Eating disorders during the Edo period between 1603 and 1867 in Japan

The purpose of this study is to examine whether Fushoku-byo and Shinsen-ro are eating disorders or not.

We completed a retrospective review of Fushoku-byo and Shinsen-ro during the Edo period (1603-1867) using the original books of these disorders written by Kampo doctors and compared these disorders with eating disorders in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

There were more than 50 patients with Fushoku-byo and Shinsen-ro during the Edo period, when Japan was closed to the rest of the world. More than 90% of them were young women. All patients demonstrated food restriction or avoidance that significantly impaired their physical health or psychosocial functioning. Kampo doctors did not mention any fat phobia and disturbed body image. They considered these disorders to be caused by psychological distress and recommended psychological treatment.

The finding in this study challenges some of the presumptions that the development of eating disorders in non-Western countries is attributed to modern Western influence. It is plausible that these patients could have been categorized as having unspecified feeding or eating disorder in the DSM-5, when the presence or absence of fat phobia and disturbed body image is unclear.