Anorexia nervosa: rediscovery of a disorder

THE LANCET • Vol 351 • May 9, 1998 1427 external heat during treatment. He found no gastric disorder in self-starvation and consequently believed that “. . . its origin is central and not peripheral”; to imply involvement of the brain rather than the gastrointestinal tract, he named the disorder anorexia nervosa. Today, the outcome for patients with anorexia nervosa seems to have worsened since Gull’s time. Thus, patients have less than a 50% chance of recovery within 10 years and a 6·6 to 15% risk of dying 10–20 years after the onset of the disorder. Also, in many patients the disorder becomes chronic with frequent episodes of relapse, and there is no effective treatment. In fact, of only two studies published in which a treatment was evaluated scientifically, one reported a minor effect, and the other reported no effect. Anorexia nervosa is one of the most serious health problems facing teenaged girls. If more than 100 years ago Gull was able to cure anorexic patients, why has their situation deteriorated since then? We suggest that the reason can be found in the late 19th century when the distinction between In 1874, Sir William Gull noted that self-starving adolescent girls were not only emaciated but also restless and hypothermic. Considering the patients’ poor physical condition, Gull was surprised by their restlessness, which was not only difficult to control but also “seemed agreeable”. Although he knew that self-starvation could be fatal, he was apparently capable of curing his patients, since some were reported to recover in 1–4 years; an extremely emaciated patient recovered after only 3 months of treatment. Gull warned against “allowing the starvationprocess to go on”; yet it is not clear precisely how he managed his patients, although he did point out the importance of reducing physical activity and supplying Anorexia nervosa: rediscovery of a disorder