in today's medical practice.

Pubertal process and green-sickness in Renaissance drama: a form fruste of anorexia nervosa?

OBJECTIVE: The aim of this paper is to investigate the relationship between puberty and the onset of green-sickness in early modern popular culture with findings on puberty and the onset of anorexia nervosa. METHOD: Four plays from the late 16th and early 17th centuries dealing with 14-15-year-old girls were analysed for information on puberty and for precipitating factors for the onset of green-sickness. These were then contrasted with the literature on anorexia nervosa where puberty has been proposed as a potential risk factor for the development of the disorder. RESULTS: These four plays endorse a common understanding in early modern popular culture that puberty presents a major developmental challenge for young women. Four common precipitating factors for the development of green-sickness were identified: socio-economic status; age at onset; nutrition and sexual development. These have a striking resemblance to our current understanding of the development of anorexia nervosa in adolescence. CONCLUSION: Green-sickness shares certain similarities with anorexia nervosa. It is a post menarcheal condition arising out of the body's ripeness for reproduction at around the age of 14. Affluence and improved nutrition were recognized as contributory factors. The development of both green-sickness and anorexia nervosa appear to share a common theme in the context of puberty.