Anorexia and bulimia in late antiquity and early Byzantine period in the eastern Mediterranean region

Abstract

Objective The purpose of this study is to identify clinical manifestations of eating disorders in the Eastern Mediterranean region from the first century AD until the seventh century AD and evaluate relevant awareness among the physicians of the era. Method The authors searched original medical texts written in Greek by physicians practicing in the Eastern Mediterranean region from the first century AD to the seventh century AD. The search focused on passages that include possible references to clinical entities analogous to anorexia nervosa (AN) and bulimia nervosa (BN) as described in the DSM‐5 and the contemporary literature. Results Descriptions of conditions that resemble AN or BN can be found in the work of Galen, Oribasius, Aetius of Amida, Leon Philoumenos, Alexander Trallian, and Paul of Egina. Successive physicians confirmed the observations of their predecessors and add to the description of the clinical presentations and their etiology. Discussion This research provides evidence of awareness of presentations resembling currently defined eating disorders in the Eastern Mediterranean region during a period with different norms and values. Observations from the period can serve as a point for reflection about the characteristics and etiology of AN and BN in the 21st century.

Therapeutic Effects of Flibanserin in Rat Activity-Based Anorexia

“…The AN patient death rate is nine times higher than age-matched peers, and in long-term follow up studies, up to 18% of deaths were attributed to AN (Arcelus et al, 2011;Khalsa et al, 2017;Mehler et al, 2022). The incidence of AN among those under 15 years of age is increasing, and recent statistics estimate a lifetime prevalence of 4% in females and 0.3% in males (Suokas et al, 2013;van Eeden, van Hoeken & Hoek 2021).…”

“…Progress has been made towards discovering the biological underpinnings of EDs, however they continue to be characterized as ailments with largely psycho-socio-cultural aetiologies. The first modern case of AN was identified by Sir William Gull in 1873 and published in the Lancet in 1888, though clinical manifestations of eating disorders that correspond with DSM-IV-TR diagnostic criteria are documented in Mediterranean texts from the first through seventh century AD (Tsagkaris et al, 2022). While the media and the Western obsession with thinness and BMI have a clear causal role in body dissatisfaction and EDs, a proliferation of bio-psychiatric scientist-practitioners see this contention as a diversion from the need to acknowledge that EDs are severe, selfsustaining psychiatric illnesses with genetic, biochemical bases (Levine and Maine, 2010).…”