Contemporary reflections on William Gull's case studies of anorexia nervosa, 150 years on

Objective

To analyse and compare the original four published anorexia nervosa (AN) case histories of William Gull with modern-day approaches.

Method

Case histories of the patients described by Gull were reviewed and placed in a tabulated format (which included demographics, clinical presentation, treatment, and prognosis) along with his general comments on AN, for easier comparison.

Results

Many of the presenting features of AN are similar to cases seen in more modern times but lack weight or body image disturbances. The cases described by Gull can be categorised as AN under the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) and the Text Revision (DSM-5-TR) however, they were excluded by the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) and the International Classification of Diseases-10th Revision (ICD-10) criteria. Reference to Gull's work might have avoided the necessary change in diagnostic criteria.

Conclusions

150 years on, Gull's cases resemble presentations of AN without weight or body image issues and emphasise the heterogeneity of the diagnostic conceptualisation of AN in the modern era. Nutritional rehabilitation remains core to the treatment with other interventions supporting this goal while aetiology remains elusive.