Was late-nineteenth-century nervous vomiting an early variant of bulimia nervosa?

Abstract

We studied a wide variety of medical publications to find out whether late- nineteenth-century nervous or hysterical vomiting was clinically consistent with modern bulimia nervosa. Since modern diagnostic criteria of bulimia nervosa may be time- and culture-bound, we made use of adapted criteria, focusing on the more overt, physical and behavioural features of the syndrome. In retrospect, it became obvious that only some of these specific diagnostic requirements were met. Indeed, late-nineteenth-century nervous or hysterical vomiters most likely have been non-organically-ill neurotics. However, their disorder was more closely associated with food abstinence in general and anorexia nervosa in particular than with overeating. Only in a few cases doctors made mention of recurrent episodes of binge eating, but there was no convincing evidence of any concern for body shape and weight. Obviously, late-nineteenth-century nervous or hysterical vomiting was still located at the crossing between classic hysteria, the 'new' clinical entity of anorexia nervosa, and forms of psychogenic vomiting.