The
CLINICAL HANDBOOK OF EATING DISORDERS: AN INTEGRATED APPROACH, edited
by Timothy D. Brewerton, MD, DFAPA, FAED of the Medical University of
South Carolina Department of Psychiatry & Behavioral Sciences, is a
timely, authoritative, and up to date new reference, which incorporates
the latest research findings in the field of eating disorders.
This 577
page 23 chapter handbook, which includes contributions from 35 of the
most respected names in the field, is intended as a cutting-edge
resource for all clinicians and researchers in mental health and
medicine who are involved in the evaluation and/or treatment of
patients with eating disorders and/or feeding disorders. These would
include psychiatrists (including child psychiatrists), psychologists,
nurse practitioners, social workers, counselors, dietitians,
nutritionists, pediatricians, internists, endocrinologists, family
physicians, gynecologists, neurologists, behavioral scientists, and
upper-level undergraduate, graduate, and medical school students in
these disciplines.
Divided into 4 major sections{1) Diagnosis,
Epidemiology and Course; 2) Risk Factors, Etiology, and Comorbidity; 3)
Psychobiology, and; 4) Treatment}, the CLINICAL HANDBOOK OF EATING
DISORDERS: AN INTEGRATED APPROACH reviews and integrates the most
current research on diagnosis, psychometric assessment, epidemiology,
etiology, risk factors, developmental aspects, course, morbidity,
mortality, comorbidity, psychobiology, genetics, molecular biology and
treatment of anorexia nervosa, bulimia nervosa and binge eating
disorder. In addition, this text covers feeding disorders of infancy
and early childhood.
The various empirically based therapeutic
approaches used in the care of eating disorder patients are described
in detail within a biopsychosocial framework and developmental context,
and include inpatient and partial hospitalization, nutrition
counseling, cognitive-behavioral therapy, interpersonal therapy, family
therapy, dialectical behavior therapy, and pharmacotherapy. In
addition, the principles of an integrated treatment approach for the
traumatized eating disorder patient with comorbidity is depicted.
Finally, a view of potential future directions in eating disorder
treatment is portrayed. Specific benefits to the reader include the following: * proposes a new classification scheme for anorexia nervosa that is culture-independent *
offers a sample diagnostic interview that is suitable for
distinguishing between anorexia nervosa (AN), bulimia nervosa (BN), and
binge eating disorders (BED) * examines structured interviews, self-report instruments, and motivation-to-change assessment tools for patient evaluation *
provides a highly integrated and detailed overview of known risk
factors for the development of AN, BN, and BED complemented by
comprehensive tables depicting these risk factors from a developmental
viewpoint for each illness * contains a table that links various
phenomenological aspects associated with eating disorders to various
neurotransmitter systems * moves beyond traditional studies of twins and families into modern genetic association analyses *
explains the principles of well-established treatment modalities for
AN, BN, and BED, as well as for the comorbid patient with a history of
trauma; these approaches are highlighted by the use of tables which
depict fundamental guidelines underlying these approaches.
The
CLINICAL HANDBOOK OF EATING DISORDERS: AN INTEGRATED APPROACH is
published by Marcel Dekker, Inc. and is available online at
www.amazon.com, www.barnesandnoble.com, or www.bulimia.com (go to
Professional Books). Reviews of My Book
Clinical Handbook of Eating Disorders: An Integrated Approach edited by Timothy D. Brewerton, M.D.; New York, Marcel Dekker, Inc., 577 pages, $175 Just a Little Too Thin: How to Pull Your Child Back From the Brink of an Eating Disorder by Michael Strober, Ph.D. and Meg Schneider, M.A., L.M.S.W.; Cambridge, Massachusetts, DaCapo Press, 2005, 235 pages, $25
Eating disorders have pervaded society for many centuries, even dating back to the ancient Greeks, who described ?vomitoriums? and adhered to the philosophy of eat, drink,
and be merry.? Voluntary selfstarvation has also been long
reported,including among nuns who restricted their caloric intake to
avoid sinful gluttony and cachectic women who were once accused of
being witches, because people believed that the women were losing
weight in order to fly more easily. But only more recently have eating
disorders been acknowledged as psychiatric illness and been given
treatment and research consideration.
The Clinical Handbook of Eating Disorders strives to provide an integrated and current overview of the full spectrum of eating disorders: anorexia, bulimia, binge-eating disorder, as well as obesity - perhaps a contemporary validating nod to the nutritional impropriety and indiscretion of the multitudes. An international panel of authors, as well as writers from many disciplines, creates a convergence-and divergence-in the way one may approach patients with such afflictions.
The handbook ranges in complexity from the extremely technical to the simplistic. Although a wide array of interested readers will benefit from many aspects of the text, to say that one type of practitioner would appreciate the book in its entirety would be minimizing its heterogeneity. Physicians, psychologists, and other therapists would particularly benefit from such a reference, although students of medicine and nursing, dieticians, and researchers may also find it useful.
This source provides material outlined in four principal parts: diagnosis, epidemiology, and course; risk factors, etiology, and psychiatric and medical comorbidities; psychobiology, including a discussion of neurotransmitters, neuroendocrine and neuropeptide dysregulation, as well as neuroimaging and some molecular details of the illnesses; and treatment, which combines a consideration of psychotherapy, psychopharmacology, nutritional counseling, and a particularly insightful chapter on family assessment and therapy.
Common themes interwoven throughout the text, which may be found especially useful given the current financial climate of medicine, are the emerging role of cognitive- behavioral therapy in treatment as well as the increased use of partial hospitalization programs and intensive outpatient programs. Cultural aspects of eating disorders are emphasized in the first section and are incorporated at various points in other chapters, likely representing the diversity of contributors. Psychodynamic theory, as it pertains to the meaning of symptoms and their role in maintaining the psychic homeostasis of patients, is also addressed by several authors throughout multiple chapters.
The extensive referencing is suggestive of a comprehensive evaluation of the most up-to-date literature. Almost universally, the authors are not seduced by the temptation of subjectivity, nor do they minimize the complexity of these illnesses. This is also possibly a statement about the editor, Timothy Brewerton, who is affiliated with the Medical University of South Carolina. Although impressively evidence based, the text is coupled nicely with observed clinical material and relevant anecdotes. Overall, this is an impressive integration of ideas and information, which will be illuminating to anyone seeking to further understand these multifaceted diagnoses.
Clinicians aren't the only people who need information on eating disorders. For any parents who have ever wondered if their child is on the brink of an eating disorder, Just a Little Too Thin can assist in navigating through the confusion. This book is not only terrific for therapists taking care of adolescents who may be affected but also concrete reading for parents who are trying to figure out how to proceed with dealing with their child's problems.
Dr. Strober and Ms. Schneider have extensive experience in this area. Dr. Strober is on the faculty at the University of California, Los Angeles, Medical School and is editorin- chief of the International Journal of Eating Disorders. Ms. Schneider, a private practitioner in New York, is coauthor of several books on parenting. They are aware that most parents experience fear and bewilderment and don't know how to begin to help their child. This book offers concrete advice on what to say, what to look for, and what to do.
The authors strive to accomplish multiple things: alert parents to changes that may signal conversion from a benign diet to one that is more disturbing, instruct parents how to back their child off the slippery slope, help parents to understand where their child may rest on the continuum of eating disorders, and help parents understand the emotional components of the disorder.
This is primarily a book about restrictive eating. Other disorders are touched upon but not deeply explored. An account of the progression of dieting, in very simple terms, is easy to understand for the lay public and nonmedically trained professionals.
Although physicians may find it useful to recommend to families, the text does not explain how these disorders affect the body medically or address pharmacologic treatment. Further, parts seem outdated, such as referring to the four food groups and implying that avoidance of dairy is unhealthy.
The book describes the barely visible stage of The Innocent Dieter, in which the child is beginning to study food labels. Recommendations are made to ensure the child's diet is healthy and to communicate in such a way that innocent dieting remains exactly that. An examination of the subtle transition to The Exhilarated Dieter follows.
This piece reveals signs that a child's symptoms have progressed-such as, she or he eats in a secretive manner or cannot identify how much weight she or he wants to lose. Suggestions include explaining the concept of maintenance and understanding the connection between pain and chaotic eating patterns. The striking progression to the next stage, The Obsessed and Preoccupied Dieter, seems easier to notice. The authors discuss disturbing, unpleasant, and dangerous dilemmas that evolve with this type of dieting.
The physical effects of food deprivation are outlined, and a connection is made with binge eating and purging behavior. Warning signs are identified, including avoiding certain social gatherings and forsaking interests unrelated to food.
The authors deserve ample praise in producing such an easy-to-understand account. The tangible and explicit suggestions they offer make this book perfect for perplexed parents or therapists seeking to help them and their child.
Jeffrey L. Geller, M.D., M.P.H., Editor Clinical Handbook of Eating Disorders: An Integrated Approach edited by Timothy D. Brewerton, M.D.; New York, Marcel Dekker, Inc., 577 pages, $175 Just a Little Too Thin: How to Pull Your Child Back From the Brink of an Eating Disorder by Michael Strober, Ph.D. and Meg Schneider, M.A., L.M.S.W.; Cambridge, Massachusetts, DaCapo Press, 2005, 235 pages, $25 Lorie Gearhart, M.D. Dr. Gearhart is a psychiatry resident at the University of Maryland/Sheppard Pratt Psychiatry Residency Training Program, Baltimore.
