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Descriptions of disordered eating in German psychiatric textbooks, 1803–2017


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Bergner, L, Himmerich, H, Kirkby, KC ORCID: 0000-0002-4730-1199 and Steinberg, H 2021 , 'Descriptions of disordered eating in German psychiatric textbooks, 1803–2017' , Frontiers in Psychiatry, vol. 11 , pp. 1-16 , doi: 10.3389/fpsyt.2020.504157.

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The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa(AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders havereceived increasing attention in psychiatry due to rising prevalence and high morbidityand mortality. The diagnostic category “anorexia nervosa,” introduced by Ernest-CharlesLasègue and William Gull in 1873, first appears a century later in a German textbook ofpsychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior hasbeen described and discussed in German psychiatric textbooks throughout the past 200years. We reviewed content regarding eating disorder diagnoses but also descriptionsof disordered eating behavior in general. As material, we carefully selected eighteenGerman-language textbooks of psychiatry across the period 1803–2017. Previously, inGerman psychiatry, disordered eating behaviors were seen as symptoms of depressivedisorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnosesno longer used by the majority of psychiatrists such as neurasthenia, hypochondria andhysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke,Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomitingunder these outdated diagnostic categories, whereas nowadays they are listed as corecriteria for specific eating disorder subtypes. A wide range of medical conditions such asendocrinopathies, intestinal or brain lesions were also cited as causes of abnormal foodintake and body weight. An additional consideration in the delayed adoption of eatingdisorder diagnoses in German psychiatry is that people with EDs are commonly treatedin the specialty discipline of psychosomatic medicine, introduced in Germany after WorldWar II, rather than in psychiatry. Viewed from today’s perspective, the classification ofdisorders associated with disordered eating is continuously evolving. Major depressivedisorder, schizophrenia and physical diseases have been enduringly associated withabnormal eating behavior and are listed as important differential diagnoses of EDsin DSM-5. Moreover, there are overlaps regarding the neurobiological basis andpsychological and psychopharmacological therapies applied to all of these disorders.

Item Type: Article
Authors/Creators:Bergner, L and Himmerich, H and Kirkby, KC and Steinberg, H
Keywords: eating disorders, anorexia nervosa, bulimia nervosa, history of psychiatry, German psychiatry
Journal or Publication Title: Frontiers in Psychiatry
Publisher: Frontiers Research Foundation
ISSN: 1664-0640
DOI / ID Number: 10.3389/fpsyt.2020.504157
Copyright Information:

Copyright 2021 Bergner, Himmerich, Kirkby and Steinberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)

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