The earliest pathological description of anorexia nervosa appeared in 1694 when Dr. Richard Morton reported two patients, one male and one female, who were described by him as ‘neurotic depletion’. What shocked Dr. Morton was that these two patients had no organic pathology and appeared to be completely voluntarily restricting In both cases, Dr. Morton was struck by the fact that the patients had no organic pathology and appeared to be completely voluntarily restricting their food intake, causing physical exhaustion. Both patients eventually died in one case and recovered in the other. Subsequent reports of series available appear in the late 19th century and until the early 20th century, the pathological-behavioral characteristics of reported cases of anorexia nervosa were similar to those seen today, except for one thing – the reasons for not eating in past cases did not include ‘fear of fat’ and ‘pursuit of slenderness’. And these two points seem to be culturally specific to the times. Pierre Janet, a famous French psychiatrist, summarized three developmental stages after carefully observing the clinical characteristics of patients with anorexia nervosa. The first stage is the ‘gastrointestinal stage’, in which patients mostly complain of gastrointestinal discomfort and believe that reducing the amount of food eaten and limiting the variety of food is the solution. However, the careful Dr. Janet also observed that these complaints often had emotional problems as a background. The second stage is the ‘I’m not sick, so I’m not sick’ stage, when most patients no longer have complaints of gastrointestinal discomfort and replace them with a state of ‘I feel fine, so I’m fine’. Often this period is filled with family wars, with relatives and friends taking turns trying to change the patient’s eating behavior through their own influence on the patient. The result seems to be that the patient is in ‘danger’ of changing his or her status from that of anorexic to that of a rambunctious child if any concessions are made, so the patient resists and maintains the status quo with surprising force. The third stage is the ‘end stage’ where the patient begins to experience physical symptoms associated with the eating problem, including extreme lethargy, weakness, frailty, edema, etc. At this stage the patient can often begin to make some changes, such as beginning to resume eating something, but still reluctantly, harboring the desire to both avoid danger while not giving up their perception and the benefits of the disease. Of course there is also the ’till death do us part’ insistence of some patients. Janet is impressed by the severity of the patients’ food refusal and hyperactivity (both physical and mental), but he does not believe that this is a core feature of anorexia nervosa. He believes that the central feature of anorexia nervosa is “a peculiar sense of pleasure, a state of euphoria in which the patient’s need for food, feelings of weakness, and depressive experiences disappear. The evolution of the treatment of anorexia nervosa has been recognized by almost all medical practitioners as difficult to treat. Dr. Morton, who first reported a case of anorexia nervosa, could do nothing for the female patient who eventually died, and in another male patient who eventually recovered, Dr. Morton described doing ‘everything possible to divert his attention, keeping him happy by exercising and talking with friends, and keeping the air fresh and circulating to help the mind and body relax ‘. The advice for diet is ‘delicious food and avoid homogenization’. The mode of action of the patient with anorexia nervosa entangled with his family was clearly described early in the hindrance revealed in treatment. 1860 Dr. Marce argued in this way: as long as one remains in the original family, the patient creates a lively emotional atmosphere with his endless expressions of various reasons and grievances, causing the doctor to lose the freedom of clinical operation and the necessary authority. Therefore, it is necessary to leave the original environment and the patient must be entrusted to strangers to provide medical care. In terms of nutritional recovery, from the beginning Dr. Marce recommended a gradual approach, while the results of the treatment were good, it was also noted that relapses were common. Dr. Gull emphasized the importance of not forgetting from the beginning that the main goal of treatment is to restore the nutritional status and not to give in to any reason or protest given by the patient. He believes that the patient’s thinking and logical reasoning is faulty at this point in the disease. He advocates that ‘moral kidnapping’ by the patient needs to be avoided in treatment, that the process of nutritional rebuilding needs to be structured and not left to the patient’s own choice, and that any approach that the patient ‘likes’ should be judged appropriate by consultation with the physician. He points out the misconceptions in the management of some early or milder patients – “Many doctors will reassure anxious parents by saying: please let the patient make his or her own choice, don’t interfere’, and at first I thought such advice was feasible, but with experience With increased experience, I found that the result of such an approach is often that patients will continue to starve themselves and the pathological effects of starvation will persist. So there is a need for structured nutritional programs that are carried out by people who will not be ‘morally abducted’ by the patient, and often family and friends are the worst caregivers in this regard.” There are certainly different voices regarding the involvement of family and friends in treatment, and Dr. John Ryle, for one, does not believe that treatment should necessarily be administered in isolation from the family environment. He believes that treatment can proceed as long as the condition is clearly and appropriately explained to the patient and parents, and their partnership with the family doctor is maintained. He emphasized that the physician should be able to explain the nature of the disease clearly and distinctly, rule out the possibility of the existence of somatic disease with certainty, inform the patient that he or she can be cured if nutrition is restored, including bodily functions and gastrointestinal functions, and make the patient and his or her family feel that the physician has complete control over the patient’s disease. However, if treatment does not progress well, eventual hospitalization is still necessary, and Dr. Ryle emphasizes in this section the professional attitude that the nurse needs to maintain – firm, kind, and tactful and sophisticated – to avoid being convinced to make concessions by the patient. An important contribution to the treatment of anorexia nervosa by Hilda Bruch, a later psychoanalyst, was an analytical presentation on the relationship between psychotherapy and nutritional somatic treatment. She began by endorsing the primacy of nutritional recovery in the treatment of anorexia nervosa, a conclusion derived in part from her finding that psychoanalysis had little success in the treatment of anorexia nervosa! Her argument addressed the polarization of treatment at the time – one side emphasized only psychotherapy, the other only somatic treatment – and she pointed out that neither approach was sufficient. In her view, the treatment of anorexia nervosa had to deal with at least three aspects: 1. nutritional recovery; 2. excessive family involvement; and 3. the patient’s internal confusion and misconceptions. However, ‘the psychological problems associated with the patient’s persistent malnutrition are biologically determined and not psychodynamically caused, and with this confounding factor at play, we cannot accurately parse the patient’s psychological problems or do further work unless his or her severe malnutrition state is alleviated and the ability to absorb and process new information is restored ‘. In summary, we see the contribution of distinguished physicians throughout history to the understanding and treatment of anorexia nervosa. The principle was to share with patients and their families their understanding of the patient’s illness and then to help them overcome the difficulties they encountered in correcting malnutrition. Although they all saw the psychological problems that existed beneath the surface phenomenon of the disease, they still gave priority to restoring nutrition. Modern treatment continues to be based on the principle that we want our treatment to be based on ‘active cooperation’ with the patient and family, and that ‘active cooperation’ is predicated on providing the patient and family with the information they need. So, hopefully, the information we provide here will be of use to our patients and families.