Catherine of Siena’s personality sprang from her familial background, and it was her personality that was almost wholly responsible for her religious self-discipline. Her ‘holy anorexia’ was the medium through which her asceticism was expressed, but it was only one factor in its development. As is commonly found with modern day anorexics, Catherine’s struggles for identity led to family conflict, which in turn often found expression in her ‘anorexia’.
She manifested psychological phenomena which are familiar today. Raymond of Capua’s Legenda shows her to have been a happy and obedient child, although prone to precocious religious expressions. When she was a little girl, she played the quasi-religious 'games' that many of contemporaries did: they flagellated each other with knotted rope; and Catherine sat in a grotto all day, and ate only a small fragment of bread, in order to emulate a hermit. In addition, 'When she was five-years-old she was found genuflecting and saying a Hail Mary at each step as she climbed to her bedroom'. Although such actions were not extraordinary, and may simply have been youthful replication of common religious behaviour of the time, they do reveal an early interest in the spiritual life which later developed into strict devoutness.
Several key events occurred in Catherine’s life that may have shaped her personality and contributed to her religious demeanour. At the age of six she experienced a vision of Jesus, although she kept the apparition a secret for several years. This may point to the fact that even at such a young age she was developing an independence from her family while drawing nearer to God; it was this internal strength that later enabled her to persevere with her routine of self-starvation. ‘While in earthly matters she is an obedient and good child, her soul, spirit, psyche, or what you will, is becoming hers alone, nourished by a fusing of God’s design and her ego that she alone interprets and arbitrates.’
In addition, Catherine’s closest sister, Bonaventura, died in childbirth in her sixteenth year. Catherine was devastated and became deeply introspective, believing that she was responsible for the death due to a short period where she focused on her outward appearance, rather than religious thought. As a result, worldliness repelled her, and she vowed to withdraw herself from mundane and superficial matters. She embarked on a quest to mortify and subdue the flesh, beginning with the act of cropping short her long blonde hair, and renounced any bridegroom bar Jesus – much to her mother’s displeasure.
Her troubled relationship with food began when she gave up eating meat entirely, after developing abhorrence for its smell. She would eat no cooked food aside from bread, and drank only the minimal quantity of wine sufficient for communion. From the time of her sister’s death, she lived solely on water, uncooked vegetables and bread. Five years later she abstained from the latter so that she was eventually surviving on ‘next to nothing’. (Interestingly, the modern-day anorexic also 'rigorously avoids such carbohydrates.') She battled fatigue until she only needed to sleep for half an hour on alternate days, and built on her childhood games; beating herself with a metal chain several times a day. Although these actions brought spiritual benefits – Raymond reports that she presented as 'youthful, energetic and jovial' when able to engage in congenial religious exercises, but became ‘weak and lifeless' when not able to do so – her life of austere deprivation became disturbingly apparent. The 'once sturdy girl, within a short space of time, lost half her body weight’.
The behaviour of Catherine of Siena that we draw from the sources is consistent with the picture of anorexia as it is understood today. Although the origin of her fasting had been a logical but voluntary conclusion of her personal spirituality, she lost control of it as it undoubtedly went beyond religious asceticism, and she eventually died of starvation. In keeping with Gull and Janet’s research findings, and the familiar characteristics of modern-day anorexia, Catherine survived on very little food and suffered from sleeplessness and hyperactivity. Bynum recalls her restless energy: she 'plunged into a combination of fasting, sleeplessness and hyperactivity, [and] particularly frenetic housework.' She also reportedly, ‘did the laundry’ at night’, which resembles the behaviour of many modern-day anorexics, for:
At night the anorexic will wake up more often, particularly during the early hours of the morning. Hyperactivity also explains to some extent her ceaseless daytime activity. It is an effect that can be seen in animals that are hungry, for they too prowl restlessly rather than sleep.
Catherine’s fame spread, and she became best-known for her self-starvation. This attracted bitter critics, who at the mildest accused her of egotism, and at worst of fabrication and heresy. She came under pressure, and orders, to eat, and entered into the patterns of eating and vomiting familiar today as chronic anorexia and bulimia.
However, it is an obstacle to an understanding of Catherine’s spirituality to focus on her self-starvation, because whatever the severity and importance of her medical condition, it was her will and intellect that gave it religious significance. In her battle against her physical appetite for food, she concentrated on the sanctity and implications of the Host – a concentration that prompted Raymond of Capua to ask her whether she felt hunger pangs when she did not receive communion. She replied: ‘When I cannot receive the sacrament, it satisfies me to be nearby and see it; indeed, even to see a Priest who has touched the sacrament consoles me greatly, so that I lose all memory of food’.
This reveals a preoccupation with food, typical of sufferers of anorexia nervosa, where, despite their denial of hunger and abstention from eating, anorexics commonly exhibit an obsessive interest in food. Such fixation is also characteristic of the holy anorexic, and food is highly significant and symbolic in their writings, their expression of spirituality and their care for the sick. Both medieval and modern anorexics are reported as lavishing attention to feeding others, and the 'painstaking preparation of meals for their families, is entirely consistent with their preoccupation with the food they will not allow themselves to eat.' In addition, Catherine ‘gave away great quantities of food. The ten years of her extreme inedia, were by all accounts, filled with caring for the poor and sick, often by preparing food for them at odd hours’. The miracles she performed were also often food related: ‘Take note dear Reader of this miracle in which bread is multiplied. How great must have been the merit of this maiden when the Queen of Heaven herself assisted her in making bread for her children…’ Like many contemporary anorexics, she had to be ‘around’ food, either in the form of the Host, or her charitable works.
 Raymond of Capua was Catherine’s confessor and spiritual guide. He constructed a Legenda, which is a documented account of her life
 Bell, R, Holy Anorexia, p.34
 Dorothy White, My Servant Catherine, p.8
 Marilyn Duker & Roger Slade, Anorexia Nervosa and Bulimia: How to Help, p.37
 Bell, R, Holy Anorexia, p.43
 Raymond of Capua, Legenda, 57-63
 Bynum, C, Holy Feast and Holy Fast, p.170
 Duker M, and Slade, R, Anorexia Nervosa and Bulimia: How to Help, p.43
 Ibid. p.171
 Ibid. p.89
 Bynum, C, Holy Feast and Holy Fast, p.170