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By the time of Catherine of Siena, however, the Church became concerned about extreme fasting as an indicator of spirituality and as a criterion for sainthood.

Indeed, Catherine of Siena was told by Church authorities to pray that she would be able to eat again, but was unable to give up fasting.

By the thirteenth century, it was increasingly common for women to participate in religious life and to even be named as saints by the Catholic Church.

Many women who ultimately became saints engaged in self-starvation, including Saint Hedwig of Andechs in the thirteenth century and Catherine of Siena in the fourteenth century.

A further important event was the death of the popular singer Karen Carpenter in 1983, which prompted widespread ongoing media coverage of eating disorders.

Mary Stewart, known as Mary, Queen of Scots, was brought up as a child in the court of Henry II of France.

Her medical history is documented in some detail thanks to the accounts of various ambassadors who sent reports back to their respective sovereigns.

It is known, for example, that she had measles when she was five, rubella when she was seven, dysentery and malaria when she was 14 and smallpox when she was 15.

She also had an unnamed illness as a teenager that some now believe to have been anorexia nervosa/chlorosis Her condition is described as involving weight loss, uneven appetite, vomiting and diarrhoea, pallor, fainting fits and breathing difficulties.

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