From hysteria to anorexia: An archival and thematic analysis of female patients’ records in an Italian asylum (1907-1951)

Introduction: Hysteria and anorexia nervosa have long been recognized as Western culture-bound syndromes, shaped by sociocultural dynamics and gender norms. While hysteria was frequently diagnosed in psychiatric hospitals during the late 19th and early 20th centuries, anorexia nervosa gained nosographic recognition only later. However, historical medical literature suggests that extreme food restriction and emaciation – often classified as sitophobia or hysteria – may represent early manifestations of modern anorexia nervosa. Building on these insights, this study investigates restrictive eating behaviors within hysteria diagnoses and explores how shifts in psychiatric classification reflect broader sociocultural transformations. Methods: Archival research at the State Archive of Padua enabled the examination of 1,079 medical records from the historical Padua Psychiatric Hospital (1907-1951). A total of 272 diagnostic labels were identified and grouped into macro-categories, with a particular focus on hysteria-related cases and associated restrictive eating behaviors. A thematic analysis was conducted on patient records presenting both hysteria diagnoses and severe food restriction, tracking patterns in diagnostic classification, symptom descriptions, and treatment approaches over time. Results: Among the total cases, 41 (3.8%) were diagnosed with hysteria, with eating-related symptoms documented in 17 cases (41.46%). Severe emaciation was reported in 7 cases (17.07%). Treatments included forced feeding, sedatives, and ovarian massage, reflecting gendered psychiatric interventions. The limited presence of hysteria in the sample suggests that its classification was not as widespread as commonly assumed, likely influenced by regional, cultural, and institutional factors shaping psychiatric practice. Discussion: Findings indicate that hysteria and anorexia nervosa historically overlapped but were progressively delineated as separate conditions. The lower incidence of hysteria diagnoses in this sample highlights the role of contextual variables, such as medical paradigms, institutional policies, and sociocultural expectations, in shaping psychiatric classification. Further research should extend this analysis to later archival records and contemporary epidemiological data to better understand the evolving relationship between psychiatric diagnoses, culture, and female mental health.